Narrative review of salvianolic acids for kidney disease pharmacokinetics and anti-fibrotic activity

Kidney diseases, including acute kidney injury (AKI), chronic kidney disease (CKD), nephrotic syndrome (NS) and diabetic nephropathy (DN), represent a major global public health concern. Salvianolic acids are water-soluble bioactive components from Salvia miltiorrhiza, among which salvianolic acid A (SAA), salvianolic acid B (SAB) and salvianolic acid C (SAC) are the focus of current research. This review systematically elaborates their renoprotective value, establishes a clear pharmacokinetic-pharmacodynamic (PK-PD) correlation, summarizes multi-target protective effects in multiple kidney disease models, and conducts in-depth horizontal comparisons of efficacy intensity, target affinity and pathway specificity among the three components, key pharmacokinetic parameters including half-life (T1/2), time to peak concentration (Tmax), peak plasma concentration (Cmax), and area under the curve (AUC). Low oral bioavailability, rapid metabolism and insufficient renal distribution are common bottlenecks that restrict therapeutic efficacy, especially long-term anti-fibrotic activity and chronic intervention effects. Accordingly, promising strategies such as kidney-targeted nanodelivery systems and structural modification are proposed, and the mechanism of enhancing efficacy by optimizing pharmacokinetic properties is clarified. This review improves the mechanistic understanding of salvianolic acids, strengthens the horizontal comparison of three components, and supports their further translation into clinical therapies.