Histopathological Insights into Nephroprotective Effects of Traditional Herbal Remedies in Diabetic Nephropathy

Diabetic nephropathy (DN), a microvascular complication of diabetes mellitus, is one of the most prevalent causes of end-stage renal disease globally. It is pathologically defined by glomerular basement membrane thickening, mesangial expansion, progressive glomerulosclerosis, and tubulointerstitial fibrosis. Despite significant advances in glycemic control and renin-angiotensin system (RAS) blockade, DN remains difficult to manage effectively, particularly in its later stages. Increasing attention has been given to traditional herbal remedies, which have demonstrated promising nephroprotective effects through the modulation of oxidative stress, chronic inflammation, fibrosis, and apoptosis. These botanical agents contain bioactive phytoconstituents such as flavonoids, saponins, alkaloids, and terpenoids, which act through diverse molecular pathways, including inhibition of TGF-β1 signaling, NF-κB activation, and oxidative damage pathways. This review synthesizes histopathological evidence from both experimental and limited clinical studies that highlight the capacity of traditional herbal medicines to preserve renal architecture and function. Herbal agents such as Astragalus membranaceus, Salvia miltiorrhiza, and Curcuma longa have shown beneficial effects in reducing mesangial proliferation, glomerular damage, and interstitial fibrosis. By evaluating the mechanisms and efficacy of these herbal therapies, this review aims to inform the development of integrative treatment strategies that complement conventional care in diabetic nephropathy. Keywords: diabetic nephropathy, nephroprotection, histopathology, herbal remedies, oxidative stress, fibrosis, podocytes, traditional medicine