College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, 4811, Australia.
College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Clinical Chemistry, University of Gondar, Gondar, Ethiopia.
J Nephrol. 2024 Jan;37(1):39-51. doi: 10.1007/s40620-023-01585-0. Epub 2023 Feb 20.
Both early recognition of glomerular injury and diagnosis of renal injury remain important problems in clinical settings, and current diagnostic biomarkers have limitations. The aim of this review was to determine the diagnostic accuracy of urinary nephrin for detecting early glomerular injury.
A search was conducted through electronic databases for all relevant studies published until January 31, 2022. The methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Pooled sensitivity, specificity, and other estimates of diagnostic accuracy were determined using a random effect model. The Summary Receiver Operating Characteristics (SROC) was used to pool the data and to estimate the area under the curve (AUC).
The meta-analysis included 15 studies involving 1587 participants. Overall, the pooled sensitivity of urinary nephrin for detecting glomerular injury was 0.86 (95% CI 0.83-0.89) and specificity was 0.73 (95% CI 0.70-0.76). The AUC-SROC to summarise the diagnostic accuracy was 0.90. As a predictor of preeclampsia, urinary nephrin showed a sensitivity of 0.78 (95% CI 0.71-0.84) and specificity of 0.79 (95% CI 0.75-0.82), and as a predictor of nephropathy the sensitivity was 0.90 (95% CI 0.87-0.93), and specificity was 0.62 (95% CI 0.56-0.67). A subgroup analysis using ELISA as a method of diagnosis showed a sensitivity of 0.89 (95% CI 0.86-0.92), and a specificity of 0.72 (95% CI 0.69-0.75).
Urinary nephrin may be a promising marker for the detection of early glomerular injury. ELISA assays appear to provide reasonable sensitivity and specificity. Once translated into clinical practice, urinary nephrin could provide an important addition to a panel of novel markers to help in the detection of acute and chronic renal injury.
肾小球损伤的早期识别和肾损伤的诊断仍然是临床中的重要问题，而目前的诊断生物标志物存在局限性。本综述旨在确定尿足细胞蛋白诊断肾小球早期损伤的准确性。
通过电子数据库检索截至 2022 年 1 月 31 日发表的所有相关研究。使用诊断准确性研究质量评估工具（QUADAS-2）评估方法学质量。使用随机效应模型确定合并敏感性、特异性和其他诊断准确性估计值。使用汇总受试者工作特征曲线（SROC）对数据进行合并，并估计曲线下面积（AUC）。
荟萃分析纳入了 15 项研究，共涉及 1587 名参与者。总体而言，尿足细胞蛋白检测肾小球损伤的合并敏感性为 0.86（95%置信区间 0.83-0.89），特异性为 0.73（95%置信区间 0.70-0.76）。SROC 曲线汇总诊断准确性的 AUC 为 0.90。作为子痫前期的预测指标，尿足细胞蛋白的敏感性为 0.78（95%置信区间 0.71-0.84），特异性为 0.79（95%置信区间 0.75-0.82），作为肾病的预测指标，敏感性为 0.90（95%置信区间 0.87-0.93），特异性为 0.62（95%置信区间 0.56-0.67）。使用 ELISA 作为诊断方法的亚组分析显示，敏感性为 0.89（95%置信区间 0.86-0.92），特异性为 0.72（95%置信区间 0.69-0.75）。
尿足细胞蛋白可能是一种有前途的早期肾小球损伤检测标志物。ELISA 检测似乎具有合理的敏感性和特异性。一旦转化为临床实践，尿足细胞蛋白可能会为帮助检测急性和慢性肾损伤的一组新型标志物提供重要补充。
