Extracellular Vesicles in Calcium Oxalate Nephrolithiasis: Emerging Biomarkers and Therapeutic Potential

Kidney stone ranks as one of the most prevalent disorders in the urology department, causing substantial personal suffering and healthcare costs globally. However, the prediction, early diagnosis, and treatment of kidney stone disease are still limited. Extracellular vesicles (EVs), loaded with nucleic acids, proteins, metabolites, and lipids, are released by a wide variety of cell types and have potential as biomarkers for kidney stone disease. Meanwhile, some natural EVs derived from plants and animals have been evidenced to have substantial effects on the elimination of calcium oxalate crystals. More importantly, recent explorations have elucidated the multifaceted role of EVs in therapeutic applications. These engineered EVs can be loaded with therapeutic RNAs, oligonucleotides, peptides, and small molecules; this approach has shown great promise in targeted drug delivery and presents a potential solution to the challenges of kidney stone prevention and treatment. This review focuses on EVs derived from blood, urine, kidney, gut microbiota, and urine bacteria, which contribute to calcium oxalate crystal elimination. The therapeutic potential of EVs is significant, offering personalized treatment options. However, it is crucial to assess the challenges in moving EV-based therapies from laboratory settings to clinical applications.