Lactylation in kidney diseases: a review of regulatory mechanisms and therapeutic prospects

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Lactylation, a novel post-translational modification (PTM) of proteins, plays a critical role in various diseases through the regulation of gene expression and metabolic reprogramming. Recent studies have increasingly highlighted its pathological and physiological relevance in kidney diseases. Lactylation exerts pleiotropic effects across diverse renal pathologies, from promoting fibrotic progression in Chronic kidney disease (CKD) to modulating immune evasion in clear cell renal cell carcinoma (ccRCC), thereby positioning it at the epicenter of metabolic-epigenetic interplay in kidney disease. This review systematically delineates the dynamic regulatory mechanisms of PTMs and their pivotal roles and current research status in kidney diseases, explores the latest advancements in lactylation research concerning CKD, acute kidney injury (AKI), and ccRCC, and discusses its potential as a therapeutic target. By synthesizing current findings, the article aims to offer new perspectives and directions for future treatments of kidney diseases and the development of targeted therapies.