Exosomes in kidney disease: From Pathophysiology to Diagnostic and Therapeutic Tools.

BACKGROUND: Kidney disease is a significant global public health and economic burden, with unmet clinical requirements for early diagnostic biomarkers and targeted therapies. Exosomes, nanoscale lipid bilayer vesicles that facilitate intercellular communication through bioactive cargo, have emerged as a promising translational tool for addressing these gaps. OBJECTIVE: This review summarizes the classification, biological functions, technical workflows (isolation, characterization, and storage), and physiological/pathological roles of exosomes in kidney disease. It also emphasizes clinically actionable advances in exosome-based diagnosis and therapy and identifies translational barriers. METHODS: This narrative review was conducted through a comprehensive literature search across PubMed, Web of Science, and Scopus databases up to April 2026. KEY FINDINGS: Exosomes regulate renal pathological processes, including inflammation, oxidative stress, and fibrosis. Urinary/blood exosomal molecules are potential non-invasive biomarkers for acute/chronic kidney disease. Cell-derived exosomes demonstrate preclinical therapeutic efficacy for renal repairs. However, technical standardization and large-scale clinical validation remain significant challenges. CONCLUSION: Exosomes have a high translational potential for the diagnosis and treatment of kidney diseases. Addressing standardization, validation, and regulatory challenges is crucial for clinical adoption, and this review provides a roadmap for bridging preclinical findings to clinical practice.