Natural Compounds as Nephroprotective Agents: Therapeutic Potential Against Drug-Induced Kidney Injury

Drug-induced nephrotoxicity poses a significant clinical challenge that limits the therapeutic application of various critical medications, such as antibiotics, chemotherapeutic agents, and nonsteroidal anti-inflammatory drugs. It accounts for 19%-26% of Acute Kidney Injury cases and may advance to chronic kidney disease if not promptly addressed. The kidneys are particularly vulnerable to injury caused by xenobiotics due to their role in drug metabolism and excretion. The mechanisms of nephrotoxicity include oxidative stress, mitochondrial dysfunction, apoptosis, inflammation, crystal nephropathy, and vascular injury, all of which impair renal structure and function. Contemporary therapeutic approaches are primarily confined to supportive care and depend on traditional renal biomarkers, including serum creatinine and blood urea nitrogen, which exhibit insufficient sensitivity for early detection. Thus, there is an increasing demand for efficacious nephroprotective measures and dependable diagnostic indicators. Phytochemicals have garnered considerable interest due to their renoprotective capabilities, which are attributed to their antioxidant, anti-inflammatory, and anti-apoptotic properties. Compounds like quercetin, silymarin, resveratrol, and curcumin have shown encouraging results in experimental models of nephrotoxicity. Furthermore, innovative biomarkers such as NGAL, KIM-1, IL-18, and cystatin C enhance diagnostic accuracy for early renal injury. This narrative review examines nephroprotective phytochemicals, novel biomarkers, and nanotechnology-based delivery methods to improve therapeutic efficacy.