Pomegranate (Punica granatum L.): A narrative review of its protective role against nephrotoxicity

Pomegranate (Punica granatum L.) has been traditionally used in various cultures for its health benefits, particularly in promoting kidney health. Its rich composition of bioactive compounds, including polyphenols and flavonoids, has drawn attention for their potential protective effects against nephrotoxicity, a condition characterized by kidney damage due to various toxic agents.

This review aims to evaluate the efficacy of pomegranate and its active constituents in mitigating nephrotoxicity and promoting kidney health.

A literature review was conducted from 2010 to 2025, encompassing relevant in vitro and in vivo studies sourced from databases such as Scopus, Google Scholar, Web of Science, and PubMed. The focus was on the effects of pomegranate on nephrotoxicity and its underlying mechanisms.

The nephroprotective effects of pomegranate are attributed to its bioactive compounds, including ellagic acid, gallic acid, and punicalagin, which exhibit robust antioxidant properties and reduce inflammation, apoptosis, and fibrosis. These compounds suppress the TGF-β1/Smad pathway while enhancing protective regulators (SIRT1, SIRT6, TUG1, and Nrf2), contributing to antioxidant defense and cellular homeostasis. Furthermore, pomegranate mitigates nephrotoxicity by decreasing markers like MCP-1, NF-κB, LDH, HIF-1α, KIM-1, and NGAL, and it modulates renal transport proteins (OAT1 and OAT3). By preserving glomerular filtration rate, alleviating tubular damage, and promoting renal repair mechanisms, pomegranate demonstrates its protective actions against nephrotoxicity.

Pomegranate shows multifaceted nephroprotective properties through modulation of oxidative stress, inflammation, fibrosis, and apoptosis-related signaling pathways. However, further research is essential to confirm these findings, explore clinical applications, and evaluate safety profiles and potential interactions with other medications.