The Mechanism and Application of Traditional Chinese Medicine Nano-Formulations in the Treatment of Renal Fibrosis

Chronic kidney disease (CKD) is a global public health threat, and renal fibrosis represents the common pathological pathway toward end-stage disease. Current clinical treatments are limited by single-target mechanisms and their inability to reverse established fibrosis. Traditional Chinese medicine (TCM) offers multi-target advantages but encounters challenges including low bioavailability and lack of targeting. Nanodelivery systems overcome these limitations by enabling precise renal targeting and enhanced efficacy. This review provides a comprehensive and systematic overview of the mechanisms and applications of TCM nanoformulations for anti-renal fibrosis, with an emphasis on bridging nanocarrier material properties to clinical translation potential. To achieve this, we summarize the pathogenesis of renal fibrosis, elucidate the principles of renal-targeted nano-delivery (glomerular filtration, tubular reabsorption, and secretion), categorize five classes of nanocarriers with their physicochemical properties and in vivo fate, review the anti-fibrotic mechanisms and nanodelivery strategies of four major TCM active components (flavonoids, anthraquinones, phenolic compounds, and glycosides), and present preclinical evidence in CKD and acute kidney injury (AKI) models. In conclusion, TCM nanoformulations represent a promising strategy for renal fibrosis treatment by integrating multi-component synergy with precise renal targeting. However, significant hurdles remain, including batch-to-batch consistency, long-term safety evaluation, and regulatory pathway establishment. Addressing these challenges is essential for successful clinical translation.