Role of oxidant-antioxidant enzymes in managing the cardiovascular risks in nephrotic syndrome patients www.nephropathol.com DOI: 10.34172/jnp.2022.17276 J Nephropathol. 2022;11(2):e17276 Journal of Nephropathology *Corresponding author: Souparnika Sreelatha, Email: souparnika.s@nitte.edu.in Souparnika Sreelatha 1* ID , Benedicta D’souza 2 , Vivian D’souza 3 , Kalaiselvi Rajendiran 4 1 Department of Biochemistry, National Institute of Research in Tuberculosis, Chennai, India 2 Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India 3 Department of Biochemistry, Kanachur Institute of Medical Sciences, Natekal, University Road, Mangalore, Karnataka, India 4 Department of Biochemistry, Tutor, Panimalar Medical College Hospital and Research Institute, Chennai, India ARTICLE INFO Article type: Review Article history: Received: 13 September 2021 Accepted: 4 December 2021 Published online: 18 December 2021 Keywords: Nephrotic syndrome Lipid peroxidation Cardiovascular risk Myeloperoxidase Paraoxonase Prognostic markers Increased reactive oxygen species (ROS) in nephrotic syndrome (NS) are involved in the oxidation of membrane proteins, lipoproteins and several receptor molecules ultimately leading to their functional defcit. It is involved in the pathogenesis of dyslipidemia in NS and also increases the oxidation of LDL (oxLDL), which is an important risk factor in thrombus generation and atherosclerosis. Myeloperoxidase (MPO) is an early predictor of myocardial infarction and adverse cardiac events in patients with chest pain. MPO can also foresee the recurrent acute coronary syndrome (ACS) and myocardial infarction in patients. ‘MPO oxidized LDL’ also induces ROS production, lipid accumulation and reduces the antioxidant response in macrophages, however in an augmented way by using diferent pathways and might be more atherogenic. Paraoxonase 1 (PON1) prevents the oxidative modifcation of serum lipoproteins, which is one of the crucial steps in the initiation of atherogenesis. PON1 also contributes to the anti-atherogenic efect of HDL-c. Adult NS patients have increased lipid hydroxide levels and signifcantly decreased PON1 activity and total sulfhydryl levels when compared to healthy controls. While the increased risk of cardiovascular disease in NS patients is well documented, the exact etiology still remains controversial. Tis prevents the development of a specifc treatment modality for the same. MPO as well as PON1 were found as important markers for the management of cardiovascular risk in NS patients. Estimation of these enzymes can therefore be performed in routine clinical practice as prognostic markers, owing to its ease of estimation and cost efectiveness. ABSTRACT Implication for health policy/practice/research/medical education: Cardiovascular risk in NS is a serious matter of concern and preventive measures are to be taken from the initial stages of NS. In addition to dyslipidemia [with increased non-high density lipoprotein cholesterol and lipoprotein (a)] enhanced oxidative stress also should be considered as therapeutic targets. MPO as well as PON1 were found as important cardiac risk markers as well as prognostic markers to assess the severity of NS. Estimation of these enzymes can therefore be performed in routine clinical practice as prognostic markers, owing to its ease of estimation and cost effectiveness. Even after effective steroid therapy to normalize the symptoms of NS, dyslipidemia and oxidative stress persist in adult NS patients, which demands more attention to the impending cardiovascular risk in them. Please cite this paper as: Sreelatha S, D’souza B, D’souza V, Rajendiran K. Role of oxidant-antioxidant enzymes in managing the cardiovascular risks in nephrotic syndrome patients. J Nephropathol. 2022;11(2):e17276. DOI: 10.34172/jnp.2022.17276. Introduction Nephrotic syndrome (NS), a distinct combination of clinical and laboratory findings, is characterized by edema, hyperlipidemia, hypoalbuminemia and proteinuria. It accounts for significant morbidity which includes complications like infections, thrombotic events, hypertension, cardio-vascular diseases, side effects of corticosteroid therapy, low-quality of life and thereby early mortality. NS is further subdivided into discrete categories based on renal histopathology. Due to this, a Review