An estimated one-third of adults in developed countries and more than 80% of the population in many low- and middle-income countries use herbal and traditional medicines to promote health or for the treatment of common diseases. Herbal medicines can cause kidney damage as a result of intrinsic toxicity, adulteration, contamination, replacement, misidentification, mistaken labeling, and unfavorable herb-drug interactions. The kidneys, due to their high blood flow rate, large endothelial surface area, high metabolic activity, active uptake by tubular cells, medullary interstitial concentration, and low urine pH are particularly vulnerable to development of toxic injury in the form of different syndromes like acute kidney injury, nephrolithiasis, chronic interstitial fibrosis, or uroepithelial cancer. Herbal medicines can also cause crystalluria or hypertension and some could increase potassium blood levels in patients with kidney damage. It is of critical importance that health care organizations around the world regulate herbal and traditional remedies in order to reduce the risk of herb-toxic acute kidney injury or chronic kidney disease. The nephrologist must be aware of the potential nephrotoxicity from herbal medicine and supplements. A careful history and specific questioning about use of herbal medicines use is essential.
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