Advances in Clinical Applications of 1H NMR-Based Urine Metabolomics

Urinary 1H Nuclear Magnetic Resonance (NMR)-based metabolomics has emerged as a robust, non-invasive approach for profiling systemic and renal metabolic alterations. This review summarizes recent clinical applications across kidney disease, cardiometabolic disorders, cancer, immune-mediated and infectious diseases, pediatric disorders, and lifestyle or environmental exposures. We first outline methodological aspects specific to urine, including sampling strategies, osmolarity variation, normalization approaches, and spectral analysis. We then discuss disease-focused applications, emphasizing key metabolites, study designs, and diagnostic performance, and we highlight areas of concordance and inconsistency cross-studies. Shared advantages and limitations of 1H NMR-based urine metabolomics are consolidated in a dedicated section on challenges, and future directions are explored with particular attention to standardization, automation, artificial intelligence–assisted spectral interpretation, multi-omics integration, and large-scale validation. A brief comparison with mass spectrometry (MS) illustrates the complementary roles of NMR and MS in clinical metabolomics. Overall, 1H NMR-based urine metabolomics has potential as a scalable platform for non-invasive phenotyping and holds considerable promise for personalized medicine once technical and translational barriers are addressed.