Herbal and traditional medicines remain an essential component of healthcare systems worldwide, deeply embedded in cultural traditions and widely utilized across Asia, Africa, South America, and increasingly in Western countries. According to the World Health Organization, nearly 80% of the global population relies on herbal remedies for primary healthcare due to their accessibility, affordability, and long-standing cultural acceptance. Despite these advantages, the rapid expansion in the use of herbal and alternative medicines has not been matched by equivalent progress in safety evaluation, pharmacovigilance, and regulatory monitoring. The kidneys are particularly vulnerable to toxic injury because of their physiological role in filtering large volumes of blood, regulating fluid and electrolyte balance, maintaining acid–base homeostasis, and metabolizing xenobiotics. Their high metabolic activity and extensive blood supply make them susceptible to damage from potentially toxic herbal constituents. In recent years, increasing reports of renal impairment have been associated with the consumption of certain herbal preparations, particularly when used through self-medication, in excessive doses, or within poorly regulated polyherbal formulations. These risks are further exacerbated in resource-limited settings where regulatory oversight and clinical monitoring are minimal. This review examines the global patterns of herbal and alternative medicine use, highlights documented cases and mechanisms of herbal-induced nephrotoxicity, and discusses the need for improved safety assessments, public awareness, and regulatory frameworks to ensure the safe integration of traditional medicines into modern healthcare systems.