Abelmoschus manihot in Chronic Kidney Disease: Evidence-Based Therapeutics and Mechanistic Insights

Chronic kidney disease is a major global health burden with limited treatment options. Abelmoschus manihot (L.) Medicus (AM), a traditional Chinese medicine, has been used for centuries for edema and related disorders. Since the 1980s, it has been systematically applied in clinical nephrology, leading to the development of Huangkui capsules, an AM extract now widely used to treat proteinuria. Several high-quality clinical trials led by Chinese researchers show that AM preparations, alone or with standard therapy, significantly reduce proteinuria and preserve renal function in patients with kidney disease. The renoprotective effects of AM are attributed to its bioactive flavonoids. Its core mechanisms involve potent anti-inflammatory and antifibrotic actions alongside direct protection of renal parenchymal cells. Emerging research also highlights benefits in reducing oxidative stress, modulating gut microbiota, regulating programmed cell death, and alleviating dyslipidemia. Increasing evidence demonstrates that AM exemplifies a successful transition from traditional application to evidence-based medicine, supported by robust clinical trials and preclinical studies revealing its multitargeted mechanisms against key chronic kidney disease drivers. Further research will continue to expand its therapeutic application and refine crucial therapeutic targets. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.