From AKI to CKD: Biomimetic Nanomedicine Strategies for Kidney Diseases

Kidney diseases, including acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD), represent an interconnected clinical continuum characterized by complex etiologies, pathological heterogeneity, dispersed pathogenic cells, and limited therapeutic windows. Although current therapies can delay disease progression, they remain insufficient for precise renal lesion targeting, cell-specific intervention, and coordinated regulation of oxidative stress, inflammation, cell death, immune imbalance, microvascular injury, and fibrosis. Biomimetic nanomedicine has recently emerged as a promising preclinical strategy by mimicking natural biological structures, optimizing biointerfaces, and enhancing selective intrarenal delivery. Compared with conventional nanocarriers, biomimetic nanoplatforms based on cell membrane camouflage, engineered extracellular vesicles, extracellular matrix mimicry, ligand-guided delivery, and nanozyme catalysis can improve circulation stability, lesion recognition, and multipathway therapeutic regulation. In this review, we systematically summarize biomimetic nanomedicine strategies across AKI-, CKD-, and ESRD-related settings, focusing on cell membrane-coated nanoparticles, targeting ligand modification, biomimetic nanozymes, engineered extracellular vesicles, and extracellular matrix-inspired systems. We also discuss their expanded applications in dialysis membrane engineering, transplant monitoring, and regenerative medicine. Finally, we analyze key translational challenges, including long-term biosafety, interspecies differences, protein corona effects, manufacturing scale-up, quality control, and regulatory translation. Although still mainly at the preclinical stage, biomimetic nanomedicine offers important potential for improving renal delivery efficiency, enhancing cellular selectivity, and enabling synergistic intervention in kidney diseases.