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As the primary excretory organ responsible for maintaining internal homeostasis, renal dysfunction constitutes the pathological foundation of kidney injury. Renal cells are rich in endoplasmic reticulum(ER) structures, making endoplasmic reticulum stress(ERS) a central mechanism in regulating renal homeostasis. Numerous studies have revealed that aberrant activation of ERS leads to abnormal programmed cell death(PCD) in intrinsic renal cells and is closely associated with the progression of various kidney diseases. Consequently, suppressing ERS has emerged as a promising therapeutic direction in renal disease research. TCM offers wide clinical applicability and demonstrates advantages such as multi-target regulation, efficacy enhancement, and toxicity reduction. Accumulating research demonstrates that TCM ameliorates pathological renal damage by modulating ERS in kidney cells, thereby attenuating disease progression. Based on the regulatory mechanisms of ERS signaling pathways, this review focuses on the mechanistic actions of TCM in modulating ERS and its downstream PCD. It summarizes current evidence on the roles of Chinese herbal monomers and compound formulas for treating acute kidney injury(AKI), renal interstitial fibrosis(RIF), and diabetic kidney disease(DKD) by targeting ERS, aiming to provide novel perspectives for innovative clinical prevention and treatment strategies in renal diseases.