Diagnostic and Therapeutic Roles of Extracellular Vesicles in Chronic Kidney Disease: A Systematic Review.

Extracellular vesicles (EVs) are increasingly investigated across a wide range of diseases as potential biomarkers and therapeutic tools. To date, EVs have been isolated from diverse sources, including urine, blood, saliva, tissue, and cell cultures, with research focusing primarily on their protein and RNA cargo. Owing to their non-invasive accessibility, selective cargo loading, and molecular richness, biological fluid-derived EVs have been proposed as promising candidates for biomarker discovery. In addition, several studies have explored EVs for therapeutic purposes, either by direct administration to diseased cells or organisms, by engineering them to enhance their efficacy, or by targeting them to modulate pathological processes. In this systematic review, we synthesize current evidence on the diagnostic and therapeutic roles of EVs in CKD and related conditions, integrating findings across different EV sources, cargos, and disease models, and providing an integrated perspective on the role of EVs in chronic kidney disease-related research. By comparing molecular findings from diagnostic and therapeutic studies, we also identify key overlapping pathways and biological processes that may represent relevant mechanistic frameworks. Recognizing these convergent pathways can help unify data and guide future research toward mechanism-driven, and clinically translatable EV applications in nephrology.