From Renal Tubule to Glomerulus： Emerging Insights into Pathogenesis of Diabetic Kidney Disease and Therapeutic Interventions with Traditional Chinese Medicine
10.13422/j.cnki.syfjx.20260304
- VernacularTitle:从肾小管到肾小球：糖尿病肾病发病机制及中药干预新视角
- Author:
Yanying LI
1
;
Yang WANG
2
;
Xueying LIU
1
;
Chen JIANG
2
;
Pengwei ZHUANG
1
;
Yanjun ZHANG
1
;
Qingsheng YIN
1
Author Information
1. State Key Laboratory of Modern Chinese Materia Medica Innovation， Tianjin University of Traditional Chinese Medicine （TCM）， Tianjin 301617， China
2. First Teaching Hospital of Tianjin University of TCM，National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion， Tianjin 300381， China
- Publication Type:Journal Article
- Keywords:
diabetic kidney disease;
renal tubule;
glomerulus;
tubuloglomerular feedback;
traditional Chinese medicine
- From:
Chinese Journal of Experimental Traditional Medical Formulae
2026;32(20):260-268
- CountryChina
- Language:Chinese
-
Abstract:
Diabetic kidney disease （DKD）， a prevalent microvascular complication of diabetes mellitus， is characterized by intricate pathophysiological mechanisms and persistent clinical management challenges. Historically， glomerular injury has been regarded as the central pathological hallmark of DKD， with research predominantly focusing on hyperfiltration， glomerular basement membrane thickening， and podocyte dysfunction. Emerging evidence， however， underscores the renal tubule-not merely as a passive bystander but as an early initiator and pivotal driver-in DKD pathogenesis. Hyperglycemia， metabolic dysregulation， and chronic low-grade inflammation induce tubular epithelial cell injury at early disease stages. Such injury disrupts tubuloglomerular feedback， thereby elevating intraglomerular pressure and sustaining hyperfiltration. Concurrently， injured tubular cells secrete pro-inflammatory cytokines and profibrotic factors， promoting epithelia-mesenchymal transition， interstitial hypoxia， and progressive tubulointerstitial fibrosis that ultimately culminate in irreversible decline of renal function. This "tubule-first" paradigm represents a fundamental shift from the classical glomerulocentric model and redefines the conceptual framework of DKD progression. Traditional Chinese medicine（TCM）， with its inherent advantages of multi-component synergy， multi-target engagement， and systemic homeostatic regulation， has demonstrated compelling renoprotective effect， particularly in preserving tubular integrity and function， mitigating tubular cellular stress， and indirectly alleviating glomerular hemodynamic burden. Accumulating preclinical and clinical evidence supports the efficacy of numerous single herbs and standardized formulae of TCM in attenuating tubulointerstitial injury and slowing down DKD progression. This review systematically delineates the sequential pathogenic cascade-from initial tubular insult to secondary glomerular deterioration-and critically evaluates the mechanism basis and translational potential of TCM-based interventions targeting tubular resilience. We aim to provide a refined pathophysiological rationale and actionable insights for optimizing clinical strategies and accelerating the development of novel therapeutics for DKD.
