A COMPREHENSIVE GLOBAL REVIEW OF RENAL TOXICITY ASSOCIATED WITH HERBAL AND ALTERNATIVE MEDICINES

The widespread use of herbal and traditional medicines across cultures continues to grow, driven by the perception that “natural” equals “safe.” However, an alarming trend of renal complications—including acute kidney injury (AKI) and chronic kidney disease (CKD)—has emerged in association with various herbal products. This review provides a critical assessment of the nephrotoxic potential of traditional and herbal medicines. It explores the pathophysiological mechanisms of toxicity, including direct tubular damage, oxidative stress, immune-mediated injury, and hemodynamic alterations. Common nephrotoxic agents include Aristolochia species (containing aristolochic acid), Aloe vera, Tripterygium wilfordii, and heavy metal-adulterated Ayurvedic preparations. The paper highlights clinical case reports and epidemiological data indicating rising herb-induced nephropathies, particularly in regions with weak pharmacovigilance systems. Vulnerable populations, including those with pre-existing renal disease, the elderly, and individuals engaging in polyherbal or herb-drug combinations, face the highest risks. In many countries, lax regulatory oversight allows contaminated, mislabeled, and adulterated products to proliferate. The absence of standardized dosing, proper labeling, and systematic reporting mechanisms hampers both prevention and response. Special emphasis is placed on the interplay between traditional healing practices and modern medical challenges, including herb-drug interactions, underreported toxicities, and the need for integrative policy frameworks. This review calls for the implementation of toxicovigilance programs, healthcare provider education, and global regulatory harmonization to address these public health threats. Additionally, the application of artificial intelligence (AI) in predicting herb-induced toxicity and improving surveillance systems is proposed as a frontier area of research. In conclusion, the balance between preserving the therapeutic value of herbal medicine and ensuring renal safety must be achieved through multidisciplinary collaboration and evidence-based strategies.