{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T12:02:01Z","timestamp":1784808121374,"version":"3.55.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Previous studies have indicated an association between the novel biomarker urinary exosomes and both IgA nephropathy (IgAN) and diabetic kidney disease (DKD). This study aimed to investigate the diagnostic value of urinary exosomes in patients with IgAN and DKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify eligible studies from their inception to December 4, 2025. Data on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and their corresponding 95% confidence intervals (95% CI) were extracted and pooled. Diagnostic meta-analysis was performed using Stata software (version 15.0; Stata Corporation, College Station, TX, USA) and Meta-DiSc version 1.4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 22 articles involving 6,482 participants were included. The pooled results showed that for the diagnosis of DKD, urinary exosomes had a sensitivity of 0.86 (95% CI: 0.77\u20130.92), a specificity of 0.83 (95% CI: 0.75\u20130.89), a DOR of 31.10 (95% CI: 11.09\u201387.19), and an area under the curve (AUC) of 0.91. For the diagnosis of IgAN, urinary exosomes had a sensitivity of 0.78 (95% CI: 0.71\u20130.83), a specificity of 0.70 (95% CI: 0.63\u20130.77), a DOR of 8.26 (95% CI: 5.03\u201313.56), and an AUC of 0.81.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Urinary exosomes showed stronger summary diagnostic performance for DKD than for IgAN. For IgAN, the pooled results support a moderate diagnostic contribution rather than a clearly established clinical role. Standardized prospective studies with prespecified thresholds are needed before routine clinical use can be established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>identifier: CRD420251252373.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1811135","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:10:19Z","timestamp":1784805019000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic value of urinary exosomes in patients with IgA nephropathy and diabetic kidney disease: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ru","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Beilun People's Hospital","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lele","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Beilun People's Hospital","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"e382","DOI":"10.1016\/S2214-109X(23)00570-3","article-title":"An update on the global disparities in kidney disease burden and care across world countries and regions","volume":"12","author":"Bello","year":"2024","journal-title":"Lancet Glob Health"},{"key":"B2","article-title":"Global regional and national burden of chronic kidney disease in adults 1990-(2023) and its attributable risk factors: a systematic analysis for the global burden of disease study 2023","author":"GBD","year":"2025","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1038\/s41581-024-00885-3","article-title":"The Pathogenesis of IgA Nephropathy and Implications for Treatment","volume":"21","author":"Cheung","year":"2025","journal-title":"Nat Rev Nephrol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.amjms.2020.10.003","article-title":"IgA Nephropathy: An Interesting Autoimmune Kidney Disease","volume":"361","author":"Rajasekaran","year":"2021","journal-title":"Am J Med Sci"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.2215\/CJN.04710420","article-title":"Systematic review and meta-analysis of native kidney biopsy complications","volume":"15","author":"Poggio","year":"2020","journal-title":"Clin J Am Soc Nephrol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3390\/genes15010078","article-title":"Liquid Biopsy: A New Avenue for the Diagnosis of Kidney Disease: Diabetic Kidney Disease Renal Cancer and IgA Nephropathy","volume":"15","author":"Dybiec","year":"2024","journal-title":"Genes"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.62347\/DAKE5842","article-title":"Urinary exosomes as promising biomarkers for early kidney disease detection","volume":"13","author":"Liu","year":"2025","journal-title":"Am J Clin Exp Urol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1001\/jama.2017.19163","article-title":"Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement","volume":"319","author":"McInnes","year":"2018","journal-title":"JAMA"},{"key":"B9","doi-asserted-by":"publisher","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2 Group QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann Intern Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1016\/j.ajpath.2018.06.006","article-title":"Association of Elevated Urinary miR-126 miR-155 and miR-29b with Diabetic Kidney Disease","volume":"188","author":"Beltrami","year":"2018","journal-title":"Am J Pathol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e70208","DOI":"10.1002\/jev2.70208","article-title":"CKAP4 in Extracellular Vesicle-Derived from Podocyte Serves as a Non-Invasive Diagnostic Biomarker for Diabetic Nephropathy and Promotes Vascular Calcification","volume":"14","author":"Zhang","year":"2025","journal-title":"J Extracell Vesicles"},{"key":"B12","doi-asserted-by":"publisher","first-page":"86","DOI":"10.3892\/etm.2020.9214","article-title":"Diagnostic Value of VDBP and miR-155-5p in Diabetic Nephropathy and the Correlation with Urinary Microalbumin","volume":"20","author":"Bai","year":"2020","journal-title":"Exp Ther Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"23991","DOI":"10.1038\/s41598-025-06002-z","article-title":"Expression and Diagnostic Value Evaluation of Urinary Exosomal miR-142-3p in Diabetic Nephropathy","volume":"15","author":"Li","year":"2025","journal-title":"Sci Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"23897","DOI":"10.1038\/s41598-025-06810-3","article-title":"Expression of Urinary Exosomal miR-136-5p in Diabetic Kidney Disease and Evaluation of Its Clinical Diagnostic Value","volume":"15","author":"Zheng","year":"2025","journal-title":"Sci Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2121929","DOI":"10.1080\/0886022X.2022.2121929","article-title":"Expression of Urinary Exosomal miRNA-615-3p and miRNA-3147 in Diabetic Kidney Disease and Their Association with Inflammation and Fibrosis","volume":"45","author":"Wang","year":"2023","journal-title":"Ren Fail"},{"key":"B16","doi-asserted-by":"publisher","first-page":"13560","DOI":"10.3390\/ijms241713560","article-title":"Identification of a Non-Invasive Urinary Exosomal Biomarker for Diabetic Nephropathy Using Data-Independent Acquisition Proteomics","volume":"24","author":"Ding","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2562996","DOI":"10.1080\/07853890.2025.2562996","article-title":"Performance of Novel Biomarkers for Prediction of Diabetic Kidney Disease in Patients with Diabetes Mellitus","volume":"57","author":"Zou","year":"2025","journal-title":"Ann Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"709","DOI":"10.7754\/Clin.Lab.2018.171031","article-title":"Potential Value of Urinary Exosome-Derived Let-7c-5p in the Diagnosis and Progression of Type II Diabetic Nephropathy","volume":"64","author":"Li","year":"2018","journal-title":"Clin Lab"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2459","DOI":"10.1002\/pmic.201000443","article-title":"Proteomic Analysis of Urinary Exosomes from Patients of Early IgA Nephropathy and Thin Basement Membrane Nephropathy","volume":"11","author":"Moon","year":"2011","journal-title":"Proteomics"},{"key":"B20","doi-asserted-by":"publisher","first-page":"23498","DOI":"10.1038\/srep23498","article-title":"Selection of Urinary Sediment miRNAs as Specific Biomarkers of IgA Nephropathy","volume":"6","author":"Duan","year":"2016","journal-title":"Sci Rep"},{"key":"B21","doi-asserted-by":"publisher","first-page":"92","DOI":"10.4239\/wjd.v15.i1.92","article-title":"Urinary Exosomal microRNA-145-5p and microRNA-27a-3p Act as Noninvasive Diagnostic Biomarkers for Diabetic Kidney Disease","volume":"15","author":"Han","year":"2024","journal-title":"World J Diabetes"},{"key":"B22","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1620\/tjem.256.215","article-title":"Urinary Exosomal MicroRNAs as New Noninvasive Biomarkers of IgA Nephropathy","volume":"256","author":"Li","year":"2022","journal-title":"Tohoku J Exp Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2319326","DOI":"10.1080\/0886022X.2024.2319326","article-title":"Urinary Exosomal miRNA-451a Can Be Used as a Potential Noninvasive Biomarker for Diagnosis Reflecting Tubulointerstitial Damage and Therapeutic Response in IgA Nephropathy","volume":"46","author":"Zhang","year":"2024","journal-title":"Ren Fail"},{"key":"B24","doi-asserted-by":"publisher","first-page":"590","DOI":"10.3389\/fendo.2020.00590","article-title":"Urinary Exosomal MiRNA-4534 as a Novel Diagnostic Biomarker for Diabetic Kidney Disease","volume":"11","author":"Zhao","year":"2020","journal-title":"Front Endocrinol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"208","DOI":"10.2152\/jmi.65.208","article-title":"Urinary Exosomal mRNA of WT1 as Diagnostic and Prognostic Biomarker for Diabetic Nephropathy","volume":"65","author":"Abe","year":"2018","journal-title":"J Med Invest"},{"key":"B26","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1186\/s12882-023-03343-7","article-title":"Urinary Exosome Proteins PAK6 and EGFR as Noninvasive Diagnostic Biomarkers of Diabetic Nephropathy","volume":"24","author":"Li","year":"2023","journal-title":"BMC Nephrol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2542","DOI":"10.1016\/j.ajpath.2018.07.017","article-title":"Urinary Exosomes and Exosomal CCL2 mRNA as Biomarkers of Active Histologic Injury in IgA Nephropathy","volume":"188","author":"Feng","year":"2018","journal-title":"Am J Pathol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.cca.2022.03.006","article-title":"Urinary Mi-106a for the Diagnosis of IgA Nephropathy: Liquid Biopsy for Kidney Disease","volume":"530","author":"Szeto","year":"2022","journal-title":"Clin Chim Acta"},{"key":"B29","doi-asserted-by":"publisher","first-page":"6048","DOI":"10.1038\/s41598-023-32910-z","article-title":"Urinary miR-16-5p Can Be Used as a Potential Marker of Endocapillary Hypercellularity in IgA Nephropathy","volume":"13","author":"Zhang","year":"2023","journal-title":"Sci Rep"},{"key":"B30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s12882-019-1267-4","article-title":"Urinary miRNA Profile for the Diagnosis of IgA Nephropathy","volume":"20","author":"Szeto","year":"2019","journal-title":"BMC Nephrol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"83","DOI":"10.2478\/jomb-2019-0026","article-title":"Urinary Nephrin Is Earlier More Sensitive and Specific Marker of Diabetic Nephropathy than Microalbuminuria","volume":"39","author":"Kostovska","year":"2020","journal-title":"J Med Biochem"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1016\/S0895-4356(03)00177-X","article-title":"The diagnostic odds ratio: a single indicator of test performance","volume":"56","author":"Glas","year":"2003","journal-title":"J Clin Epidemiol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1126\/science.aau6977","article-title":"The Biology Function and Biomedical Applications of Exosomes","author":"Kalluri","year":"2020","journal-title":"Science"},{"key":"B34","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1146\/annurev-biochem-013118-111902","article-title":"Exosomes","volume":"88","author":"Pegtel","year":"2019","journal-title":"Annu Rev Biochem"},{"key":"B35","doi-asserted-by":"publisher","first-page":"15629","DOI":"10.1038\/s41598-021-95082-8","article-title":"Longitudinal Stability of Urinary Extracellular Vesicle Protein Patterns within and between Individuals","volume":"11","author":"Erozenci","year":"2021","journal-title":"Sci Rep"},{"key":"B36","doi-asserted-by":"publisher","first-page":"F664","DOI":"10.1152\/ajprenal.00292.2020","article-title":"Decreased Secretion and Profibrotic Activity of Tubular Exosomes in Diabetic Kidney Disease","volume":"319","author":"Wen","year":"2020","journal-title":"Am J Physiol Renal Physiol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1811135\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:10:20Z","timestamp":1784805020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1811135\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":36,"alternative-id":["10.3389\/fmed.2026.1811135"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1811135","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"1811135"}}