Aug 2026· Seminars in Nephrology· pp.
151712
· 0 citations· 163 references
Medicine
TL;DR
This review uses Tangshen formula, a classic traditional Chinese medicine (TCM) for DKD, to detail TCM's protective mechanisms and concisely summarizes the DKD-related preclinical progress of other TCMs over 5 years.
Abstract
Diabetic kidney disease (DKD) persists as the predominant etiology of end-stage renal disease globally. Despite advances in conventional pharmacotherapies, which primarily target single pathogenic pathways, a considerable residual risk of renal function decline and end-stage renal disease progression remains unresolved, highlighting the need for alternative therapeutic paradigms. This review involves dissecting and integrating mechanistic insights derived from preclinical investigations, including in vitro cellular models, in vivo animal models of DKD, and molecular biology-based analyses. It uses Tangshen formula, a classic traditional Chinese medicine (TCM) for DKD, to detail TCM's protective mechanisms and concisely summarizes the DKD-related preclinical progress of other TCMs over 5 years. Unlike monotarget strategies, TCM interventions exert synergistic effects across multiple organ systems: they reshape the renal microenvironment by mitigating oxidative stress and extracellular matrix accumulation, reprogram hepatic glucose and lipid metabolism to alleviate insulin resistance, and fortify the intestinal mucosal barrier to prevent endotoxemia-induced systemic inflammation. At the microscopic and molecular levels, these TCM-derived agents orchestrate coordinated crosstalk among key pathogenic cascades, including chronic inflammation, renal fibrosis, gut microbiota dysbiosis, metabolic flux dysregulation, microcirculatory impairment, and hypoxic injury. By targeting these interconnected pathways simultaneously, TCM facilitates the restoration of systemic homeostasis, thereby addressing the complex, multifactorial pathogenesis of DKD more comprehensively than pathway-specific interventions.
Abstract Diabetic kidney disease (DKD) is the most prevalent microvascular complication of diabetes mellitus and the leading cause of chronic kidney disease and end-stage renal disease, with its global incidence rising continuously and imposing a substantial disease burden and medical strain worldwide. Current conventional Western therapies only retard disease progression via single-target approaches and fail to comprehensively block multi-dimensional renal pathological injuries including renal inflammation and fibrosis as well as podocyte damage. Moreover, individualized intervention regimens tailored for patients with non-proteinuric DKD and genetically susceptible populations remain scarce. Most existing reviews separate modern pathological mechanisms of DKD from traditional Chinese medicine (TCM) theories and lack systematic integration of multi-target regulatory networks, cutting-edge molecular mechanisms, clinical evidence and medication safety of TCM, which leaves prominent research gaps. Against this backdrop, this review takes TCM intervention for DKD as the core research thread. It systematically summarizes the global epidemiology and risk factors of DKD as well as novel early diagnostic biomarkers and imaging techniques, sorts out susceptibility genes and polygenic risk prediction models, and further dissects a full spectrum of pathophysiological injury pathways covering glomerular lesions, tubulointerstitial damage, inflammation and oxidative stress. Based on the core TCM pathogenesis of “deficiency in origin and excess in superficiality” for DKD, this paper emphatically analyzes the multi-pathway molecular mechanisms through which Chinese herbal formulas and active ingredients regulate renal injury, and generalizes core therapeutic principles, standardized treatment protocols and personalized medication strategies under syndrome differentiation. In addition, it objectively summarizes clinical evidence of TCM efficacy and sorts out key points for safety management of herbal medications. This review aims to construct an integrated analytical framework of “Western medical pathological injury—TCM syndrome and pathogenesis—molecular targets of Chinese herbal medicines”, clarify the unique holistic advantages of TCM with multi-pathway and multi-target regulatory effects, and illustrate that TCM, as a complementary therapy to Western medicine, can synergistically alleviate renal injuries throughout all stages of DKD. Accumulated studies have verified that TCM can compensate for the deficiencies of single-agent Western treatments and exhibits prominent application potential in the full-cycle prevention and intervention of DKD. Nevertheless, large-sample multicenter clinical trials are still required to deeply explore the underlying action targets of TCM, so as to facilitate the improvement of an integrated precise prevention and treatment system combining Chinese and Western medicine for DKD.
Yu-Xin Guan, Jian-Mei Huang, Jin-Cheng Ma et al.· Journal of Multidisciplinary...· 0 citations
Chronic renal failure (CRF), the common end-stage outcome of progressive chronic kidney diseases, is characterized by irreversible decline in glomerular filtration rate and multisystem complications. With over 840 million affected individuals worldwide, CRF poses a major public health challenge. In recent years, mechanistic research on CRF has expanded from traditional hemodynamic abnormalities and fibrotic drivers to encompass immunoinflammatory regulation, mitochondrial energy metabolism reprogramming, and gut-kidney axis dysbiosis. Biomarker studies have focused on the value of tubular injury markers (KIM-1, NGAL) and inflammatory mediators (TNF-α, IL-6) in early diagnosis and prognostic assessment. In terms of therapeutic strategies, accumulating evidence supports the use of SGLT2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and GLP-1 receptor agonists, while traditional Chinese medicine interventions—including rhubarb preparations, Cordyceps mycelial products, and blood-activating and stasis-resolving formulas—have garnered increasing attention for their adjunctive roles in slowing renal function decline. This review systematically synthesizes these advances and critically evaluates current research bottlenecks and translational prospects, aiming to inform clinical decision-making and future investigations.
Zilong Yan, Yun Tian· Journal of Artificial Intell...· 0 citations
Diabetic kidney disease (DKD) is a common microvascular complication of diabetes and an important cause of chronic kidney disease progressing to kidney failure. Its onset and progression are not attributable to hyperglycemia alone, but rather to the combined effects of multiple factors, including disorders of glucose and lipid metabolism, abnormal glomerular hemodynamics, oxidative stress, inflammatory responses, impaired autophagy, programmed cell death, and renal fibrosis. Modern medical treatment has evolved from simply controlling blood glucose and blood pressure to comprehensive interventions aimed at reducing proteinuria and providing cardiorenal protection. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, renin-angiotensin-aldosterone system (RAAS) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists play important roles in slowing disease progression. In traditional Chinese medicine (TCM), DKD is considered a disorder characterized by deficiency in the root and excess in the branch, with qi-yin deficiency and spleen-kidney deficiency as the root and dampness, blood stasis, phlegm, turbidity, and toxin as the manifestations of excess. Chinese herbal formulas, proprietary Chinese medicines, and herb pairs may ameliorate renal injury through multitarget regulation. This review summarizes the major pathogenic mechanisms of DKD and advances in Western and Chinese medical treatment, with the aim of providing a reference for clinical prevention and management.
Xiao-Duo Ai, Genping Lei· Journal of Artificial Intell...· 0 citations
This review summarizes recent advances in the use of natural products for the treatment of renal fibrosis, with a particular focus on their underlying molecular mechanisms, current status of clinical translation, and the challenges that remain.
Yan Liu, Lei Gao, Hao Xu et al.· Renal Failure· 0 citations
Uremic Cardiomyopathy (UCM) represents a severe cardiovascular complication at the terminal stage of Chronic Kidney Disease (CKD), characterized by high morbidity and mortality rates that pose a significant global public health challenge. The pathogenesis of UCM is intricate, involving metabolic reprogramming, mitochondrial dysfunction, inflammatory responses, oxidative stress, among other facets, while clinical treatment lacks specific interventions. Conventional Western medicine primarily offers symptomatic support, which, although alleviates certain symptoms, fails to reverse the core pathological progression of myocardial injury. Traditional Chinese Medicine (TCM), leveraging its strengths in holistic regulation and multi-target intervention, demonstrates significant potential in improving cardiac and renal function in UCM patients, modulating metabolic disorders, and mitigating inflammatory damage. The integration of TCM and Western medicine, through the synergy of complementary advantages, achieves a “symptomatic control + root cause regulation” effect, and has become a pivotal developmental direction in UCM treatment. This paper systematically reviews the pathogenesis and treatment status of UCM from a Western medical perspective, elucidates TCM pathogenesis and therapeutic strategies, examines the clinical application and mechanistic studies of integrated treatment approaches, summarizes existing research challenges, and forecasts future trends, thereby providing a reference for the clinical management and scientific research of UCM.
Yuhan Yan, Xiaohui Li· Journal of Artificial Intell...· 0 citations
This review systematically examines the mechanisms of metabolic reprogramming in different renal cell types and highlights their contribution to renal injury, highlighting the ability of natural products to confer renal protection by modulating key regulatory nodes of metabolic reprogramming.
Wenru Wang, Han Zhu, Keqin Zhao et al.· Journal of Translational Int...· 0 citations
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