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Mesenchymal stem cell\u2010derived extracellular vesicles (MSC\u2010EVs) are nanoscale membrane\u2010bound particles carrying bioactive proteins, lipids, and regulatory RNAs across biological barriers. Target cells are EVs that enter via membrane receptors and endocytic\/fusion pathways and provide cargo delivery and modulation of downstream signaling. Engineering techniques such as genetic modification of parent cells, chemical surface functionalization, stimuli\u2010responsive materials, and synthetic materials have improved the therapeutic potential of MSC\u2010EVs by improving tissue targeting and antifibrotic activity. This review summarizes MSC\u2010EV colloidal biology, biogenesis, surface properties, cargo composition, and engineered modifications for antifibrotic applications. Mechanisms that inhibit fibrosis, such as suppression of the TGF\u2010\u03b2\/Smad pathway, reversal of epithelial\u2013mesenchymal transition, and modulation of macrophage behavior at the tissue\u2013vesicle interface, are discussed. Effects of donor cell preconditioning and microenvironmental factors on surface properties and therapeutic potency are discussed. This paper is a paradigm shift from traditional biology to precision nanomedicine engineering using colloidal surface chemistry, biointerface dynamics, and translational manufacturing. We bridge material science with renal pathophysiology to develop a rational roadmap for future clinically available EV therapeutics targeting multifactorial renal fibrotic diseases.<\/jats:p>","DOI":"10.1002\/adhm.71577","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:42:22Z","timestamp":1786513342000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Engineered Mesenchymal Stem Cell\u2010Derived Extracellular Vesicles as Antifibrotic Nanotherapeutics for Chronic Kidney Disease"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9549-7552","authenticated-orcid":false,"given":"Wen","family":"Zhang","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)  Hangzhou 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