EVIDENCE-BASED NEPHROPROTECTIVE AYURVEDIC HERBAL FORMULATIONS: PHARMACOLOGICAL MECHANISMS AND CLINICAL IMPLICATIONS

Abstract

Kidney diseases, one of the increasing health burdens in the world today is kidney diseases such as acute kidney injury, chronic kidney disease, and diabetic kidney disease, which have few preventive and treatment measures. Although there is an improvement in traditional nephrology, currently used measures are not usually enough to prevent the development of disease or renal damage as a result of medications. In that regard, there is a growing interest in traditional medical systems, specifically Ayurveda, which is characterized by the focus on formulation-based, multi-target solutions to protect organs. This is an evidence-based review of nephroprotective Ayurvedic herbal formulations with emphasis on their pharmacological action mechanism and clinical implications. The experimental and translational research reveals that the reno protective effect of chosen Ayurvedic herbs and polyherbal preparations is manifested through the regulation of the major pathological processes, such as oxidative stress, inflammation, mitochondrial dysfunction, apoptosis, autophagy dysregulation, and renal fibrosis. In vivo, in vitro, and systems pharmacology studies demonstrate their ability to maintain renal architecture, positively change functional biomarkers and enhance cellular resilience in nephrotoxicity caused by drugs, diabetic nephrotoxicity and chronic kidney disease models. Similarities in mechanistic pathways have a comparative understanding of other non-Ayurvedic botanical studies, which support the unique formulation-based rationale of Ayurveda. Despite the promising outlook, the existing evidence base is predominantly preclinical in nature, which highlights the necessity of standardized preparations, lenient clinical trials, and biomarker-based assessment. All in all, Ayurvedic nephroprotective formulations can be viewed as potential adjunctive approaches in integrative nephrology, and thus, further studies are required to translate to their safe and effective clinical implementation.