Urinary exosomes: Emerging biomarkers for urinary tract infection

Urinary tract infections (UTIs) are among the most prevalent bacterial infections worldwide, often presenting diagnostic challenges owing to nonspecific symptoms and limitations of conventional biomarkers. Recent advances in EV research have highlighted urinary exosome nanosized vesicles secreted by renal and urothelial cells as promising noninvasive biomarkers for UTI detection and monitoring. These exosomes encapsulate a rich cargo of proteins, lipids, and nucleic acids reflective of the physiological and pathological state of the urinary tract. This review synthesizes current evidence on the diagnostic potential of urinary exosomes in UTIs, emphasizing their role in pathogen recognition, immune modulation, and inflammation signaling. We discuss emerging methodologies for exosome isolation and characterization and evaluate their clinical applicability in differentiating bacterial strains, predicting disease severity, and guiding antimicrobial therapy. By integrating molecular insights with translational perspectives, urinary exosomes may redefine the diagnostic landscape of UTIs and pave the way for precision urological care.