Diagnostic accuracy of serum and urinary biomarkers for renal scarring in children with vesicoureteral reflux: A systematic review and meta-analysis.

BACKGROUND

Renal scarring (RS) is a significant long-term complication of vesicoureteral reflux (VUR), traditionally diagnosed by dimercaptosuccinic acid (DMSA) scintigraphy-a costly imaging modality involving ionizing radiation. Non-invasive serum and urinary biomarkers have been proposed as alternative diagnostic tools. This systematic review and meta-analysis evaluated the diagnostic accuracy of these biomarkers for detecting RS in children with VUR.

METHODS

A comprehensive search was conducted in MEDLINE, EMBASE, Scopus, Web of Science, LILACS, Cochrane Library, and ProQuest through July 2024. Studies including children (0-18 years) with VUR confirmed by voiding cystourethrography and using DMSA scintigraphy as the reference standard were eligible. Data extraction and quality assessment (QUADAS-2) were independently performed by two reviewers. Pooled sensitivity and specificity were estimated using a bivariate random-effects model.

RESULTS

Ten studies met inclusion criteria; eight were included in meta-analyses. Serum biomarkers showed pooled sensitivity of 0.73 (95 % CI: 0.63-0.81) and specificity of 0.74 (95 % CI: 0.52-0.88). Urinary biomarkers had pooled sensitivity of 0.65 (95 % CI: 0.32-0.88) and specificity of 0.71 (95 % CI: 0.58-0.82). NGAL adjusted for creatinine (NGAL/Cr) was the most frequently studied urinary biomarker, with sensitivity of 0.72 (95 % CI: 0.58-0.83) and specificity of 0.63 (95 % CI: 0.55-0.70). Considerable heterogeneity was observed.

CONCLUSIONS

Selected serum and urinary biomarkers-particularly NGAL and cystatin C-demonstrate moderate diagnostic accuracy for RS in children with VUR. These non-invasive biomarkers may complement DMSA scintigraphy, although further high-quality studies are needed to confirm their clinical utility.