Research Progress on Pathogenesis of Diabetic Nephropathy and Intervention with Traditional Chinese Medicine

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.