Mitochondrial Dynamics in Diabetic Kidney Disease: Underlying Mechanisms and Novel Therapeutics

Diabetic kidney disease (DKD) is a prevalent and serious complication of diabetes and a leading cause of end-stage renal disease (ESRD). As the central organelles for cellular energy metabolism, mitochondria play a pivotal role in the pathogenesis of DKD. Structural and functional impairments of mitochondria trigger multiple renal pathological processes, such as oxidative stress, apoptosis, chronic inflammation, and fibrosis. Mitochondrial dynamics are crucial for maintaining mitochondrial integrity, and their involvement in the progression of DKD is increasingly recognized. Nevertheless, comprehensive reviews addressing the relationship between mitochondrial dynamic homeostasis and DKD are still lacking. This review systematically summarizes the pivotal role of imbalanced mitochondrial dynamics in the pathogenesis and progression of DKD. It details the underlying regulatory mechanisms and stage-specific pathological contributions across different renal cell types, discusses potential diagnostic and therapeutic applications, and evaluates the prospects of natural products that target mitochondrial dynamics in DKD. By integrating current evidence, this work aims to provide a theoretical foundation and strategic guidance for innovative drug development and precision medicine in DKD.