Ruchita I. Patil*, Ruchika R. Patil, Nikhil N. Patil, Azam Z. Shaikh, Akash S. Jain, Divakar R. Patil, Sameer R. Shaikh, Hamid S. Hasani
Department of pharmaceutics P.S.G.V.P.Mandal’s College of Pharmacy, Shahada, Maharashtra - 425409, India.
*Corresponding Author E-mail: azamph46@gmail.com
ABSTRACT:
Medicinal plants have been valued for millennia for their therapeutic properties in preventing various ailments. Kidney stones and urinary calculi are increasingly prevalent due to changes in lifestyle such as industrialization and poor nutrition. In India, calcium oxalate kidney stones are the most common. This article examines the prevalence, types, and treatments for kidney stones, with a focus on the use of medicinal herbs. Medicinal herbs have been used for centuries because they are safer, more effective, culturally acceptable, and have fewer adverse effects compared to manufactured medications. Patients with kidney stones are advised to consume a low-fat diet and incorporate fibers from naturally occurring plants and herbal treatments into their regimen. The article outlines steps to maximize the potential of medicinal plants in dissolving kidney stones. Combining herbal remedies with allopathic treatments is suggested as an effective approach to address all issues associated with kidney stones. This integrated treatment method can leverage the strengths of both systems, providing a holistic and effective solution for kidney stone patients. The purpose of this article is to emphasize the benefits and applications of herbs in the treatment of urinary stones, advocating for their use alongside conventional medical treatments.
KEYWORDS: Herbal plants, Kidney stone, Urinary stone, Calcium oxalate crystals.
INTRODUCTION:
The kidneys are vital bean-shaped organs, each about the size of a clenched fist, situated just beneath the rib cage on either side of the spine. These essential organs perform a critical function in maintaining the body’s overall health by filtering approximately half a cup of blood every minute. This filtration process removes waste products and excess water from the bloodstream, resulting in the formation of urine. Once urine is produced by the kidneys, it travels to the bladder through a pair of thin, muscular tubes called ureters. There is one ureter on each side, connecting each kidney to the bladder.
The ureters are responsible for propelling the urine from the kidneys to the bladder through rhythmic muscular contractions known as peristalsis. This ensures that urine moves efficiently and continuously from the kidneys to the bladder, regardless of the body’s position or activity level. The bladder, a hollow, muscular organ located in the pelvis, serves as a temporary storage site for urine. As the bladder fills, its muscular walls stretch and expand, allowing it to hold increasing amounts of urine without significantly raising internal pressure. When the bladder reaches its capacity, signals are sent to the brain, indicating the need to urinate. During urination, the bladder muscles contract, and a sphincter at the bladder’s outlet relaxes, allowing urine to flow out of the body through the urethra. Together, the kidneys, ureters, bladder, and urethra form the urinary tract, a system responsible for producing, transporting, storing, and excreting urine. This system plays a crucial role in maintaining the body’s fluid and electrolyte balance by ensuring that waste products and excess fluids are efficiently removed from the bloodstream and expelled from the body. The urinary tract also helps regulate blood pressure, red blood cell production, and calcium metabolism by managing the composition and volume of body fluids. Healthy kidneys are vital for filtering out toxins, metabolic waste products, and surplus substances, ensuring that the body’s internal environment remains stable and balanced. This filtration process involves complex networks of tiny blood vessels called nephrons within the kidneys, which selectively filter and reabsorb various substances, maintaining a precise balance of water, salts, and other essential compounds in the blood. The entire urinary system must function harmoniously to ensure the effective elimination of waste and the regulation of essential bodily functions. Any disruption or impairment in the kidneys, ureters, bladder, or urethra can lead to a range of health issues, highlighting the importance of maintaining urinary tract health through proper hydration, a balanced diet, and regular medical check-ups.1
Types of kidney stones:
There are four major types of kidney stones: calcium stones, which account for 75 to 85% of cases; 1 to 2%. The distribution and frequency of these stones vary based on geographical location and the population studied. Rarely, long-term use of certain drugs can also lead to kidney stones, representing about 1% of cases.2
Figure 1: Types of kidney stone
Calcium Stone:
Calcium oxalate, urate, and phosphate stones result from hypercalciuria due to hyperparathyroidism, causing increased calcium absorption, renal leaks, and imbalances.3
Strutive Stone:
formed by magnesium ammonium phosphate, grow from chronic UTIs caused by Gram-negative urea-splitting bacteria like Proteus and Klebsiella.4
Uric Acid Stone:
Form from high purine intake, drugs, or high cell turnover, like in gout. They develop in acidic urine (pH 5.5) and are radiolucent on X-rays.5
Cystine Stone:
arise from cystinuria, a genetic metabolic disorder that impairs cystine reabsorption in the renal tubules. Their high sulfur content makes them hard to detect on X-rays. Various drugs can also contribute to renal stone formation.6
Drug Induce Stone:
Certain drugs, such as indinavir and atazanavir, used for treating other conditions, can also contribute to the formation of renal stones. Their use in therapy is linked to increased risk of stone development.7
Mechanism of stone formation:
Urinary Supersaturation and Crystallization:
Urinary supersaturation and crystallization are key factors in intrarenal crystal precipitation, which can lead to kidney stone formation. This process is often associated with inherited or acquired diseases that impair renal function. Factors influencing urinary supersaturation include urine pH and the concentration of various substances such as calcium oxalate (CaOx), calcium phosphate (CaP), uric acid, struvite, certain amino acids like cysteine, purines such as 2,8-dihydroxyadenine and xanthine, and drugs like atazanavir and sulfamethoxazole.8-9 Moreover, the modulation of crystal formation involves several molecules acting as receptors, promoters, or inhibitors. Promoters of Stone
Formation Crystal-cell interaction:10-11
Which plays a critical role in crystal retention in the kidney, is mediated by various receptors or receptor-like features. For instance, a study on calcium oxalate monohydrate (COM) crystal-cell interaction identified 1,141 differentially expressed proteins in COM-treated HK-2 cells,12 highlighting the role of proteins and glycosaminoglycans such as CD44, nucleolin, hyaluronan, heat shock protein 90 (HSP90),13 annexin II,14 and osteopontin12-15 as modulators of stone formation. Additionally, calcium, oxalate, urate, and phosphate ions promote crystallization and aggregation of stone constituents by activating various mechanisms. Elevated serum calcium and 1,25-dihydroxyvitamin D levels in nephrolithiasis patients suggest altered calcium and vitamin D regulation in stone formation, with the calcium-sensing receptor (CaSR) playing a significant role.16 Urate and phosphate ions also enhance heterogeneous nucleation and crystal attachment to the epithelium.17-18 Urine pH is another crucial factor, with low pH promoting CaOx crystallization19-20 and high alkaline urine also facilitating CaOx precipitation. Proteins like lysozyme and lactoferrin promote COM crystal growth by accelerating layer advancement on crystal surfaces21.
Inhibitors of Stone Formation:
Normal urine contains numerous inhibitors that prevent crystallization and crystal aggregation or adhesion to tubular epithelial cells.22-23 These inhibitors include anions like citrate, which effectively inhibit crystal growth at concentrations above 0.1 mM.24-25 Many nephrolithiasis patients exhibit decreased citrate excretion, and alkali supplements are used to restore citrate levels in hypocitraturic recurrent nephrolithiasis patients. Hydroxycitrate, a structural analog of citrate, shows equivalent capacity in forming complexes with calcium to inhibit crystallization.26-27 Metallic cations like magnesium synergize with citrate in acidic environments28-29 to inhibit crystal growth and aggregation. Macromolecules, including osteopontin (OPN), Tamm-Horsfall protein (THP), urinary prothrombin fragment 1 (UPTF-1), nephrocalcin, and serum IαI subunits, are highly effective in inhibiting crystal growth, aggregation, and adhesion.
Randall's Plaque and Calcium Oxalate Stone Formation:
Randall's plaques (RPs), first described by Alexander Randall in 1937,30 are subepithelial mineralized regions at the papillary tip containing CaP.31 These plaques consist of calcified tubule walls mixed with CaP plugs, [32] an organic matrix rich in proteins and lipids, and various extracellular matrix components.33 Studies suggest that RPs are the origin of renal stones,32-34 developing as overgrowths on RP. Vitamin D supplementation and calcium intake can accelerate RP formation, although the mechanisms remain unclear. Recent research indicates that long non-coding RNAs (lncRNAs) H19 and MALAT1 mediate osteogenic differentiation of human renal interstitial fibroblasts and participate in RP formation through pathways like Wnt/β-catenin signaling and HMGB1/TLR4/NF-κB signaling.
Role of Sex Hormones in Calcium Oxalate Nephrolithiasis:
Men have a higher incidence of CaOx nephrolithiasis compared to women, with a ratio of 2-3:1.35 Androgens increase urinary oxalate excretion, plasma oxalate concentration, and kidney CaOx crystal deposition, while estrogens have the opposite effect. Androgen receptor (AR) signaling upregulates hepatic glycolate oxidase and kidney epithelial NADPH oxidase subunit p22-PHOX,36 increasing oxalate biosynthesis and promoting kidney stone formation.37 Testosterone induces renal tubular epithelial cell apoptosis and necrosis via the HIF-1α/BNIP3 pathway and enhances COM crystal-cell adhesion by increasing surface α-enolase. Conversely, estrogen can reduce CaOx crystal receptor surface expression, enhance cell proliferation, and promote renal tubular cell tissue healing. Targeting AR and promoting estrogenic effects might be potential therapeutic approaches for CaOx nephrolithiasis.
Figure 2: Role of sex hormons in calcium oxalate nephrolithiasis
Figure 3: Role of urease producing bacteria in stone formation
Role of the Microbiome in Stone Formation:
Microorganisms of the human microbiome, including those in the kidney and urinary tract, significantly impact urological health. Urease-producing bacteria like Proteus mirabilis and Klebsiella pneumoniae are associated with struvite stone formation,38-39 promoting ammonia and carbon dioxide formation, leading to urine alkalinization and phosphate salt formation. Urease inhibitors and urinary acidification have been proposed for struvite stone prevention, though long-term use is limited by ineffectiveness and toxicity.40 Non-urease-producing bacteria like Escherichia coli may cause secondary infections in stones.41-42 Nanobacteria (NB), or calcifying nanoparticles (CNPs), have been isolated from kidney stones, suggesting they play a role in calcium nucleation and stone formation through calcium apatite production. However, the nature of NB and their mechanisms in stone formation remain controversial. Immune Response to Urinary CrystalsMacrophages play a crucial role in renal CaOx crystal formation.43 Recruited macrophages promote COM crystal development through interactions with CD44, OPN, and fibronectin.44 Macrophages secrete mediators causing renal interstitial inflammation and enhance immune cell recruitment.45 Macrophage-derived exosomes in COM-treated macrophages are involved in kidney stone pathogenesis. M1/M2 macrophage differentiation is significant in renal CaOx crystal formation, with M1 macrophages potentially causing acute tissue injury associated with crystal deposition. M2 macrophages, however, can phagocytize and degrade CaOx kidney stone fragments through a clathrin-dependent mechanism. Given the immune response's critical role in CaOx crystal formation,46 immunotherapy has been proposed to prevent stone recurrences by modulating the immune response to degrade CaOx crystals. Further research into immunotherapeutic targets is needed to develop effective treatments for kidney stone disease.
Figure 4: Renal tubular cells
Symptoms:
The symptoms you’re describing are consistent with kidney stones or a urinary tract infection (UTI). Here are some details on each
1. Kidney Stone: Severe colicky pain (typically in the back or side). - Blood in the urine. - Nausea/vomiting. Inability to urinate if a stone blocks the urinary tract.
2. Urinary Tract Infection (UTF): Cloudy, foul-smelling urine. - Fever, chills, or weakness. - Blood in the urine. - Pain or a burning sensation during urination (dysuria). If you or someone else is experiencing these symptoms, it's important to seek medical attention promptly. Kidney stones and UTIs can cause serious complications if not treated properly.47
Risk of Factors:
Dietary factors play a significant role in the formation or prevention of kidney stones. however, other factors such as environment, body weight, genetics, and fluid intake also contribute to the risk. here are the key factors that can increase the risk of kidney stones: dehydration: insufficient fluid intake can lead to concentrated urine, increasing the risk of stone formation.48
1. Genetics:
Certain genetic disorders, such as cystinuria, can increase the risk of developing cystine stones.
2. Diet:
High intake of proteins, fats, sodium, and sugar can elevate the risk of kidney stones.
4. Infections:
People with kidney infections, particularly women, and those with urinary tract infections (utis) are more prone to developing struvite stones.
5. Metabolic Syndrome:
This condition can contribute to the formation of kidney stones.
6. Obesity:
Excess body weight is associated with a higher risk of developing kidney stones.
Herbs for Prevention of Urolithiasis:
1. Barberry Root Bark (Berberis vulgaris):
· Research: Animal studies indicate Barberry inhibits calcium oxalate crystallization and prevents kidney damage from oxidative stress. The water extract is particularly effective (Bashir, et al, 2010)49
· Dosage: Tea: Use 1 tsp of dried root bark per 10 oz of water. Decoct for 10-15 minutes, steep for 30 minutes, and take 4 oz twice or thrice daily.
2. Black Cumin Seed (Nigella sativa):
· Research: Animal studies show significant protection against calcium oxalate stones (Hadizadeh, et al, 2007)50
· Dosage: Tea: Use ½ tsp of dried seeds in 8 oz of hot water. Steep covered for 20 minutes, and take 4 oz twice or thrice daily.
3. Chanca Piedra/Stonebreaker (Phyllanthus niruri):
· Known for preventing and passing kidney stones. Studies indicate it reduces urinary calcium and slows stone growth (Freitas, et al, 2002; Nishiuria, et al, 2004; Barrlos, et al, 2006)51
· Dosage: Tea: Use 1-2 tsp of dried herb per 8 oz of hot water. Steep for 30 minutes, and take 2-3 cups daily. Tincture: 3-6 ml (60-120 drops) thrice daily.
4. Evening Primrose Seed Oil (Oenothera biennis):
· Research: Daily ingestion increases urinary citrate and reduces urinary oxalate, calcium, and the risk of forming stones (Rodgers, et al, 2009)52
· Dosage: Tea: Use 2 tsp of dried leaf per 8 oz of hot water. Steep for 45 minutes, and take 8 oz twice daily. Tincture: 1.5-3 ml thrice daily.
5. Fagolitas
· Research: This Spanish formula significantly reduces kidney calcification in animals (Grases, et al, 2008)53
· Components: Uva Ursi, Corn Silk, Ricinus zanzibarensis, Saw Palmetto, Buchu, Glycerin, and Anise essence.
6. Fenugreek Seed (Trigonella foenum-graecum):
· Research: Used in northern Africa for kidney stones, shown to reduce kidney calcification in animals (Lasonbi, et al, 2007)54
· Dosage: Tea: Use 1-2 tsp of dried seed per 10 oz of water. Decoct for 15-20 minutes, steep for 30 minutes, and take 4-6 oz thrice daily. Tincture: 2-4 ml (40-80 drops) thrice daily.
7. Gokshura Fruit/Root (Tribulus terrestris):
· Research: Prevents kidney stones and may reverse early-stage urolithiasis. Protects against calcium oxalate-induced renal injury (Williamson, 2002;)55 (Aggarwal, et al, 2010)56
· Dosage: Powder: ½-1 tsp thrice daily.
8. Hibiscus Flowers (Hibiscus sabdariffa):
· Research: Increases urinary oxalate excretion and reduces oxalate deposition. Enhances urinary citrate levels (Wooltisin, et al, 2011)57 (Prasongwatana, et al, 2008)58
· Dosage Tea: Use 1-2 tsp of dried flowers per 8 oz of hot water. Steep for 20 minutes, and take 8 oz twice or thrice daily. Tincture: 2-4 ml thrice daily.
9. Jin Qian Cao Herb (Desmodium styracifolium):
· Research: Inhibits urinary calcium excretion and increases urinary citrate, reducing stone formation (Hirayama, et al, 1993)59
· Dosage: Tea: Use 2-3 tsp of dried herb per 8 oz of hot water. Steep for 40 minutes, and take 2-3 cups daily.
10. Rose Hips (Rosa canina):
· Research: Promotes increased urinary citrate and reduced urinary calcium excretion (Grases, et al, 1992)60
· Dosage: Tea: Use ½-1 tsp of cut/sifted Rose hips per 8 oz of hot water. Steep for 30 minutes, and take 4 oz thrice daily.
11. Rupture Wort Herb (Herniaria hirsuta)
· Research: Inhibits deposition of calcium oxalate crystals in kidneys (Atmani, et al, 2004)61
· Dosage: Tea: Use 1 tsp of dried herb per 8 oz of water. Decoct for 5-10 minutes, and take 1-2 cups daily.
12. Shatavari Root (Asparagus racemosus)
· Research: Inhibits formation of calcium oxalate stones in animals (Christina, et al, 2005)62
· Dosage: Tea: Use 1 tsp of dried, powdered root per 8 oz of water. Decoct for 10 minutes, steep for 40 minutes, and take 2 cups daily. Tincture: 2-4 ml thrice daily.
13. Varuna Bark (Crataeva nurvala):
· Research: Reduces urinary calcium excretion and kidney stone formation (Prasad and Bharuth, 2007)63
· Dosage: Tea: Use 2 tsp of dried bark per 12 oz of water. Decoct for 15 minutes, steep for 30 minutes, and take 8 oz 2-3 times daily. Tincture: 4-5 ml (80-100 drops) thrice daily.
14. Water Plantain Root (Alisma orientalis):
· Research: Inhibits calcium urolithiasis (Cao, et al, 2003)64
· Dosage: Tea: Use 2 tsp of dried root per 10 oz of water. Decoct for 20 minutes, steep for 30 minutes, and take 4 oz thrice daily.
15. Wu Ling San:
· Components: Water Plantain root, Polyporus umbellatus, Atractylodes macrocephala, Fu Ling, and Cinnamon bark.
· Research: Reduces calcium oxalate deposition in kidneys (Tsai, et al, 2008)65
· Dosage: Powder: 6-9 grams twice daily. Tablets: 4-5 tablets twice daily.
Herbs for Treating Kidney Stones:
1. Couch Grass Rhizome (Elymus repens):
· Uses: Soothing diuretic, promotes uric acid excretion.
· Dosage: Tea: Use 2-3 tsp of dried rhizome per 12 oz of water. Decoct for 30 minutes, steep for 30 minutes, and take 1 cup thrice daily. Tincture: 3-5 ml (60-100 drops) thrice or four times daily
2. Goldenrod Herb (Solidago spp):
· Uses: Helps pass kidney stones.
· Dosage: Tea: Use 1-2 tsp of dried herb per 8 oz of hot water. Steep covered for 20-30 minutes, and take 2 cups daily. Tincture: 2-3 ml (40-60 drops) thrice or four times daily.
3. Gravel Root (Eupatorium purpureum):
· Uses: Eases passing of stones, relieves kidney and urinary tract pain.
· Dosage: Tea: Use 1 tsp of dried root per 8 oz of water. Decoct for 15 minutes, steep for 45 minutes, and take 2 cups daily. Tincture: 1.5-2 ml (30-40 drops) thrice daily.
4. Horse Chestnut Seed (Aesculus hippocastanum)
· Uses: Reduces pain and swelling of the ureter.
· Dosage: Tincture: 0.25-0.75 ml (5-15 drops) thrice daily. Capsules: Standardized product (16-20% Escin) 300 mg every 12 hours.
5. Horsetail Herb (Equisetum arvense)
· Uses: Promotes healing of minor kidney damage and helps expel urinary calculi.
· Dosage: Tea: Use 1 tsp of dried herb per 8 oz of water. Decoct for 15 minutes, steep for 1 hour, and take 4 oz thrice daily. Tincture: 1-2 ml (20-40 drops) thrice daily.
6. Hydrangea Root Bark (Hydrangea arborescens)
· Uses: Effective urinary tract analgesic.
· Dosage: Tea: Use ½-1 tsp of dried bark per 8 oz of cool water. Steep for 1 hour, and take 4 oz thrice daily. Tincture: 2-3 ml thrice daily
7. Jin Qian Cao Herbs (Desmodium styracifolium)
· Uses: Helps pass kidney stones.
· Dosage: Tea: Use 2-3 tsp of dried herb per 8 oz of hot water. Steep for.
CONCLUSION:
Kidney stones are a prevalent issue worldwide, affecting the urinary system. Several medical conditions increase the risk of kidney stones, including high-fat diets, inadequate nutrition, consumption of foods containing oxalate crystals, high-protein diets, and post-surgical defects. Common physiological functions, such as abnormal growth of the parathyroid glands, which control calcium metabolism, can also lead to stone formation by creating high levels of calcium in the blood and urine. Kidney stone disease remains a growing problem influenced by various metabolic, environmental, and nutritional factors. Advances in diagnostic techniques have improved our understanding of this disease. Treatment options include allopathic and herbal medications, as well as surgical removal of stones. Many people prefer herbal therapies for their safety and cost-effectiveness, although these treatments require time to take effect.
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Received on 08.08.2024 Revised on 03.09.2024 Accepted on 20.09.2024 Published on 07.12.2024 Available online on December 30, 2024 Res.J. Pharmacology and Pharmacodynamics.2024;16(4):321-327. DOI: 10.52711/2321-5836.2024.00055 ©A and V Publications All right reserved
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