Ischemic acute renal failure is characterized by damages to the proximal straight tubule in the outer medulla. Lesions include loss of polarity, shedding into the tubule lumen, and eventually necrotic or apoptotic death of epithelial cells. It was recently shown that peroxisome proliferator-activated receptor /␦ (PPAR/␦) increases keratinocyte survival after an inflammatory reaction. Therefore, whether PPAR/␦ could contribute also to the control of tubular epithelium death after renal ischemia/ reperfusion was tested. It was found that PPAR/␦ ؉/؊ and PPAR/␦ ؊/؊ mutant mice exhibited much greater kidney dysfunction and injury than wild-type counterparts after a 30-min renal ischemia followed by a 36-h reperfusion. Conversely, wild-type mice that were given the specific PPAR/␦ ligand L-165041 before renal ischemia were completely protected against renal dysfunction, as indicated by the lack of rise in serum creatinine and fractional excretion of Na T he proximal straight tubule in the outer medulla of the kidney is particularly susceptible to ischemia/reperfusion injury, which remains the leading cause of acute renal failure (1,2). Damages to this segment are characterized initially by the disruption of tight junctions that control both paracellular permeability and cell polarity (3,4). The loss of cell polarity is responsible for the redistribution of integrin subunits from the basolateral to the apical membrane, contributing to the shedding of cells into the tubule lumen (4). Both increase in paracellular permeability and desquamation lead to back-leakage of glomerular filtrate (5). With more sustained ischemia/reperfusion, epithelial cells of the proximal tubule undergo necrotic or apoptotic cell death (6). Epithelial cells that do not die participate in the regeneration of tubular epithelium and the restoration of renal function (2,7). They use integrins to flatten, spread, and migrate into areas denuded by exfoliation, where they dedifferentiate, proliferate, and differentiate again (8).Peroxisome proliferator-activated receptor /␦ (PPAR/␦; called PPAR hereafter) is a ligand-activated transcription factor that belongs to the nuclear hormone receptor family (9). It plays a key role in cell survival (10 -14). For example, PPAR activation leads to the expression of genes that increase the resistance of keratinocytes to apoptotic death (11,13). In these cells, PPAR expression is also involved in the control of cell adhesion to the extracellular matrix and migration (10). All of these properties may account for the finding that PPAR expression and activation participate in skin wound repair (10).By contrast with PPAR␣ and PPAR␥, PPAR is ubiquitously expressed in all nephron segments within the kidney. In particular, it is the predominant PPAR isotype in the proximal straight tubule (15). Because of this high expression, we assessed whether PPAR would contribute to the survival of proximal tubular cells in a model of ischemic acute renal failure. We found that PPAR-deficient mice were remarkably susc...