Kidney diseases, particularly those associated with diabetes, represent a significant global health challenge. The use of herbal remedies as adjunctive therapies for these conditions is gaining traction, with safflower (Carthamus tinctorius L.) emerging as a notable candidate due to its pharmacological attributes. Hydroxysafflor yellow A (HSYA), a bioactive constituent of safflower, has demonstrated reno-protective properties by mitigating oxidative stress and inflammation. This review examines the potential of HSYA in the management of diabetic nephropathy, acute kidney injury, chronic renal failure, renal fibrosis, and drug-induced nephrotoxicity. In diabetic nephropathy, HSYA exhibits renal function enhancement and attenuation of complications associated with hyperglycaemia. Moreover, it shows promise as an anti-diabetic agent by modulating relevant pathways implicated in diabetes pathogenesis. In acute kidney injury, HSYA serves to safeguard renal integrity against diverse injurious stimuli, including inflammatory triggers. Furthermore, it holds potential in averting complications such as arteriovenous fistula stenosis in chronic renal failure. Additionally, HSYA displays favourable prospects in counteracting renal fibrosis, a pervasive consequence of kidney ailments. Furthermore, HSYA manifests protective effects against drug-induced nephrotoxicity, notably against agents like cyclosporine. While these findings are encouraging, further elucidation of HSYA's mechanisms of action and its clinical applicability is warranted. Collectively, safflower and its constituent HSYA offer promising avenues for the management of kidney diseases, instilling optimism for enhanced therapeutic modalities in the future
