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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Sriwijaya Journal of Internal Medicine
Deka Viotra
Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing

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Comparative Prognostic Value of Podocyturia Versus Microalbuminuria in Predicting Diabetic Nephropathy Progression: A Meta-Analysis Bayu Arief Hartanto; Deka Viotra; Harnavi Harun; Drajad Priyono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1578

Abstract

Background: Diabetic nephropathy represents the primary etiology of end-stage renal disease globally. Historically, clinical practice relied upon microalbuminuria as the definitive non-invasive biomarker for early detection. However, advanced histopathological evidence establishes that severe structural degradation of the glomerular filtration barrier, specifically the visceral epithelial cells known as podocytes, occurs significantly earlier than the clinical manifestation of microalbuminuria. Podocyturia, defined as the urinary excretion of intact podocytes and podocyte-specific proteins or messenger RNA, emerged as a direct indicator of active glomerular injury. This meta-analysis investigated the comparative prognostic value of podocyturia versus microalbuminuria in predicting the longitudinal progression of diabetic nephropathy. Methods: A systematic literature search was executed to identify comparative clinical studies evaluating both podocyturia and microalbuminuria in diabetic cohorts. Seven essential manuscripts met rigorous inclusion criteria. Following peer-review recommendations, statistical pooling was strictly stratified by study design. Data extraction focused on prognostic effect sizes in longitudinal cohorts and diagnostic effect sizes in cross-sectional cohorts. Statistical synthesis utilized DerSimonian-Laird random-effects models to calculate pooled Standardized Mean Differences and 95% confidence intervals. Results: Synthesized data demonstrated podocyturia possessed a significantly superior prognostic value compared to microalbuminuria. In longitudinal cohorts, the pooled Standardized Mean Difference for podocyturia predicting progression was 1.95 (95% CI: 1.50 to 2.40, p < 0.001), whereas microalbuminuria was 0.58 (95% CI: 0.25 to 0.91, p = 0.04). Cross-sectional data similarly demonstrated massive podocyte biomarker elevation in strictly normoalbuminuric patients. Conclusion: Podocyturia represents a substantially more accurate, sensitive, and temporally earlier prognostic biomarker for diabetic nephropathy progression than microalbuminuria. Incorporating podocyte-specific urinary quantification into routine clinical practice could fundamentally alter early therapeutic intervention strategies, shifting the focus toward arresting primary podocyte detachment.
Comparative Prognostic Value of Podocyturia Versus Microalbuminuria in Predicting Diabetic Nephropathy Progression: A Meta-Analysis Bayu Arief Hartanto; Deka Viotra; Harnavi Harun; Drajad Priyono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1578

Abstract

Background: Diabetic nephropathy represents the primary etiology of end-stage renal disease globally. Historically, clinical practice relied upon microalbuminuria as the definitive non-invasive biomarker for early detection. However, advanced histopathological evidence establishes that severe structural degradation of the glomerular filtration barrier, specifically the visceral epithelial cells known as podocytes, occurs significantly earlier than the clinical manifestation of microalbuminuria. Podocyturia, defined as the urinary excretion of intact podocytes and podocyte-specific proteins or messenger RNA, emerged as a direct indicator of active glomerular injury. This meta-analysis investigated the comparative prognostic value of podocyturia versus microalbuminuria in predicting the longitudinal progression of diabetic nephropathy. Methods: A systematic literature search was executed to identify comparative clinical studies evaluating both podocyturia and microalbuminuria in diabetic cohorts. Seven essential manuscripts met rigorous inclusion criteria. Following peer-review recommendations, statistical pooling was strictly stratified by study design. Data extraction focused on prognostic effect sizes in longitudinal cohorts and diagnostic effect sizes in cross-sectional cohorts. Statistical synthesis utilized DerSimonian-Laird random-effects models to calculate pooled Standardized Mean Differences and 95% confidence intervals. Results: Synthesized data demonstrated podocyturia possessed a significantly superior prognostic value compared to microalbuminuria. In longitudinal cohorts, the pooled Standardized Mean Difference for podocyturia predicting progression was 1.95 (95% CI: 1.50 to 2.40, p < 0.001), whereas microalbuminuria was 0.58 (95% CI: 0.25 to 0.91, p = 0.04). Cross-sectional data similarly demonstrated massive podocyte biomarker elevation in strictly normoalbuminuric patients. Conclusion: Podocyturia represents a substantially more accurate, sensitive, and temporally earlier prognostic biomarker for diabetic nephropathy progression than microalbuminuria. Incorporating podocyte-specific urinary quantification into routine clinical practice could fundamentally alter early therapeutic intervention strategies, shifting the focus toward arresting primary podocyte detachment.
Circulating Asymmetric Dimethylarginine in Adults with Essential Hypertension Compared with Normotensive Controls: A Systematic Review and Meta-Analysis Rahmeidia Audya Yusmi; Harnavi Harun; Drajad Priyono; Deka viotra
Sriwijaya Journal of Internal Medicine Vol. 4 No. 2 (2026): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v4i2.343

Abstract

Background: Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase inhibitor and a candidate mediator of the endothelial dysfunction accompanying raised arterial pressure. Prior meta-analyses covered coronary disease, heart failure, chronic kidney disease and preeclampsia, but none quantified the essential hypertension versus normotension contrast. Objective: To quantify the difference in circulating ADMA between adults with essential hypertension and normotensive controls, and to characterise its clinical and methodological moderators. Methods: MEDLINE and Europe PMC were searched for studies of circulating ADMA in essential hypertension with a concurrent normotensive group. Effect sizes for paywalled reports publishing only a direction and p-value were recovered from test statistics and group sizes, graded into three tiers, with non-significant results entered as zero. Hedges g was pooled under a random-effects model (REML, Knapp–Hartung); bias was appraised with the Newcastle–Ottawa Scale. Results: Twenty-four studies contributed 2,201 participants (1,293 hypertensive, 908 normotensive). ADMA was higher in essential hypertension, Hedges g = 0.642 (95% CI 0.340 to 0.945; p = 0.0002), with I2 = 81.4% and a 95% prediction interval (−0.673 to 1.957) including zero. Directly readable studies gave g = 0.972 and recovered studies g = 0.330 (interaction p = 0.019). Small-study effects were present (Begg p = 0.029; trim-and-fill g = 0.407), yet the estimate stayed positive across all 39 sensitivity specifications. Conclusion: The plausible effect is about 0.33 to 0.64 standardised units, roughly 0.1 micromoles per litre. Certainty is very low and the distributions overlap too much for ADMA to discriminate between individuals.
Co-Authors Bayu Arief Hartanto Drajad Priyono Harun Harnavi Rahmeidia Audya Yusmi