13.1

Introduction

Nanotechnology is an innovative approach with potential utilization in drug delivery

system. Using nanotechnology to produce nanodrugs is a revolutionary strategy that

amends the delivery of compounds for improved medical diagnosis and curing

diseases (Maurya et al. 2019). Nanodrugs improve the therapeutic index of the

drugs by improving their efficacy through targeted delivery and triggered release.

The in vivo fate of the drug is ameliorated as efficient delivery to the target site that is

achieved with low accumulation at other sites in the body. The nanodrugs also have

the ability to stimulate cellular uptake and improve intracellular trafficking (Hua

et al. 2018).

Kidneys perform several vital functions such as maintaining homeostasis, urine

formation, etc., and any impairment in its usual operation would lead to several

issues like hypertension, inflammation, urinary tract infections, renal calculi and

various others. Therefore, drug targeting to kidneys has remained a major area of

research (Kandav et al. 2019). Use of nanomedicines has comprehensive role in

treating renal diseases. Today it has become possible to synthesize nanomedicines in

terms of kidney retention and those that can bind to key membranes and cell

populations associated with renal diseases. Evolution with respect to three-level

fabrication of new nanomaterial, coating and discovery of novel drug delivery agents

for biodistribution of therapeutic molecules deep into the kidney tissues has been

observed through the past several years (Upadhyay 2017). Nephrolithiasis or kidney

stones is a renal disease whose increasing prevalence has received considerable

attention from researchers all over the world. It is mainly related to elevated oxalate

levels in the blood and urine which lead to accumulation of calculi in the renal pelvis,

ureters and collecting duct, eventually resulting in renal pathological problems

(Kandav et al. 2019). Current treatment options in patients with nephrolithiasis are

limited and do not always lead to effective cure of renal stones. Hence rational

medical management with new therapeutic strategies aiming to prevent kidney stone

formation has become the need of the hour. Since a decade, attempts have been made

to use plants and oxalate-degrading microbial enzymes to solubilize oxalate kidney

stones and some success has been achieved in the same. In particular, this article

highlights how oxalate-degrading enzymes could be developed in the form of

nanodrugs for the treatment and management of kidney stones. It also discusses

the various challenges in the development of such nanodrugs as well as reviews the

current research that has been conducted in this aspect.

13.2

Nephrolithiasis and Its Management

Nephrolithiasis, i.e., kidney stone formation, is a common and painful disorder, the

prevalence and frequency of which are surging at an astonishing rate (Gupta and

Kanwar 2020a). It is a multifactorial process evolving from a chain of

physiochemical reactions such as super-saturation, nucleation, growth aggregation

and retention inside the renal tubes (Das et al. 2017). Calcium oxalate forms the chief

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G. Shruti and K. S. Singh