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<p>Diabetic nephropathy (DN), the most prevalent microvascular complication of diabetes, affects 20–40% of patients and remains a leading global cause of end-stage renal disease (ESRD). Current Western therapies, such as renin–angiotensin–aldosterone system (RAAS) inhibitors (ACEIs/ARBs etc.) and sodium-glucose cotransporter 2 (SGLT2) inhibitors, primarily target single pathways like glycemic control or hemodynamic stress in early DN. These approaches, while effective in reducing albuminuria, are limited by side effects like hyperkalemia in 10–20% of ACEI/ARB users and incomplete addressing of multifactorial pathogenesis, including oxidative stress and fibrosis, contributing to persistent progression to ESRD. Salvia miltiorrhiza (SM), a traditional Chinese herb known for promoting microcirculation and exerting anti-thrombotic effects, shows renoprotective potential in DN by multiple pathways. Its bioactives, including liposoluble tanshinones and hydrophilic salvianolic acids, mitigate oxidative stress, inflammation, and renal fibrosis through pathways such as Nrf2/Keap1, TGF-β/Smad, and PI3K/Akt. This review highlights SM’s therapeutic potential as a multi-target therapy for the treatment of DN, emphasizing the need for clinical validation.</p> Graphical abstract <p></p>

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Salvia miltiorrhiza (Danshen) and its extracts in the alternative treatment of diabetic nephropathy: mechanisms and clinical perspectives

  • 期刊论文

  • 发表日期：

    2026年2月19日

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  • Lu Song,
  • Yan Li,
  • Huakui Zhan,
  • Ling Wu,
  • Li Tang,
  • Xinyu Wang,
  • Qinyuan Deng

摘要

Diabetic nephropathy (DN), the most prevalent microvascular complication of diabetes, affects 20–40% of patients and remains a leading global cause of end-stage renal disease (ESRD). Current Western therapies, such as renin–angiotensin–aldosterone system (RAAS) inhibitors (ACEIs/ARBs etc.) and sodium-glucose cotransporter 2 (SGLT2) inhibitors, primarily target single pathways like glycemic control or hemodynamic stress in early DN. These approaches, while effective in reducing albuminuria, are limited by side effects like hyperkalemia in 10–20% of ACEI/ARB users and incomplete addressing of multifactorial pathogenesis, including oxidative stress and fibrosis, contributing to persistent progression to ESRD. Salvia miltiorrhiza (SM), a traditional Chinese herb known for promoting microcirculation and exerting anti-thrombotic effects, shows renoprotective potential in DN by multiple pathways. Its bioactives, including liposoluble tanshinones and hydrophilic salvianolic acids, mitigate oxidative stress, inflammation, and renal fibrosis through pathways such as Nrf2/Keap1, TGF-β/Smad, and PI3K/Akt. This review highlights SM’s therapeutic potential as a multi-target therapy for the treatment of DN, emphasizing the need for clinical validation.

Graphical abstract