Protein lactylation modification is a novel post-translational modification mechanism that participates in disease development by regulating epigenetics and cellular metabolism. Recent studies have found that this modification plays an important regulatory role in kidney diseases such as diabetic nephropathy, acute kidney injury, and clear cell renal cell carcinoma. This review systematically explains how lactylation plays a key role in the pathological process of kidney disease through molecular mechanisms such as influencing histone function, mitochondrial dynamics, and signaling pathway activation, and how changes in its levels are closely related to disease progression. Based on existing evidence, specific interventions targeting lactylation are expected to provide new targeted strategies for the treatment of kidney disease. This review not only provides a new theoretical basis for a deeper understanding of the mechanism of kidney disease, but also points the way for the future development of innovative treatments based on the regulation of lactylation, which has important scientific significance and clinical translational value.

肾脏作为维持机体稳态的核心器官，承担着维持人体内分泌、基础代谢和电解质平衡的重要任务，然而肾脏疾病已成为全球公共卫生危机之一，近年研究发现，一种由乳酸介导的蛋白质翻译后修饰在免疫调节、纤维化进程及能量代谢中发挥关键作用，参与糖尿病肾病、急性肾损伤等肾脏疾病的进展。本文系统阐述乳酸化修饰通过影响组蛋白功能、线粒体动力学及信号通路活化等分子机制在肾脏疾病病理进程中的关键作用，揭示肾脏疾病的新治疗靶点，还可为早期诊断标志物和精准干预策略提供理论依据，为未来开发基于乳酸化修饰调控的创新治疗方法指明了方向，对减轻全球肾脏疾病负担具有重大科学与社会价值。