Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134 Florence, Italy.
Nephrology and Dialysis Unit, Meyer Children's University Hospital, 50139 Florence, Italy.
Int J Mol Sci. 2020 Sep 19;21(18):6889. doi: 10.3390/ijms21186889.
Noninvasive tools for diagnosis or prediction of acute kidney allograft rejection have been extensively investigated in recent years. Biochemical and molecular analyses of blood and urine provide a liquid biopsy that could offer new possibilities for rejection prevention, monitoring, and therefore, treatment. Nevertheless, these tools are not yet available for routine use in clinical practice. In this systematic review, MEDLINE was searched for articles assessing urinary biomarkers for diagnosis or prediction of kidney allograft acute rejection published in the last five years (from January 1, 2015 to May 31, 2020). This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Articles providing targeted or unbiased urine sample analysis for the diagnosis or prediction of both acute cellular and antibody-mediated kidney allograft rejection were included, analyzed, and graded for methodological quality with a particular focus on study design and diagnostic test accuracy measures. Urinary C-X-C motif chemokine ligands were the most promising and frequently studied biomarkers. The combination of precise diagnostic reference in training sets with accurate validation in real-life cohorts provided the most relevant results and exciting groundwork for future studies.
近年来，人们广泛研究了用于诊断或预测急性肾移植排斥反应的非侵入性工具。血液和尿液的生化和分子分析提供了一种液体活检，可以为排斥反应的预防、监测以及治疗提供新的可能性。然而，这些工具尚未在临床实践中常规使用。在这项系统评价中，我们检索了 2015 年 1 月 1 日至 2020 年 5 月 31 日期间发表的评估尿液生物标志物用于诊断或预测肾移植急性排斥反应的文章，检索数据库为 MEDLINE。本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。纳入了针对急性细胞和抗体介导的肾移植排斥反应的诊断或预测进行靶向或非靶向尿液样本分析的文章，并对其进行了分析和方法学质量分级，特别关注研究设计和诊断测试准确性指标。尿趋化因子配体是最有前途和经常研究的生物标志物。在训练集中提供精确的诊断参考，并在真实队列中进行准确验证，为未来的研究提供了最相关的结果和令人兴奋的基础。
