Extracellular vesicles in diabetic kidney disease: Emerging mechanisms, therapeutic implications, and biomarker...

Diabetic kidney disease (DKD), a leading contributor of kidney failure, arises from glomerular damage, podocyte depletion, and fibrosis due to high blood glucose, worsened by inflammation and oxidative stress. Current therapies targeting late-stage symptoms (e.g., proteinuria, declining glomerular filtration rate) show limited efficacy and side effects.Extracellular vesicles (EVs), enriched in urine and kidney tissues, carry disease-associated cargoes, such as miRNAs and pro-fibrotic proteins, which interfere with intercellular communication and enhance pathological remodeling when absorbed by renal cells. Urinary and blood EV profiles are emerging as non-invasive biomarkers applicable to early diagnosis and surveillance with DKD advancement. Preclinical studies demonstrate engineered EVs deliveringanti-fibrotic agentsorpodocyte-protective moleculesas promising therapies, mitigating renal damage. This review describes the dual functions of EVs in DKD progression, highlighting their promise for diagnostic tools and targeted drug delivery systems, and discusses strategies to utilize EVs for precise kidney protection.