The use of herbs as medicine has grown in popularity in this country over the past decade, contributing to a $4.1 billion supplement industry. The popularity of herbs is due to several factors: they can be purchased without a prescription, a belief that \"natural\" products are safer and the knowledge that many of our modern drugs are derived from herbs. Toxicity can occur when a herb with unknown toxicity is consumed, incorrect identification leads to substitution of an innocuous herb with a toxic one, preparations are contaminated with toxic non-herbal compounds or when a herb potentiates the nephrotoxic effect of a conventional therapy. Renal injury has been reported in association with several herbs. The best known herb induced chronic kidney disease (CKD) is aristolochic acid nephropathy. The condition is characterized by progressive interstitial nephritis, with a proportion of patients developing urothelial malignancies. The toxic compound is aristolochic acid (AA), recent evidence suggests that AA also contributes to the development of Balkan endemic nephropathy. The role of herbs has been postulated in the development of CKD in other parts of the developing world, especially amongst the rural population. Public awareness and regulation of use of herbal medicines are required to eradicate this entity from the community.
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