Proteínas podocitárias como biomarcadores urinários de lesão glomerular em estágio inicial: uma revisão sistemática e metanálise

Abstract

The use of podocyte proteins as urinary biomarkers may be a promising noninvasive tool to detect glomerular injury at an early stage. After podocyte injury, the appearance of podocyte proteins in urine may identify glomerular injury before the onset of albuminuria. Early detection may contribute to the adoption of timely treatment, delaying or reducing disease progression. The objective was to analyze the scientific evidence on the use of podocyte proteins as urinary biomarkers of glomerular injury at an early stage. A protocol was developed and published in PROSPERO (CRD42021265630). A systematic review was performed following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was performed for articles published until April 2024 in the PubMed, Embase, Web of Science, Scopus and Google Scholar databases, without language restrictions. The clinical question was formulated according to the Population, Index Tests, Reference Test, Diagnostic (PIRD) strategy, and observational case-control studies were included according to the eligibility criteria. Study selection was performed independently by three authors who extracted data using a standardized form developed and validated by the authors. Life-threatening risk was assessed using the Newcastle-Ottawa Scale (NOS). The R CORE TEAM, 2020 software was used for quantitative synthesis. The search strategy retrieved 3,476 studies, of which 20 were read in the integration phase and 8 were included in the review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was used. Two studies presented low risk of bias and the other six presented moderate risk. The certainty of evidence for early-stage glomerular injury was considered low for podocin and very low for nephrin and podocalyxin. In conclusion, the studies developed individually demonstrate the potential of the proteins nephrin, podocin and podocalyxin in the diagnosis of glomerular injury in normoalbuminuric groups, allowing identification in the early stage of the disease.