Urinary Exosomal ATF3 as a non-invasive biomarker for early detection of acute kidney injury

Acute kidney injury (AKI) is a major clinical and economic challenge worldwide. Furthermore, early identification of AKI remains difficult given that traditional biomarkers like serum creatinine and urine output (UOP) have shown to have limitations since they reflect later stages of injury and are unable to detect the initial cellular damage in AKI. This issue creates an important gap in diagnosis given that early diagnosis could prevent worsening conditions. More research is focusing on non-invasive novel biomarkers options for early and accurate detection of AKI. Urinary exosomes are emerging as a valuable source of kidney-specific biomarkers. These nanovesicles come from all nephron segments, encapsulating intracellular components and providing a unique view of kidney health. Activating transcription factor 3 (ATF3), a transcriptional regulator induced by stress conditions, has emerged as a promising candidate for early detection of AKI. Studies in animals and humans have found that ATF3 is encapsulated and released in urinary exosomes in response to kidney injury, appearing much earlier than traditional biomarkers. This review mainly examines ATF3's role as a new biomarker for the early detection of AKI, it discusses the current understanding of ATF3's molecular role in kidney disease, evaluates the evidence for its use as a biomarker, and outlines a plan for future research and development to realize its full clinical potential.