Renal Toxicity in Herbal and Alternative Medicine: A Global Perspective

Herbal and traditional medicines have played a pivotal role in human healthcare for centuries, deeply embedded in cultural and spiritual practices across Asia, Africa, South America, and increasingly in Western societies. These therapies, encompassing systems such as Ayurveda, Traditional Chinese Medicine (TCM), and various indigenous ethnobotanical traditions, are relied upon by nearly 80% of the global population according to the World Health Organization (WHO). Valued for their accessibility, affordability, and perceived safety, herbal remedies remain a cornerstone of primary healthcare worldwide. Despite their widespread use, concerns regarding the safety of these products, particularly their potential nephrotoxic effects, have not received proportional attention. This global review addresses the emerging evidence of renal toxicity linked to herbal and alternative medicines, emphasizing acute kidney injury (AKI) and chronic kidney disease (CKD) as critical outcomes. Specific nephrotoxic compounds, such as aristolochic acid, are highlighted as significant contributors to renal damage associated with certain herbal preparations. The review underscores the urgent need for improved pharmacovigilance, rigorous safety evaluations, and increased public awareness to mitigate renal risks and safeguard patient health. By synthesizing global data, this study aims to inform clinicians, researchers, and policymakers on the renal safety challenges posed by herbal medicines, advocating for a balanced approach that recognizes both their therapeutic potential and safety concerns.