INTRODUCTION:

The solid crystalline masses known as urinary stones (calculi) can appear anywhere in the renal tract. Urolithiasis is a condition of the development of urinary stones or the occurrence of stones anywhere in the urinary tract¹. The history of urolithiasis goes back to rewind to the dawn of civilization. Paleo pathological data support its occurrence 7000 years ago, or so². The development of urinary stones is a global health concern that can affect everyone, regardless of age and sex^3,4. Nevertheless, it is a rare illness in youngsters, with men more likely than women (within the age of 20-49) to be affected⁵.

Urinary stones can be categorized according to their size, location and composition⁶. The presence of kidney stone in nephron is called nephrolithiasis. The word stones in the ureter are referred to as ureterolithiasis, while the vesical calculi, also known as cystolithiasis, are used to describe urinary bladder stones that form or have already entered the bladder⁵. Urinary stones are made up chemically of organic and inorganic crystals that are combined with proteins. The primary ingredients of frequently occurring urinary stones include Calcium (70-80%), struvite, uric acid (5-10%), cysteine stone (1%) and mixed stone consisting calcium oxalate phosphate or uric acid⁷.

Numerous factors influence urine supersaturation for calcium oxalate, being classified as promotors or inhibitors. Low urine volume, high urinary excretion of calcium, oxalate, and urate are considered as promotors. Besides, citrate, magnesium and potassium and other organic substances (nephrocalcin, urinary prothrombin fragment-1, osteopontin) are known to inhibit stone formation⁸. If there is no history of recurrence, it becomes difficult to diagnose urolithiasis since it frequently has no apparent symptoms and can go unrecognized until it is quite advanced. Small urinary stones can be effortlessly removed by urine. It is noticed that spontaneous passage rate for stones 1mm in diameter was 87%; for stones 2-4mm, 76%; for stones 5-7mm, 60%; for stones 7-9mm, 48%; and for stones larger than 9mm, 25%. Spontaneous passage rate as a function of stone location was 48% for stones in the proximal ureter, 60% for mid-ureteral stones, 75% for distal stones, and 79% for ureterovesical junction stones⁹.

Urinary stone symptoms, signs, and treatment have been covered in numerous Greek traditional medicines, Chinese medicine and Ayurveda, which are all mentioned in early medical books¹⁰. Blood in the urine, lower back or abdominal pain and urination discomfort are the condition's prevalent illness symptoms. Other signs consist of sickness and pain-induced vomiting. Waves of discomfort may be experienced by those who have urinary stones, originates at the belly and frequently radiates with increasing intensity toward the groin, testis, or vulva and finally disappear after 20 to 60 minutes. Renal colic is the name for this distinct pain¹¹.

The geographic location and the population under study affects the distribution and frequency of these stones. The effect of geography on the incidence of stone formation may be due to its effect on temperature. High temperature increases perspiration, which may result in concentrated urine, which in turn promotes increased urinary crystallization¹². It has been proposed that high blood pressure, cardiovascular diseases (CVD), diabetes, and other medical conditions predispose to stone disease¹³.

Pathophysiology of Kidney stones involves several steps, which comprise crystal nucleation, growth, aggregation, and retention¹⁴.Various factors like gender, body size and mass, heredity, climate, occupation, race, presence of promoters or inhibitors of stone in urine are the factors which affect the formation of kidney stone¹⁴.

DIAGNOSIS OF KIDNEY STONE:

Blood tests:

Blood screening tests should be a routine component of the diagnostic evaluation for kidney stones. Serum electrolyte, calcium, carbon dioxide, uric acid and creatinine levels are measured to assess renal function. These measurements are generally inexpensive, and will effectively screen for metabolic abnormalities that may contribute to formation of recurrent stone¹⁵.

Urine tests:

A simple clean catch urinalysis can be very informative and should be performed for all stone formers. The specific gravity of urine, pH, measurement of urinary constituents and microscopic examination of urine for the presence of crystals are done. The 24-hour urine collection test is the mainstay of the comprehensive metabolic evaluation. Pak and associates have recommended a single 24-hour collection for the diagnosis of metabolic conditions that increase risk of stone formation¹⁶. They found high reproducibility of stone risk factors in repeated samples. However, Parks and associates compared two separate 24-hour urine collections and found disparities great enough between the samples that clinical care may have been altered within nearly 70% of the comparisons¹⁷. Michelle and Brian advise two 24-hour urine collections on initial evaluation to maximize the diagnostic yield. If metabolic therapy is initiated, a single 24-hour collection should be done 4–6 weeks after the initiation of treatment, to ensure that the desired effect has been achieved¹⁵.

Computed tomography (CT) is predominantly used to examine stones in the urinary system. In addition to the size and location of the stone and the overall health of the kidney, CT can alsobe used to assess the density of the stone in Hounsfield units (HU), which in turn, is related to the density of the tissue or stone. A number of studies have assessed the use of HU in urology. HUs have been used to predict the type and opacity of stones during diagnosis of stone¹⁸.

TREATMENT OF KIDNEY STONE:

Ancient Medical Treatment:

From 23 to 79 AD, Pliny the Elder prescribed Paeonia officinalis infusions, Cicer arietinum with Mentha species to eliminate kidney and bladder stones, Hippocrates rejected everything stone as being true. but used diuretics for relief instead of solvents. Avicenna suggested using laurel, Cypress oil and scorpion egg ashes, melon seeds, among other things, for the breakdown of stone. Also, earlier Hindu writings include a variety of medicines for dissolving the stone¹⁹.

Pashanbheda:

Over the past several years, an attempt has been made to study chemistry and clinical research on plants known as pashanbheda, used to dissolve ureteral stones²⁰. Pashanbheda is a narcotic, used in the Ayurvedic system of medicine for several illnesses, but primarily as a lithotriptic and diuretic. It's alleged to have been capable of crumbling and shattering the frequently used medication and stones. Its identity is still up for debate.

Many diuretics and more plants such as Aerva spp. and Alternanthera sessalisin South India,²¹Rotula aquatica appears in Mysore,²² Kerala's Ammaunia baceifera,²¹Coleus species, Bauhinia racemose, and Didymo carpus, Bryophyllumspp., Ocimumbasilicum pedicellate in Bengal²³ and many others were commonly known as Pashanbheda from time to time. Now Bergenia ligulatasyn. Saxifrage ligulata is a well-known entity by this name. Bergenia ligulata's chemical effectiveness in Urinary stone removal justifies using several names assigned to it Asmaribheda, Pashana, Pashanbheda, Nagabhid, Ashmabhid, Ashmhed, Shilabhed, Parwatbhed, and Upalbhedak (melting or piercing slabs of stone), etc²⁴. The first time this medication was mentioned in Charak Samhita, 210 BC to 170 ADS, often known as Pashanbhed. It is advised for uncomfortable urination, for treating abdominal tumours and to dissolve calculi. Sushruta Samhita (170 AD- 340 BC) references the drugs under various synonyms inchikitsasilianam- as the name pasanbhed for treatment of uric acid calculi and for biliary calculi, use ashnibhid. According to Sushruta Samhita, decoction of Pashanbhed, Ashmantaka, Satavari, Vrihati, Bhalluka, kola, kulatha, and varana (Crataevanurvula) and the benefits of kataka seeds are beneficial for VatajaAshmari patients, while Trikantaka, Patala, Kusa, Ashmabhid, Punarnava, Silajatu, Sirisha are beneficial for Pittaja²⁵. Ash tang Hridaya (341AD-434AD) drugs are mentioned in chiktsitSthanam-Upalbhed for severe painas a resultblocked micturition, ashmabid for biliary calculiand Pashanbheduric acid calculi²⁶.

In Sushruta Samhita the Celosia argental plant "Sitivaraka" is tested in 'Viratarvadigana,' which supposedly specialized treatment for urinary disorders, including Ashmari's calculi, gravels (sarkara), dysuria (mutra krichhra) and urine suppression, etc. South Indian plants Aerva species, Ammaniabaccifera, and nothosasrva brachiatereported to be lithotriptic²⁶.Celosia argental is thought to be particular for the treatment of urinary ashmari stone. The aqueous decoction is utilized for stone excretion and dissolution²⁷. Didymo carpus pedicellate known as Shila pushp or Patharphodi beneficial for kidney and bladder stones. Homonoia riparia, also referred to as Kshudra Pashanbhed, also known as Pashanbhed, helpful for vesicular calculi. The aquatic rotula Rhabdialycioides, also referred to as the use of Pashanbhed for stones in the bladder. Saxifraga ligulata, Bergenia ligulata also referred to as Pashanbheda, pronounced diuretic and lithotriptic effects. Kalanchoe pinnalasyn, Bryophyllumcalycinum called Pashanbheda in Bengal and other drugs have no diuretic or lithotriptic activity Bridelia Montana also known as Pashanbhed has not yet appeared any such endeavours²⁸.

Ayurveda:

The Sanskrit word "ayurveda" means "knowledge of life span." It is one of the earliest known medical systems, having its roots in the Indian subcontinent some 3,000 years ago. It is founded on the Panchmahabhutas doctrine, which states that all things and living things are made up of the five fundamental elements of earth, water, fire, air, and sky. Each person's body (prakriti), which consists of three doshas or bodily humours (vata, pitta, and kapha), and how their imbalance results in illness situations are the foundation of Ayurvedic remedies. Urolithiasis has been regarded as one of the eight most problematic disorders and urinary stones are typically referred to in Ayurveda as mutraashamari (mutra-urine; ashma-stone; ari-enemy) (mahagad)²⁹. Four different forms of urinary calculi, including phosphatic stones (sleshmaashmari), urate stones (pittaashmari), oxalate stones (vataashmari), and spermolith or seminal concretions (sukraashmari), have been recorded in Ayurvedic writings. Herbal preparations, alkaline fluids, and surgical methods are all used in the Ayurvedic management and treatment of urinary stones. In Ayurveda, panchakarma treatments including medicated emesis, purgation, and enemas, as well as external and internal oleation and sweat induction, are known as Shodhana and Shamana. For the treatment of disorders caused by urinary stones, therapy has been suggested³⁰.

Table 1: Herbal folk drugs used in treatment of urolithiasis

Scientific name	Family	Part used	Medicinal Uses	Reference
Abutilon indicum (L.) Sweet	Malvaceae	Seed and leaf extracts	The extract is given for urinary disorders	31
Abutilon indicum L.		Leaf juice		32
Borhaaviadiffusa Linn.	Nyctaginaceace	Root	Root decoction is taken daily for one month in kidney stone	32
Ageratum conyzoidesL.	Asteraceae	Leaves	Leaf extract given twice a day	33
Amaranthus caudatusL.	Amaranthaceae	Leaves	Extract is taken in kidney stone	34
Amaranthus spinosus L.	Amaranthaceae	Root	Root paste is used to reduces irritation in the urinary duct	34
Amaranthus viridisL.	Amaranthaceae	All parts	Given to cure kidney stone	34
Beta vulgaris L.	Amaranthaceae	Rhizome	Daily two glass of rhizome juice for seven days two cure kidney stone	34
Bombex ceiba Linn	Bombacaceace	Stem and bark	Given for urinary problems	34
Tubiflora acaulis (L.F.) Kuntze	Acanthaceace	Leaves	Leaf powder with water	34
Ceropegia bulbosa Roxb.	Asclepidaceace	Tubers	Decoction of tubers orally to get rid of urinary bladder stone	34
Chenopodium album Linn.	Chenopodiaceae	Leaves	Cooked leaves as a vegetable given in urinary trouble	34
Corbichoniadecumbens (Forrsk.) Jacq	Molluginaceae	Leaves	Crushed leaves given orally	34
Costus Specious (Koen.) SM.	Costaceae	Tubers	Decoction of tubers orally for urinary complaints	34
Digera muricata (L.) Mart	Amaranthaceae	Leaves	Once in a day	34
Diospyros melaoxylonRoxb.	Ebenaceace	Fruit and flower bark	Fruit and flower bark powder is used in urinary tract disorders	34
Equisetum debile Roxb.	Equistaceace	All parts	Whole plants juice along with 1 gram Piper nigrum Linn. Twice a day for 7 days	34
Gomphrena celosioidesMart.	Amaranthaceae	Whole plant	Juice along with Piper Nigrum Linn. And lemon juice twice a day for 10 days	34
Grewia flavescensA. Juss	Tiliaceace	Root powder and decoction of roots	For removal of stops bleeding in urinary tract	34
Aerva lanata (L.) Juss.ex Schult	Amaranthaceae	Leaves	Plant extract with Cuminum cyminum fruits and sugar is given for 10-15 days to cure kidney stones.	35
Pedalium murex Linn.	Pedaliaceace	Fruits	Decoction of fruits used for continuance of urine and other complaints of urinary system	36
Tribulus terrestrisLinn.	Zygophyllaceae	Leaves	Used in tretment of kidney stone	37
Tridex procumbens L.	Asteraceae	Leaves	Leaf paste is used taken for kidney stone	38

CHALLENGES AND FUTURE ASPECTS OF MEDICINAL PLANTS:

The use of medicinal plants is growing increasingly important in the creation of new drugs. The popularity of herbal treatments is attributed to their safety, effectivenessand absence of negative effects. Plant-derived productsand their use indisease prevention and treatment have been developed with different levels of success. Currently, many countries have a significant need.

The best combinatorial chemistry is found in nature, which has plausible treatments for all human ailments, as shown by the justification above. Herbal medicine has already caught people's attention due to the detrimental impacts of modern medicine, to increase support from the public and to establish confidence and faith in a safer indigenous system by proving its effectiveness in the treatment of many diseases. Because healthcare systems are getting more complex and costly, we need to use herbal medicine in our healthcare systems. In the hopes that Natural products will be able to compete in the future with modern medications, supplying additional advantages like improved safety and decreased prices. Because of their socioeconomic situation, the majority of the global population can no longer access a contemporary hospital for the treatment of urethral stones. Therefore, people continue to depend on herbal remedies that are available nearby to treat urinary stone issues. Several of these conventional antiurolithiatic claims have been confirmed by investigations, but they are not enough to prove a large number of these plants and herbal remedies as therapeutic procedures for the treatment of urinary stones and maintenance. Consequently, along with the chemical and clinical characterization of antiurolithiatic herbs, research is required to back up conventional claims made by these plants and herbal remedies for antiurolithiatic combinations.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this review.

REFERENCE:

1. Kirkali Z. Rasooly R. Star RA. Rodgers GP. Urinary Stone Disease: Progress, Status, and Needs. Urology. 2015; 86(4): 651-3. doi: 10.1016/j.urology.2015.07.006.

2. Eknoyan G. History of urolithiasis: Clinical Reviews in Bone and mineral metabolism. 2004; 2(3): 177–185.

3. Moe OW. Kidney stones: pathophysiology and medical management. The Lancet. 2006; 367(9507): 333–344. doi: 10.1016/s0140-6736(06)68071-9.

4. Romero V. Akpinar H. Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Reviews in Urology. 2010; 12(2-3): 86–96.

5. Edvardsson VO. Indridason OS. Haraldsson GK. Jartansson O. Palsson R. Temporal trends in the incidence of kidney stone disease. Kidney International. 2013; 83(1): 146–152. doi: 10.1038/ki.2012.320.

6. Chhiber N. Sharma M. Kaur T. Singla S. Mineralization in health and mechanism of kidney stone formation. International Journal of Pharmaceutical Science Invention. 2014; 3:25–31.

7. Barnela SR. Soni SS. Saboo SS. Bhansali AS. Medical management of renal stone. Indian J Endocrinol Metab. 2012; 16(2): 236-9. doi: 10.4103/2230-8210.93741.

8. Evan AP. Worcester EM. Coe FL. Williams J. Lingeman JE. Mechanisms of human kidney stone formation. Urolithiasis. 2015; 43: 19-23. doi: 10.1007/s00240-014-0701-0.

9. Coll DM. Varanelli MJ. Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol. 2002; 178(1): 101-3. doi: 10.2214/ajr.178.1.1780101.

10. López M. Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatric Nephrology. 2010; 25(1): 49-59. doi: 10.1007/s00467-008-0960-5.

11. Kasote D. Jagtap S. Thapa D. Khyade M. Russell R. Herbal remedies for urinary stones used in India and China: A review. Journal of Ethnopharmacology. 2017; 203: 55-68.

12. Sandhya A. Sandhya G. Sreedevi V. Deepika P. Hema Prasad M. Kidney stone disease: etiology and evaluation. International Journal of Applied Biology and Pharmaceutical Technology. 2010; 1(1): 175-82.

13. Stamatelou KK. Francis ME. Jones CA. Time trends in the reported prevalence of kidney stones in the UnitedStates. KidneyInt. 2003; 63: 1817–23.

14. Gohel MK. Patel CN. Pandya SS. A brief review on pathophysiology, contributing factors and treatment of kidney stones. World Journal of Pharmacy and Pharmaceutical Sciences. 2022; 11(9): 348-365.

15. Semins MJ. Matlaga BR. Medical evaluation and management of urolithiasis. Ther Adv Urol. 2010; 2(1): 3-9. doi: 10.1177/1756287210369121.

16. Pak CYC. Peterson R. Poindexter JR. Adequacy of a single stone risk analysis in the medical evaluation of urolithiasis. J Urol. 2001; 165: 378–381.

17. Parks JH. Goldfisher E. Asplin JR. Coe FL. A single 24-hour urine collection is inadequate for the medical evaluation of nephrolithiasis. J Urol. 2002; 167:1607–1612.

18. Gücük A. Uyetürk U. Usefulness of hounsfield unit and density in the assessment and treatment of urinary stones. World J Nephrol. 2014; 3(4): 282-6.

19. Mukerjee T. Bhalla N. Singh G. Jain HC. Herbal drugs for urinary stones. Indian Drugs. 1984; 224- 228.

20. Bahu CP. Seshadri RT. In Advances in Research in Indian Medicine (B.H.U.). 1970; 77-78.

21. Chunekar KC. Vanasuhadi Anushandhan Durshika. Chaukhamba Vidyabhawan, Varanasi. 1969; 5thed:pp.13.

22. Bhandari CR. Basu BD. Vanasuhadi Chandrodaya. Gyan Mandir, Bhanupura publisher, Indor. 1948; 2nd ed: 48.

23. Kirtikar KR. Basu BD. Herbal plants in urolithiasis. In Indian Medicinal Plants. Lalit Mohan Basu Publisher, Allahabad. 1933; 2nd ed: 56.

24. Dush B. Kashyap L. Herbal plants in Kidney stone. In Materia Medica of Ayurveda. Concept Publishing Co, New Delhi. 1979; 89.

25. Bhisa KL. Kidney stone.English Translation of Sushruta Samhita. 1981; 21:106.

26. Shah CS. Shan N. Mody KD.Drugs used in urolithiasis. Q. J. Crude Drug Research. 1972; 12:1882-93.

27. Dubey SD. Singh RS. Sen SP. Kumar N.Disease of kidney stone and urinary tract. Med. Surg. 1982; 22:9-12.

28. Shrivastava JG. Herbal plants used in stone. Q. J. Crude Drug Research. 1971; 11:1683-89.

29. Legal status of traditional medicine and complementary/alternative medicine: a worldwide review. World Health Organization. 2001. Available on: https://apps.who.int/iris/handle/10665/42452

30. Sridevi V. Rajya Lakshmi I. Sanjeeva Rao I. Urolithiasis (Mutrashmari). Scientific basis for Ayurvedic Therapies.Edited by Lakshmi Chandra Mishra. Boca Raton. CRC Press LLC. 2004; 536-548.

31. Pullaiah P. Narasimha Kumar GV. Narasimha Kumar GV. Vineela Ruth. Madhuri P. Pushpa Kumari B.Ranganayakulu D. Dhanunjaya S. Supplementation of Ethanolic Extract of Abutilon indicum (L) Sweet Prevents Urolithiasis in Experimental Rats. International Journal of Pharmacometrics and Integrated Biosciences. 2015; 1(1):7-13.

32. Chauhan PN. Kumar D.Kasana MS. Medicinal Plants of Muzaffarnagar district used in treatment of Urinary tract and Kidney stones. Indian Journal of Traditional Knowledge. 2009; 8(2):191-195.

33. MohdAzaz Khan. Debasish Pradhan. Antiurolithic activity of Ageratum conzoides extract in rats. Pharmacologyonline. 2011; 3: 953-958.

34. Sharma N. Tanwer BS. Vijayvergia R. Study of medicinal plants in Aravali regions of Rajasthan for treatment of kidney stone and urinary tract troubles. International Journal of PharmTech Research. 2011; 3(1):110-113.

35. Soundararajan P. Mahesh R. Ramesh T. Hazeena Begum V. Effect of Aerva Lanata on calcium oxalate urolithiasis in rats. Indian Journal of Experimental Biology. 2006; 44:981-986.

36. Ananta Teepa KS. Kokilavani R. Balakrishnan A. Gurusamy K. Effect of ethanolic fruit extract of Pedalium murex Linn in ethylene glycol induced urolithiasis in male wistar albino rats. Ancient Science Life. 2010; 29:29-34.

37. Satish H. Raman D. Kshama D. Shivananda BG. Shridhar KA. Study the relative effect of Spironolactone and different solvent extract of Tibulusterrestrison urolithiatic rats. Pharmacognosy Magazine. 2009; 5:83-9.

38. Sailaja BK. Bharathi KP. Protective effect of Tridax procumbens on calcium oxalate urolithiasis and oxidative stress. An International Journal of Advances in Pharmaceutical Sciences. 2011; 2(1):1-6.

Received on 31.08.2023 Modified on 25.01.2024

Res. J. Pharmacognosy and Phytochem. 2024; 16(2):133-137.

DOI: 10.52711/0975-4385.2024.00026