Recent Advances in the Pathogenesis of the Nrf2ARE Signaling Pathway in Diabetic Nephropathy and Its Treatment with Traditional Chinese and Western Medicine

Abstract

Diabetic nephropathy (DN) is the most serious microvascular complication of diabetes and the leading cause of end-stage renal disease. Its core pathological mechanism is closely related to persistent oxidative stress. The Nrf2/ARE signaling pathway is the most important endogenous defense hub against oxidative damage in the body, and its homeostasis imbalance directly drives key pathological processes such as podocyte injury, renal tubular epithelial–mesenchymal transition, renal interstitial fibrosis, and mitochondrial dysfunction-mediated ferroptosis. Therefore, targeting the Nrf2/ARE pathway and restoring renal redox homeostasis has become a highly promising therapeutic strategy for delaying DN progression. This article systematically reviews the biological characteristics of the Nrf2/ARE pathway and its pathological role in DN, with a focus on research progress in interventions targeting this pathway using both traditional Chinese and Western medicine. It is expected to provide more precise and efficient novel therapeutic strategies for overcoming DN and accelerate the translation from basic research to clinical application.