Advances in Biomimetic Cell Membrane Nanoplatforms for Renal-Targeted Theranostics: From Pathophysiological Basis to Membrane-Stratified Design.

Kidney diseases represent a major global health burden, with current clinical treatments impeded by short circulatory half-lives, inadequate renal targeting, and the risk of systemic off-target toxicity. Conventional synthetic nanocarriers face critical bottlenecks, including rapid immune clearance and insufficient targeting specificity within the complex renal pathophysiological microenvironment. While biomimetic cell membrane nanoplatforms (BCM-NPs) offer a promising solution, to the best of our knowledge, no previous review has systematically integrated the pathophysiological basis of renal targeting with a membrane-stratified synthesis of BCM-NP design for kidney-targeted therapy and diagnosis. This review first delineates the anatomical basis of the nephron and key pathological targeting sites for renal drug delivery, then systematically summarizes recent advances in BCM-NPs for renal-targeted theranostics. Finally, we critically discuss the major challenges that continue to limit clinical translation, including large-scale manufacturing, membrane source heterogeneity, quality control, biosafety, pharmacokinetic evaluation, and regulatory considerations. This review aims to provide a structured framework for the rational design and future development of BCM-NP-based precision renal theranostics.