糖尿病肾病（DN）是糖尿病最常见的微血管并发症，也是终末期肾病的主要诱因，主要由高糖环境引发的细胞损伤、炎症免疫紊乱、肾纤维化及血管破坏等复杂机制导致。传统治疗虽能延缓病情进展，但难以有效阻断肾脏损伤的不可逆恶化，探寻切实有效的治疗方法是亟待解决的关键问题。间充质干细胞（MSCs）及其外泌体因其自我更新能力与多向分化潜能，近年来成为DN治疗的研究热点。临床前研究表明，MSCs可通过包括细胞保护、调节炎症与免疫反应、抑制纤维化、表观遗传调控及"肠道—肾脏"调控等多种机制展现出修复肾脏结构与功能的潜力。不同注射途径（如静脉注射、肾动脉注射和局部注射）均显示出显著疗效。尽管如此，目前临床研究尚处于初步阶段，仅有小规模试验和病例报告表明MSCs具有一定肾脏保护潜力，其长期安全性、标准化治疗方案及不同来源MSCs的效能差异仍需进一步研究和验证。

Diabetic nephropathy (DN) is the most common microvascular complications of diabetes and serves as a leading cause of end-stage renal disease, which is caused by complex mechanisms, including cellular damage induced by hyperglycemia, dysregulated inflammatory and immune responses, renal fibrosis, and vascular injury. Although conventional treatments can delay the progress of the disease, they often fail to effectively halt the irreversible deterioration of renal function. Consequently, exploring practical and effective therapeutic strategies is a key issue that needs to be urgently addressed. In recent years, mesenchymal stem cells (MSCs) and their exosomes have garnered significant research interest due to their capacities for self-renewal and multi-lineage differentiation. Preclinical studies indicate that MSCs exhibit potential in restoring renal structure and function through various mechanisms, such as cytoprotection, modulation of inflammation and immune responses, inhibition of fibrosis, epigenetic regulation, and regulation of the gut–kidney axis. Multiple administration routes, including intravenous, renal arterial, and local injection, have demonstrated considerable therapeutic efficacy. Nonetheless, clinical research remains in the nascent stages, with only small-scale trials and case reports indicating that the MSCs have certain potential for renal protection. Their long-term safety, standardized treatment regimens, and the efficacy differences among MSCs from different sources still require further research and verification.