Exploring Chinese Herbal Medicines for Acute Kidney Injury: Pharmacological Mechanisms and Clinical Potential

Background: Acute kidney injury (AKI) is a serious clinical condition marked by a rapid decline in renal function, leading to high morbidity, mortality, and healthcare burden. Despite advances in supportive care, effective pharmacologic therapies remain lacking, prompting interest in alternative approaches, including Chinese herbal medicines (CHMs). Purpose: This review summarizes recent experimental and clinical research on CHMs for AKI, highlighting mechanisms of action, translational challenges, and future directions. Methods: A narrative review was conducted using PubMed, Web of Science, Google Scholar, and ClinicalTrials.gov through May 2025, with search terms including "acute kidney injury", "Chinese herbal medicine", "natural products", and "plant extracts". Both preclinical and clinical studies were included to provide a comprehensive overview. Results: Various CHMs and traditional formulations have demonstrated renal protective effects in AKI through anti-inflammatory, antioxidant, anti-apoptotic, and mitochondrial-protective mechanisms. Key pathways targeted include NF-κB, Nrf2, PI3K/Akt, MAPK, and apoptotic regulators like Bcl-2/Bax and caspases. Notable agents include berberine, baicalin, puerarin, and multi-herb formulas such as QiShenYiQi and Jianpi Yishen Tang, which offer multi-targeted therapeutic potential. Conclusion: CHMs present a promising avenue for AKI treatment by modulating multiple cellular pathways implicated in disease progression. While preclinical studies are encouraging, robust clinical trials and standardization of formulations are critical for validating efficacy and ensuring safety. Integrating CHMs into modern nephrology through evidence-based strategies may enhance therapeutic options for AKI and advance the development of novel, nature-derived treatments.