Receptor ativador de plasminogênio da uroquinase solúvel em todo o continuum rim-cardiometabólico: uma revisão sistemática

Resumo original em inglês

O que aconteceu

Soluble urokinase plasminogen activator receptor (suPAR), a circulating marker of innate immune activation, has been proposed as a risk biomarker in chronic kidney disease (CKD) and related cardiometabolic conditions, but its clinical utility remains uncertain.

We performed a systematic review according to PRISMA 2020 and the Synthesis Without Meta-analysis (SWiM) guideline, searching PubMed, Embase, Web of Science, Scopus, the Cochrane Library, medRxiv, ClinicalTrials.gov, and WHO ICTRP from inception to May 15, 2026. Two reviewers independently screened records, extracted data, and assessed quality using the Newcastle-Ottawa Scale, the JBI checklist, RoB 2, and QUADAS-2; certainty of evidence was rated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261320503, identifier CRD420261320503.

O que encontraram

Twenty studies comprising 31,416 participants were included. In adults with preserved kidney function, elevated suPAR predicted incident CKD (adjusted odds ratio (OR) 3.13 for the highest versus lowest quartile, 95% confidence interval (CI) 2.11-4.65) and end-stage kidney disease (ESKD) (adjusted hazard ratio (HR) 1.53 for the highest versus lowest tertile, 95% CI 1.10-2.12), but the gain in discrimination was modest (absolute C-statistic increase 0.027-0.08) and no study performed decision curve analysis (DCA). suPAR did not distinguish focal segmental glomerulosclerosis (FSGS) from other glomerular diseases, and prognostic evidence in FSGS rested on a single moderate-quality study. In pediatric CKD and in metabolic cohorts, suPAR lost independent association after adjustment for baseline kidney function or inflammatory markers. Associations with cardiovascular outcomes were directionally consistent but observational and of low certainty. No study reported sex-stratified analyses.

Por que isso importa

Routine clinical measurement of suPAR is not currently supported; assay harmonization, sex-disaggregated analyses, prospective validation with decision curve analysis, and trials of suPAR-targeted therapy are needed first.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.