A Review on Nephrotoxicity of Herbal and Traditional Medicines: A Growing Public Health Concern

Abstract

Herbal and traditional medicines are widely used globally for their therapeutic and cultural significance. However, mounting evidence indicates a significant risk of nephrotoxicity associated with various unregulated herbal formulations. This review explores the multifaceted impact of herbal and traditional medicines on renal health, detailing mechanisms of toxicity, commonly implicated herbs, vulnerable populations, clinical case studies, and existing gaps in regulatory oversight. Special emphasis is given to the rising incidence of acute kidney injury (AKI) and chronic kidney disease (CKD) linked to herbs such as Aristolochia, Aloe vera, and heavy metal-containing Ayurvedic preparations. The article also presents a comprehensive literature review, highlighting both global and region-specific trends. It critically examines current regulatory practices, identifies challenges in herbal pharmacovigilance, and outlines actionable strategies for prevention. These include public education, toxicovigilance systems, physician training, and labeling reforms. The review concludes with recommendations for future research, including the use of artificial intelligence (AI), global policy harmonization, and integrative approaches to minimize renal toxicity while preserving the beneficial aspects of traditional medicine. Ensuring the safety of herbal therapies is a pressing public health priority that demands collaborative and multidisciplinary interventions.

Keywords: Herbal nephrotoxicity; Traditional medicine; Acute kidney injury (AKI); Chronic kidney disease (CKD); Aristolochic acid; Herbal pharmacovigilance; Public health; Regulation; Ayurveda; Toxicovigilance; Herb–drug interactions