Abstract: Traditional Chinese medicine (TCM) polysaccharides are active polysaccharides extracted from Chinese herbal medicines, many of which exhibit specific biological activities. Modern research has revealed that polysaccharide components extracted from plants, animals, and algae have a significant role in improving kidney injury. Currently, drug therapy is the primary treatment for kidney injury, with few reports on the use of TCM polysaccharides. This review explores the therapeutic effects and mechanisms of TCM polysaccharides on diabetic nephropathy, nephritis, kidney stones, hypertension-induced kidney injury, chemical toxin-induced kidney injury, and drug-induced kidney injury. Additionally, it discusses the prospects for the development of TCM polysaccharides in this field to provide a reference for further research.