Cytochrome P450 3A gene family and medication in childhood nephrotic syndrome: An update

Abstract

Background Nephrotic syndrome (NS) is a renal disease characterized by excessive proteinuria (greater than 3.5 g/dl per 24 h), which results in hypoalbuminemia and leads to hyperlipidemia, edema, and various complications. NS patients typically respond to standard steroid treatment (prednisolone) and are classified as having steroid-sensitive nephrotic syndrome (SSNS). However, patients who do not respond to steroid therapy after 4 weeks are referred to as having steroid- resistant nephrotic syndrome (SRNS). The unequal response to steroid treatment in nephrotic syn-drome involved many factors, including genetic, medication, and kidney diseases. The CYP3A gene family is predominantly involved in the metabolism of medications used in the treatment of NS.

Methodology A systematic literature review was conducted from January 2014 to June 2024 using an extensive electronic search of data related to pediatric nephrotic syndrome and the CYP gene family, including associated polymorphisms. Through this review, we systematically ana-lyze factors that affect the metabolism of medications targeting the CYP3A gene family (including steroidal and non-steroidal drugs) commonly used in the treatment of NS and its comorbidities. Conclusion: Studies have correlated the relationship between polymorphisms in the CYP3A gene family and medication in NS, with 90 % of the research focusing primarily on post-kidney transplant NS patients. Many studies have reported a correlation between CYP3A gene family polymorphisms and increased tacrolimus (TAC) dosage.

Keywords

Cytochrome P450 / Nephrotic syndrome / Single nucleotide polymorphism

Ethics Statement

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethical approval

Not applicable.

Funding

The authors received no financial support for the research, authorship and publication of this article.

CRediT authorship contribution statement

All authors certify that they have participated in this work. Praveenkumar K S (Research scholar)- Conceptualization (Primary role), Data curation (Lead responsibility), Formal analysis (Lead involvement), Investigation (Lead responsibility). Yogalakshmi V (Research scholar)- - Writing - review & editing (Lead). Dr.Sudha Ekambaram (Senior Pediatric Nephrologist) Conceptualization (lead). Dr.G. Sangeetha (Assistant professor) - Conceptualization (Equal), Data curation (Equal), Formal analysis (Equal), Methodology (Equal). Megha Manoj (Graduate student) - Writing - review & editing (Equal). C.D. Mohana Priya (Associate professor) - Supervision (Primary role), Writing - review & editing (Equal contribution).

Data availability

All the data are provided in the manuscript any additional data required is available based on reasonable request from the corresponding author.

Declaration of Competing Interest

The authors have no conflict of interest.

Appendix A. Supporting information

Supplementary data associated with this article can be found in the online version at doi:10.1016/j.gmg.2024.100009.

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