Background: Nephrotoxicity, kidney damage caused by a variety of chemicals, presents a significant challenge in the medical field. To address nephrotoxicity, innovative therapeutic techniques must be investigated. Rosemary (Rosmarinus officinalis L.) has been studied for its antioxidant, anti-inflammatory, and cytoprotective effects; however, existing literature lacks a comprehensive analysis of its mechanistic role in nephrotoxicity. This narrative review evaluates current findings, highlighting gaps in previous studies and presenting an updated perspective on the molecular pathways of rosemary in renal protection.

Methods: This narrative review analyzed the nephroprotective effects of rosemary and its main components (rosmarinic acid, carnosic acid, carnosol, and ursolic acid) based on studies retrieved from Google Scholar, PubMed, Web of Science, and Scopus (2010–2025). Selection criteria focused on peer-reviewed research investigating the impact of rosemary on nephrotoxicity, including experimental and mechanistic studies. Studies unrelated to renal toxicity or lacking mechanistic insights were excluded. While no formal systematic review methodology was applied, a qualitative assessment of study relevance and methodological rigor was considered. Preclinical and mechanistic studies were prioritized to provide a comprehensive understanding of the nephroprotective properties of rosemary.

Results: This review consolidates evidence demonstrating the nephroprotective potential of rosemary and its main components. Unlike prior reviews, our analysis provides a comprehensive mechanistic overview of the effects of rosemary on nephrotoxicity, emphasizing its ability to modulate pyroptosis and pivotal molecular pathways, including NF-κB/NLRP3 inflammasome and TGF-β1/Smad/collagen IV signaling. These findings are primarily based on preclinical studies with limited direct evidence from clinical trials.

Conclusion: By addressing key mechanistic gaps, this review positions rosemary as a potential therapeutic agent for nephrotoxicity, based on promising findings from preclinical models. Our findings underscore its underexplored role in pyroptosis modulation and its ability to regulate key nephrotoxicity-related molecular pathways. Future research should focus on further elucidating these mechanisms to optimize rosemary’s potential as a nephroprotective agent.