Available online on 20.04.2022 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2011-2022 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access  Full Text Article                                                                                                                                                     Review Article 

A Synopsize Report of the Various Perspectives of Urolithiasis and its Ethno-Medical Future

Sarita Sharma¹*, Amit J. Raval², Raju Koneri³, Gaurav Kumar Sharma⁴

¹ PhD Research Scholar, Pacific Academy of Higher Education and Research University, Udaipur, India

² Professor, Pacific Academy of Higher Education and Research University, Udaipur, India

³ Professor and Dean, Karnataka College of Pharmacy, Bangalore, India

⁴ Associate Professor, Mewar University, Gangrar, Rajasthan, India

Introduction 

The presence of one or more stones in the urinary tract is known as urolithiasis. Urolithiasis is derived from the Greek words ouron (urinary system) and lithos (skin) (stone). Urinary stones are the third most frequent urinary tract ailment, with common urinary tract infections and benign prostatic hyperplasia ranking first and second, respectively. According to epidemiological research, nephrolithiasis is more common in males (12%) than in women (6%), and it is more common in men and women between the ages of 20 and 40.¹ Urinary calculi are more common in mountainous, desert, and tropical environments. The prevalence of urinary calculus disease in the United States is extremely high for its population.² In people who are prone to the disease, increased water consumption and increased urine output reduce the prevalence of urinary calculi. This disease has a complex aetiology that is strongly linked to nutritional lifestyle behaviours or practices.³ Increased rates of hypertension and obesity, both of which may be linked to nephrolithiasis, also play a role in stone formation.⁴

Pathophysiology of Urolithiasis:

Renal stones are a common cause of blood in the urine and can cause severe abdominal, flank, or groyne pain. Renal calculi are another name for kidney stones. Chemical composition is used to classify kidney stones. To produce crystals, urine must be supersaturated in relation to the stone. That is, the concentration exceeds the substance's thermodynamic solubility.⁵ When urine is overly concentrated, kidney stones are common. Calcium, oxalate, phosphate, and other compounds in the urine crystallise on the inside of the kidney as a result of this. These crystals can be linked to stones, which are small, hard masses. Supersaturation of urine with certain urinary salts, such as calcium oxalate, causes kidney oxalate stones.

Figure 1: Kidney Stone⁶

Types of Stones:

• The most prevalent types of stones are calcium oxalate stones. When the urine is acidic, they are more likely to develop.

• Calcium phosphate stones are quite uncommon. When urine is alkaline, calcium phosphate stones are more likely to develop. • Uric acid stones are more prone to form if urine is consistently acidic. This could be related to a high-purine and animal protein diet.

• Kidney infections cause struvite stones.

• Cystine stones are caused by a rare hereditary condition in which cystine — an amino acid – is produced in excess.

Figure 2: Types of Kidney Stones⁷

Table 1: Causes of Stone formation 

Hypercalciuria, hypocitraturia, hyperoxaluria, hyperuricosuria, and gout susceptibility can change the composition or saturation of the urine, which can lead to stone formation. CaOxsupersaturation and crystallisation in the kidneys can be influenced by any cellular malfunction that affects numerous urine ions and other chemicals.⁸

Symptoms and Signs⁹

• Flank discomfort (abdominal and back pain)

• Infections of the urinary tract

• Hematuria — blood in the urine • Obstructive uropathy — urinary tract disease caused by obstruction

Stone Composition: Calcium oxalate (CaOx) is the most common component of maximal stones, accounting for more than 80% of all stones.¹⁰ The remaining 20% is made up of struvite, cystine, uric acid, and other stones.¹¹

Diagnosis: There are a number of diagnostic tests that can be used to determine whether or not you have kidney stones.

• Complete blood count for the presence of increased white cellular matter (Neutrophilia), among other things.

• Urine test- shows proteins, pink blood cells, bacteria, cell casts, and crystals under a microscope.

• A urine sample is cultured to rule out infection.

• 24-hour urine collection test – calculates overall urinary volume, magnesium, salt, uric acid, citrate, calcium, oxalate, and phosphate over a 24-hour period.

Additional Diagnostic Tests

KUB (kidney ureter bladder), X-ray kidney ultrasonography, IVP (intravenous pyelogram), and CT scan (computed tomography)¹²

Treatment:

Stone illness is treated in a variety of ways, from observation (close monitoring) through surgical removal of the stones. Smaller stones (less than 5 mm) are more likely to pass spontaneously, taking up to 40 days.¹³

Patients might be treated with drinks and analgesics during the observation period. Interventional methods are used to treat stones greater than 5 mm and stones that do not pass.¹⁴

1. Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive procedure that fragments stones using shock waves. This is the most commonly utilised approach for treating kidney and ureter stones. Acute renal bleeding is the most common lesion, but its real incidence is uncertain and poorly defined. Extracorporeal shock waves are used in ESWL to penetrate through the skin and bodily tissues until they contact thick stones. The stone decomposes into sand and is carried away.¹⁵

Figure 3: Extracorporeal shock wave lithotripsy (ESWL)¹⁶

2. Percutaneous Nephrolithotomy (PCNL): Percutaneous nephrolithotomy (PCNL) is a technique that removes large or medium kidney stones from a patient's urinary tract. PCNL necessitates the use of general anaesthesia. PCNL entails cutting a half-inch cut in the back or side of the kidney, just large enough to allow a rigid telescope (nephroscope) to be introduced into the hollow centre region of the kidney where the stone is located.¹⁷ The goal of PCNL is to remove renal calculi in order to reduce pain, bleeding into the urinary tract, and blockage.¹⁸

Figure 4: Percutaneous Nephrolithotomy (PCNL)¹⁹

3. Incisional (open) surgery:  The afflicted area is opened and the stone is removed via open surgery (s). A solution containing calcium chloride, cryoprecipitate, thrombin, and indigo carmine is injected into the kidneys during this operation. This material is injected into the body, forming a jelly-like blood clot that traps the stones inside. The stone is removed with tweezers through an incision in the kidney.

To avoid the creation of new stones, you can create a specific treatment plan that includes dietary changes, supplements, and medications. The calcium salts that create the stones diminish urine saturation and dilute the promoter of CaOx crystallisation in the distal tubules when you drink a lot of water. Thiazide diuretics are the most effective hypocalciuricagents because their hypocalciuricaction increases calcium absorption in the distal renal tubules.

Fatigue, disorientation, impotence, musculoskeletal issues, and gastrointestinal complaints are some of the negative effects. Thiazide-induced potassium depletion, which produces intracellularacidosis and can lead to hypokalemia and hypocitraturia,²⁰  is another consequence.

Major drawbacks of ESWL, PCNL:

In addition to future advancements and associated high expenditures, substantial evidence suggests that therapeutic doses of shock waves can cause acute renal damage, impaired renal function, and increased stone recurrence. Furthermore, stone management is complicated by the presence of remaining stone debris and the risk of post-ESWL infection. Despite significant advances in the research of the biochemical and physical symptoms of kidney stones, no effective medicine for clinical treatment exists.

Stones are treated differently depending on their size and placement. Extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), or percutaneous nephrolithotripsy (PNL) should be used to treat stones greater than 5 mm or that do not pass through.²¹

Unfortunately, ESWL excision of the stone has no effect on the likelihood of stone recurrence, and stone recurrence remains at 50%.²² Furthermore, kidney injury, ESWL-induced hypertension, and renal failure are all possible side effects of ESWL.²³

Despite some recent findings on the beneficial benefits of medical treatments on the removal of stones in the distal ureter,²⁴ there is still no satisfactory medicine to use in clinical therapy, particularly for the prevention or recurrence of stones. Many herbs have been used to treat kidney stones in the past and have been proven to be beneficial.

Alternative therapy: herbal treatment

Traditional medicine is believed to be used by 80 percent of the world's population for illness treatment.²⁵ Medicinal herbs have been used for a long time and are generally considered to be safer than manufactured drugs.²⁶ They are a reliable source of drug discovery information.²⁷ Researchers are now concentrating their efforts on finding medicines in medicinal plants.²⁸ Plants are thought to be the source of at least one-third of all medicines.²⁹ Pharmaceutical companies consider medicinal plants to be an acceptable, low-cost, readily available, and safe source of active chemicals.³⁰ Medicinal plant therapeutic effects on renal and urinary tract illnesses have been examined extensively, and their efficacy has been established.³¹

Table 1: of plants which have been used for treatment of urolithiasis³²

Table 2: of plants which have been used for treatment of urolithiasis: In-Vitro

Dietary Changes to Prevent Calcium Oxalate Stones are part of a lifestyle change to prevent calcium oxalate stones.

• Drink More Water: By increasing the amount of water in your diet, your urine will become less concentrated in calcium and oxalate.

• Limit Protein: Too much protein in the diet might cause calcium and oxalate to build up in the urine.

• Limit Oxalate-Rich Foods: Limiting oxalate-rich foods lowers oxalate levels in the urine.

• Lower your sodium intake: Too much sodium in the diet might cause calcium to build up in the urine.⁴⁹

Figure 5: Diet Modification⁵⁰

Conclusion

In vitro, in vivo, and clinical investigations suggest that phytotherapeutic agents could be used as an alternative or adjuvant therapy for urolithiasis treatment. However, because the number of clinical trials on these plants is so small, the overall benefits are still unclear, and further study is needed to confirm the stated results.

Some probable mechanisms of action of plant extracts, according to the reviewed studies, include increased urine citrate excretion, decreased urinary calcium and oxalate excretion, or diuretic, antioxidant, or antibacterial properties.

The development of effective, safe, and standardised herbal preparations for the treatment of urolithiasis has been a priority for hours. Plants must be investigated as an alternative and/or supplemental medicine for the treatment of urolithiasis in systematic investigations.

In conclusion, additional multidisciplinary study among pharmacognosists, pharmacologists, and clinical researchers is needed to produce new plant-derived, high-quality natural products for kidney stone treatment and prevention.

Abbreviations

CaOx : Calcium oxalate

CaP: Calcium phosphate

ESWL: Extracorporeal shock wave lithotripsy

URS: Ureteroscopy

PCNL: Percutaneous nephrolithotripsy

IVP: Intravenous pyelogram

CT Scan: Computed Tomography (CT) scan

Conflicts of interest 

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publica­tion of this article.

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