Narrative review discusses exosomes for renal ischemia-reperfusion injury management and translational barriers

Renal ischemia-reperfusion injury (RIRI), which causes renal damage that occurs when blood flow is restored after a period of reduced perfusion, is a common cause of acute kidney injury. As the disease progresses, treatment options become increasingly limited, highlighting the urgent need for new therapeutic approaches. Among these, exosomes (Exos) have shown great potential in the prevention and treatment of this condition. Exos are nano-sized vesicles of endosomal origin, typically less than 200 nm in diameter, and have emerged as key mediators in diverse pathophysiological processes. This article provides a comprehensive narrative review of the mechanisms of various types of Exos in renal ischemia-reperfusion injury and the advancements in exosome therapy, and details both their renoprotective mechanisms and potential pathogenic effects. Furthermore, we highlight advanced bioengineering strategies, delivery platforms, and diagnostic potential. By explicitly addressing translational barriers and the need for rigorous methodological standardization, we aim to provide comprehensive insights for advancing exosome-based RIRI management from bench to clinic.