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Biomarker for renal scarring screening in children with vesicoureteral reflux: a systematic review

Utari Mudhia Arisa Putri1, Putu Angga Risky Raharja1, Gerhard Reinaldi Situmorang1

  • 1Urology Department, Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

Frontiers in Pediatrics
|September 11, 2025
PubMed

Insights

Urinary biomarkers, especially NGAL, show promise for detecting kidney scarring in children with vesicoureteral reflux (VUR), offering a non-invasive alternative to radiation-heavy imaging. Further research is needed for clinical use.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Biomarker Discovery

Background:

  • Vesicoureteral reflux (VUR) is a common pediatric condition leading to urinary tract infections (UTIs) and potential kidney damage.
  • Renal scarring from VUR can cause long-term issues like hypertension and chronic kidney disease (CKD).
  • Traditional DMSA scans for renal scarring involve radiation and high costs, necessitating alternative diagnostic methods.

Purpose of the Study:

  • To systematically review the diagnostic accuracy of blood and urine biomarkers for detecting renal scarring in children with VUR.
  • To compare the effectiveness of various biomarkers against established imaging techniques.

Main Methods:

  • A systematic review following PRISMA 2020 guidelines was conducted.
  • Searches were performed on PubMed, ScienceDirect, and Cochrane databases for relevant studies.
  • Diagnostic accuracy (sensitivity, specificity) and risk of bias (QUADAS-2) were assessed for included studies.

Main Results:

  • Nine studies were included, evaluating biomarkers like NGAL, CRP, CXCL8/IL-8, LL-37, and IL-6.
  • Urinary NGAL demonstrated the highest diagnostic performance, with sensitivity of 72%-84% and specificity of 60%-81%.
  • Other biomarkers showed moderate accuracy but were less reliable than NGAL for detecting renal scarring.

Conclusions:

  • Urinary biomarkers, particularly NGAL, offer a promising non-invasive approach for identifying VUR-associated renal scarring in children.
  • While NGAL shows significant potential, further validation and standardization are required for routine clinical application.
Abstract

Keywords:
NGALbiomarkersrenal scarringsystematic reviewvesicoureteral reflux

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