From pathogenic carriers to therapeutic hope: the dual role and translational prospects of exosomes in diabetic kidney disease.

Diabetic kidney disease is one of the most serious microvascular complications of diabetes. Its pathogenesis is complex, and methods for early diagnosis and intervention are limited, posing major challenges in clinical practice. Exosomes, as key carriers of intercellular communication, are involved in various physiological and pathological processes, such as immune regulation, tumor metastasis, and tissue repair. The regulation of their release is closely related to disease progression and has become a hotspot in research on disease diagnosis and treatment. In diabetic kidney disease, exosomes play a dual role: on the one hand, "pathogenic exosomes", produced under pathological stimuli such as hyperglycemia, can transmit harmful substances, exacerbating kidney damage, through inflammation and fibrosis; on the other hand, "therapeutic exosomes" that are derived from stem cells or engineered otherwise, have the potential to protect and repair the kidneys. Previous reviews have predominantly concentrated on the biomarker or therapeutic potential of exosomes in diabetic nephropathy. This paper, however, systematically integrates the multifaceted roles of exosomes in the pathogenesis of diabetic nephropathy and analyses the specific application evidence of exosome-derived biomarkers across various clinical functions. It highlights the dynamic changes in exosomes during disease progression and discusses targeted intervention strategies. Additionally, it examines the opportunities and challenges in clinical translation, aiming to offer novel insights and strategies for the precise diagnosis and targeted treatment of this condition.