From pharmacogenetics to pharmacogenomics: the birth of a new era of personalized medicine in nephrology

Recent evidence suggests that adverse drug reactions are a major cause of death and hospital admissions in Europe and the United States. Environmental/ non-genetic as well as genetic factors are responsible for the great interpatient variability in drug metabolism and in the molecular interactions between drugs and therapeutic targets. By means of pharmacogenetic approaches, several genetic settings have been linked to the effects and toxicity of many agents used in clinical nephrology. However, these strategies, which analyze single genes or candidate pathways, cannot be considered ideal because the overall pharmacological effects of drugs typically are not dependent on monogenic traits. Therefore, to identify the multigenetic influence on drug response, researchers and clinicians from different fields of medicine and pharmacology have started to perform pharmacogenomic studies employing innovative whole-genome, high-throughput technologies. In nephrology, only few pharmacogenomics reports have been published to date, suggesting the need to enlarge the number of projects and increase the research budget for this important research field. In the future, we would expect that by applying the knowledge about an individual's inherited response to drugs, nephrologists will be able to prescribe medications based on each person's genetic makeup, to carefully monitor the efficacy and toxicity of a given drug, and to modify the dose and number of medications to obtain predefined clinical outcomes.