Rhubarb in Renal Fibrosis: From Traditional Ethnopharmacology to Mechanistic Therapeutic Development

Rhubarb (Rheum spp.), a traditional herbal medicine, has garnered increasing attention for its anti-renal fibrosis properties in chronic kidney disease (CKD). This review systematically examines Rhubarb's botanical characteristics, global distribution, and diverse processing methods that influence its chemical profile and bioactivity. The major bioactive constituents, including anthraquinones, stilbenes, and polyphenols, were cataloged, while their potential activity in renal protection were elucidated. Traditional applications in nephropathy management are critically analyzed alongside contemporary pharmacological evidence demonstrating Rhubarb’s capacity to ameliorate renal fibrosis. Notably, this review highlights that various bioactive components of Rhubarb exert powerful anti-renal fibrosis effects through complex interactive regulation with multiple signaling pathways. Despite promising preclinical data, clinical translation remains hindered by insufficient understanding of pharmacokinetics and herb-drug interactions. This synthesis identifies key research gaps, advocating for interdisciplinary research to decode multi-target mechanisms, pharmacokinetic refinement for bioavailability enhancement, and translation of preclinical findings into randomized controlled trials. By bridging ethnopharmacological knowledge with modern drug discovery paradigms, this review underscores rhubarb’s promise as a multifaceted anti-fibrotic agent while advocating for methodologically robust studies to validate its therapeutic integration into CKD management protocols.