The use of alternative remedies derived from plants and animals is increasing worldwide. Their source and composition varies depending on the prevalent local practices. They are not tested for efficacy and safety; their ingredients are unknown and the dosage and route of administration are not standardized. Potentially toxic chemicals are added to them to increase their potency and mistaken identity has led to the use of toxic plants instead of the originally intended herb. Kidneys play a vital role in the metabolism and excretion of these substances and acute kidney injury is a common and important manifestation of their toxicity. The most usual renal lesions include acute tubular necrosis, cortical necrosis, and interstitial nephritis. Patients often present late to hospitals with multi-organ involvement. The diagnosis may be missed if the history is not sought specifically. These factors culminate in high mortality rates. Study of this entity is difficult because of the remoteness of the areas, unfamiliarity with local cultures, and mystery and secrecy surrounding the natural medicines used. Physicians need to be aware of this condition to make a timely diagnosis and provide appropriate management. Public awareness and regulation of the use of these medicines are required to eradicate this entity from the community.