Urban water pollution poses a serious threat to environmental sustainability and public health in rapidly growing Indian cities. Agra, a historic urban center located along the Yamuna river, has experienced significant deterioration of surface and groundwater quality due to untreated domestic sewage, industrial effluents, agricultural runoff, tourism-related activities, and inadequate solid waste management. This review critically synthesizes peer-reviewed research articles, Central and State Pollution Control Board reports, and international agency publications from 2000 to 2025, with special emphasis on recent studies (2021–2025), to evaluate the sources, distribution, and impacts of water pollution in Agra. The analysis highlights the consequences of organic pollution, nutrient enrichment, heavy metal contamination, and microbial load on human health, aquatic ecosystems, agricultural productivity, and socio-economic conditions. Existing mitigation measures, including sewage treatment infrastructure, industrial effluent regulation, and policy interventions such as the National Green Tribunal directives and Namami Gange Programme, are critically examined. The review identifies major research gaps related to long-term monitoring, pollutant load quantification, health risk assessment, and governance effectiveness. The study provides a consolidated scientific foundation to support evidence-based policymaking and sustainable urban water management strategies for Agra and comparable Indian cities.