Use of Low Dose Pioglitazone to Treat Autosomal Dominant Polycystic Kidney Disease

Patients will be randomize to placebo or 15 mg pioglitazone for 12 months, and then be crossed over to the other arm. Patients will undergo MRI of the liver and kidney and MRspectroscopy of the lumbar spine (if they choose as this is ancillary study) three times during the study. Assessments will be every 3 months and include blood work, blood pressure, and body water assessments.

Inclusion criteria

• Male or female patients with autosomal dominant polycystic kidney disease (ADPKD) aged 18-55
• estimate glomerular filtration rate (GFR) at or above ≥ 50 ml/min/1.73 m2 by any GFR formula
• Normal liver enzymes (ALT/AST)
• fasting blood glucose between 70 and120
• for female patients, a willingness to use double contraception to avoid pregnancy while in study
• able to give informed consent
• In the opinion of the investigator, high likelihood of progressive kidney disease

Exclusion criteria

• diabetes, defined as any of the following: fasting blood sugar > 130 times two, HgbA1C > 7, on any blood sugar lowering medication, or past diagnosis of diabetes not occurring during pregnancy
• uncontrolled hypertension as determined by the examining physician
• history of impaired systolic function (ejection fraction < 50%) by previous echocardiogram or known ischemic cardiovascular disease
• findings suggestive of a kidney disease other than ADPKD
• systemic illness requiring immunosuppressive or anti-inflammatory agents
• congenital absence of a kidney or history of a total nephrectomy
• history of cyst reduction or partial nephrectomy
• history of renal cyst aspiration within the previous year
• History of bladder cancer, or gross hematuria
• inability to undergo MRI due to implantable devices or foreign objects that preclude MRI
• active renal transplant
• allergy or sensitivity to any of the components of the test materials
• institutionalized
• currently pregnant or plans to become pregnant during the study