Salvianolic Acids and Their Pharmacological Promise in Kidney Diseases: A Narrative Review

Chi Chen,1,2,* Yanyan Xiao,1,2,* Weiqun Zhou,3,* Yangyang Li,1,2 Liqi Hou,4 Yi Ling See,1,2 Shengchun Liao,5 Hui Huang,1,2 Yuan Chen,6 Qi Chen,7 Junfei Xu,1,2 Hao Lu1,2 1Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3Department of General Surgery, The 922nd Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Hengyang, People’s Republic of China; 4Department of Shuguang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 5Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 6Department of Traditional Chinese Medicine, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China; 7Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hao Lu, Email luhao403@163.com Junfei Xu, Email xujunfei_liuli@163.comAbstract: Kidney disease is a major public health challenge, affecting millions of people worldwide. Conventional treatments often produce suboptimal outcomes and are associated with various adverse effects. Traditional Chinese Medicine has shown promising therapeutic potential, offering distinct advantages over conventional therapies for preventing and treating kidney diseases. Salvianolic acids, the principal bioactive constituents of Salvia miltiorrhiza, are widely used in the management of renal disorders. However, no dedicated review has systematically synthesized pharmacological evidence across different models of kidney disease. To advance both basic research and clinical applications, this review summarizes current knowledge on the therapeutic effects of salvianolic acids in acute kidney injury, diabetic kidney disease, and nephrotic syndrome. Their renoprotective actions arise from the modulation of multiple pathological processes, including inflammation, oxidative stress, apoptosis, mitochondrial dysfunction, endoplasmic reticulum stress, and autophagy dysregulation. Collectively, salvianolic acids hold promise as potential therapeutic agents for kidney diseases. Further studies are needed to confirm these molecular mechanisms and identify specific targets. Additionally, large-scale, long-term, multicenter clinical trials are crucial to evaluate the efficacy and safety of salvianolic acids in treating kidney diseases.Keywords: salvianolic acids, acute kidney injury, diabetic kidney disease, nephrotic syndrome