Biomarkers of glomerular dysfunction in pre-eclampsia – A systematic review

•Glomerular podocytes become injured in pre-eclampsia leading to subsequent proteinuria.•In this review, we identified five potential biomarkers of podocyte injury.•Pooled sensitivity of all biomarkers was 0.78 with a specificity of 0.82.•Urinary nephrin achieved a sensitivity of 0.81 and specificity of 0.84.•Glomerular biomarkers demonstrate a shorter time interval to PE manifestation than angiogenic markers. Early detection of pre-eclampsia remains one of the major focuses of antenatal obstetric care. There is often a delay in the diagnosis, mainly due to the non-specific nature of the condition. Podocytes which play a pivotal role in glomerular function become injured in pre-eclampsia leading to subsequent proteinuria. Our aim was to review available studies to determine the clinical utility of biomarkers of podocyte injury in pre-eclampsia. We used QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria to perform a systematic review of the literature to determine the clinical utility of podocyte injury biomarkers in predicting pre-eclampsia. This study identified five potential renal biomarkers including podocytes, nephrin, synaptopodin, podocin and podocalyxin. The pooled sensitivity of all biomarkers was 0.78 (95% CI 0.74–0.82) with a specificity of 0.82 (95% CI 0.79–0.85). The area under the Summary of Receiver Operating Characteristics Curve (SROC) was 0.926 (SE 0.30). Urinary nephrin achieved the highest diagnostic values with a sensitivity of 0.81 (95% CI 0.72–0.88) and specificity of 0.84 (95% CI 0.79–0.84). Biomarkers of glomerular injury show promise as diagnostic aids in pre-eclampsia. A large-scale prospective cohort study is warranted before these biomarkers can be recommended for routine clinical care.