The therapeutic potential of puerarin on diabetic kidney disease: Focus on molecular mechanisms and future perspectives

Diabetic kidney disease is one of the most severe microvascular complications of diabetes mellitus and remains the leading cause of end-stage renal disease worldwide. Although renin-angiotensin system blockade combined with hypoglycemic and lipid-regulating agents constitutes the standard therapy, residual renal risk and progressive kidney dysfunction remain substantial, highlighting the urgent need for novel therapeutic interventions. Puerarin is a vasoactive isoflavone isolated from the roots of Pueraria species like P. lobata (Willd.). It has emerged as a promising therapeutic candidate offering multiple beneficial effects that may ameliorate the progression of diabetic kidney disease. This review summarizes the multifaceted potential of puerarin in alleviating diabetic kidney disease, with a focus on its impacts on key metabolic pathways and cellular signaling processes including mitochondrial function, reactive oxygen species production, programmed cell death, and autophagy. This synthesis may provide a mechanistic basis for future targeted investigations and facilitate the translational development of puerarin for DKD management.