Urinary Transferrin as a Marker of Renal Injury in Diabetic Individuals: An Integrative Review

Abstract

Aims: Chronic Kidney Disease (CKD) significantly impacts public health, with diabetes mellitus as the second leading cause, according to the latest Brazilian Dialysis Census. CKD is linked to obesity, hypertension, and family history. While microalbuminuria is a common marker for diabetic nephropathy (DN), its limitations prompt the need for alternative biomarkers. Over the past two decades, urinary transferrin has been explored for its enhanced glomerular filtration. This review evaluates transferrin's clinical-laboratory utility as a kidney injury biomarker. Methodology: The research was an integrative review, guided by the PRISMA checklist and the PICO model. It examined the role of urinary transferrin as a kidney injury marker in diabetics. Data were sourced from PubMed, Scopus, Cinahl, Web of Science, and Cochrane Database using MeSH terms. The Rayyan platform helped filter studies, with CASP ensuring quality. Inclusion criteria covered randomized trials from 2002-2021, focusing on urinary samples. The CONSORT guidelines assessed study reliability, ensuring robust conclusions. Results: The findings suggest that urinary transferrin may have superior sensitivity in detecting glomerular damage in diabetic patients compared to microalbuminuria. It serves as an early indicator of diabetic nephropathy (DN) and can predict the onset of microalbuminuria and the progression of chronic kidney disease (CKD). Conclusion: This study emphasizes the need to clarify the role of urinary transferrin as an experimental laboratory marker for kidney injury in diabetic patients. It highlights the importance of moving from discovery to validation of new urinary biomarkers and developing diagnostic methods that include urinary transferrin for early diabetic nephropathy (DN) diagnosis.