Generic placeholder image

Current Drug Targets


ISSN (Print): 1389-4501
ISSN (Online): 1873-5592

Review Article

Phytotherapy and Herbal Medicines for Kidney Stones

Author(s): Esteban Emiliani*, Adrian Jara and Andres Koey Kanashiro

Volume 22 , Issue 1 , 2021

Published on: 29 September, 2020

Page: [22 - 30] Pages: 9

DOI: 10.2174/1389450121666200929115555

Price: $65


Background: Kidney stones are one of the longest known and most common diseases in the urinary tract, with a prevalence that ranges from 1% to 20%. Many phytotherapeutic and herbal medicines have been described for the treatment and prevention of kidney stones.

Objective: The aim of this study was to perform a comprehensive review of publications on various phytotherapeutic and herbal medicines, including both clinical and animal studies.

Results: Phytotherapy may influence the risk of recurrence of calcium oxalate and uric acid stones. The most solid evidence relates to Phyllanthus niruri, one of the most studied phytotherapeutics; findings suggest that it interferes with calcium oxalate crystallization, reduces hyperoxaluria and hyperuricosuria, and increases the efficacy of shock wave lithotripsy due to reduced crystallization, without significant adverse effects. Theobromine has been shown to reduce the crystallization of uric acid in patients and appears to be a promising supplement to treat such stones.

Conclusion: Many phytotherapeutic and herbal agents have been studied for the treatment of urolithiasis, most of them only in a small number of patients or in animal models. Further randomized clinical trials are needed to evaluate the effects of these agents on kidney stones.

Keywords: Urolithiasis, kidney stones, phytotherapy, herbal medicines, phytotherapeutic, Phyllanthus niruri.

Graphical Abstract
Trinchieri ACG, et al. Epidemiology.Stone Disease. Paris: Health Publications 2003.
Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol 2016; 69(3): 475-82.
[] [PMID: 26344917]
Nirumand MC, Hajialyani M, Rahimi R, et al. Dietary plants for the prevention and management of kidney stones: Preclinical and clinical evidence and molecular Mechanisms. Int J Mol Sci 2018; 19(3): 765.
[] [PMID: 29518971]
Pucci ND, Marchini GS, Mazzucchi E, et al. Effect of phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention. Int Braz J Urol 2018; 44(4): 758-64.
[] [PMID: 29617079]
Bagalkotkar G, Sagineedu SR, Saad MS, Stanslas J. Phytochemicals from Phyllanthus niruri Linn. and their pharmacological properties: a review. J Pharm Pharmacol 2006; 58(12): 1559-70.
[] [PMID: 17331318]
Nishiura JL, Campos AH, Boim MA, Heilberg IP, Schor N. Phyllanthus niruri normalizes elevated urinary calcium levels in calcium stone forming (CSF) patients. Urol Res 2004; 32(5): 362-6.
[] [PMID: 15221244]
Micali S, Sighinolfi MC, Celia A, et al. Can Phyllanthus niruri affect the efficacy of extracorporeal shock wave lithotripsy for renal stones? A randomized, prospective, long-term study. J Urol 2006; 176(3): 1020-2.
[] [PMID: 16890682]
Micali S, Célia A, Sighinolfi S, De Stefani S, Bian-Chi G. Ruolo del Phyllanthus niruri (Uriston) come te-rapia adiuvante alla litotrissia extracorporea per i calcoli renali. Giornale di Tecniche Nefrologiche & Dialitiche 2005; 7(4)
Barros ME, Schor N, Boim MA. Effects of an aqueous extract from Phyllantus niruri on calcium oxalate crystallization in vitro. Urol Res 2003; 30(6): 374-9.
[] [PMID: 12599017]
Brardi S, Imperiali P, Cevenini G, Verdacchi T, Ponchietti R. Effects of the association of potassium citrate and agropyrum repens in renal stone treatment: results of a prospective randomized comparison with potassium citrate. Arch Ital Urol Androl 2012; 84(2): 61-7.
[PMID: 22908773]
Jurenka JS. Therapeutic applications of pomegranate (Punica granatum L.): a review. Altern Med Rev 2008; 13(2): 128-44.
[PMID: 18590349]
Bhandari PR. Pomegranate (Punica granatum L). Ancient seeds for modern cure? Review of potential therapeutic applications. Int J Nutr Pharmacol Neurol Dis 2012; 2: 171-84.
Tugcu V, Kemahli E, Ozbek E, et al. Protective effect of a potent antioxidant, pomegranate juice, in the kidney of rats with nephrolithiasis induced by ethylene glycol. J Endourol 2008; 22(12): 2723-31.
[] [PMID: 19025399]
Elwej A, Ghorbel I, Marrekchi R, et al. Improvement of kidney redox states contributes to the beneficial effects of dietary pomegranate peel against barium chloride-induced nephrotoxicity in adult rats. Arch Physiol Biochem 2016; 122(3): 130-40.
[] [PMID: 26835741]
Boroushaki MT, Asadpour E, Sadeghnia HR, Dolati K. Effect of pomegranate seed oil against gentamicin -induced nephrotoxicity in rat. J Food Sci Technol 2014; 51(11): 3510-4.
[] [PMID: 26396355]
Alimoradian A, Changizi-Ashtiyani S, Ghiasabadi Farahani A, Kheder L, Rajabi R, Sharifi A. Protective Effects of Pomegranate Juice on Nephrotoxicity Induced by Captopril and Gentamicin in Rats. Iran J Kidney Dis 2017; 11(6): 422-9.
[PMID: 29190602]
Sadeghi F, Nematbakhsh M, Noori-Diziche A, et al. Protective effect of pomegranate flower extract against gentamicin-induced renal toxicity in male rats. J Renal Inj Prev 2015; 4(2): 45-50.
[PMID: 26060837]
Primarizky H, Yuniarti WM, Lukiswanto BS. Benefits of pomegranate (Punica granatum Linn) fruit extracts to weight changes, total protein, and uric acid in white rats (Rattus norvegicus) as an animal model of acute renal failure. Vet World 2016; 9(11): 1269-74.
[] [PMID: 27956780]
Rathod NR, Biswas D, Chitme HR, Ratna S, Muchandi IS, Chandra R. Anti-urolithiatic effects of Punica granatum in male rats. J Ethnopharmacol 2012; 140(2): 234-8.
[] [PMID: 22285521]
Bagri P, Ali M, Aeri V, Bhowmik M, Sultana S. Antidiabetic effect of Punica granatum flowers: effect on hyperlipidemia, pancreatic cells lipid peroxidation and antioxidant enzymes in experimental diabetes. Food Chem Toxicol 2009; 47(1): 50-4.
[] [PMID: 18950673]
Tracy CR, Henning JR, Newton MR, Aviram M, Bridget Zimmerman M. Oxidative stress and nephrolithiasis: a comparative pilot study evaluating the effect of pomegranate extract on stone risk factors and elevated oxidative stress levels of recurrent stone formers and controls. Urolithiasis 2014; 42(5): 401-8.
[] [PMID: 25085198]
Mathew LE, Sindhu G, Helen A. Dolichos biflorus exhibits anti-inflammatory and antioxidant properties in an acute inflammatory model. Yao Wu Shi Pin Fen Xi 2014; 22(4): 455-62.
[] [PMID: 28911460]
Atodariya U, Barad R, Upadhyay S, Upadhyay U. Anti-urolithiatic activity of Dolichos biflorus seeds. J Pharmacogn Phytochem 2013; 2: 45051.
Saha S, Verma RJ. Evaluation of hydro-alcoholic extract of Dolichos biflorus seeds on inhibition of calcium oxalate crystallization. J Herb Med 2015; 5: 41-7.
Prasongwatana V, Woottisin S, Sriboonlue P, Kukongviriyapan V. Uricosuric effect of Roselle (Hibiscus sabdariffa) in normal and renal-stone former subjects. J Ethnopharmacol 2008; 117(3): 491-5.
[] [PMID: 18423919]
Laikangbam R, Damayanti Devi M. Inhibition of calcium oxalate crystal deposition on kidneys of urolithiatic rats by Hibiscus sabdariffa L. extract. Urol Res 2012; 40(3): 211-8.
[] [PMID: 22057204]
Woottisin S, Hossain RZ, Yachantha C, Sriboonlue P, Ogawa Y, Saito S. Effects of Orthosiphon grandiflorus, Hibiscus sabdariffa and Phyllanthus amarus extracts on risk factors for urinary calcium oxalate stones in rats. J Urol 2011; 185(1): 323-8.
[] [PMID: 21075390]
Ardakani Movaghati Mohammad Reza, Yousefi Mahdi, Ahmad Saghebi Seyed, Sadeghi Vazin Mahmoud, Iraji Aida, Hamdollah Mosavat Seyed. Efficacy of black seed (Nigella sativa L.) on kidney Stone dissolution: A randomized, double-blind, placebo-controlled, clinical trial. 2007.
Hadjzadeh MA, Khoei A, Hadjzadeh Z, Parizady M. Ethanolic extract of nigella sativa L seeds on ethylene glycol-induced kidney calculi in rats. Urol J 2007; 4(2): 86-90.
[PMID: 17701927]
Hadjzadeh MA, Mohammadian N, Rahmani Z, Rassouli FB. Effect of thymoquinone on ethylene glycol-induced kidney calculi in rats. Urol J 2008; 5(3): 149-55.
[PMID: 18825620]
Han X, Shen T, Lou H. Dietary polyphenols and their biological significance. Int J Mol Sci 2007; 8: 950-88.
Mendoza-Wilson AM, Glossman-Mitnik D. Theoretical study of the molecular properties and chemical reactivity of (+)-catechin and (−)-epicatechin related to their antioxidant ability. J Mol Struct THEOCHEM 2006; 761: 97-106.
Grases F, Prieto RM, Fernandez-Cabot RA, Costa-Bauzá A, Tur F, Torres JJ. Effects of polyphenols from grape seeds on renal lithiasis. Oxid Med Cell Longev 2015.
Higdon JV, Frei B. Tea catechins and polyphenols: health effects, metabolism, and antioxidant functions. Crit Rev Food Sci Nutr 2003; 43(1): 89-143.
[] [PMID: 12587987]
Crespo ME, Gálvez J, Cruz T, Ocete MA, Zarzuelo A. Anti-inflammatory activity of diosmin and hesperidin in rat colitis induced by TNBS. Planta Med 1999; 65(7): 651-3.
[] [PMID: 10575379]
Abdel-Daim MM, Khalifa HA, Abushouk AI, Dkhil MA, Al-Quraishy SA. Diosmin Attenuates Methotrexate-Induced Hepatic, Renal, and Cardiac Injury: A Biochemical and Histopathological Study in Mice. Oxid Med Cell Longev 2017.
Ahmed S, Mundhe N, Borgohain M, et al. Diosmin Modulates the NF-kB Signal Transduction Pathways and Downregulation of Various Oxidative Stress Markers in Alloxan-Induced Diabetic Nephropathy Inflammation 2016; 39(5): 1783-97.
Rehman MU, Tahir M, Quaiyoom Khan A, et al. Diosmin protects against trichloroethylene-induced renal injury in Wistar rats: plausible role of p53, Bax and caspases. Br J Nutr 2013; 110(4): 699-710.
[] [PMID: 23402272]
Noorafshan A, Karbalay-Doust S, Karimi F. Diosmin reduces calcium oxalate deposition and tissue degeneration in nephrolithiasis in rats: a stereological study. Korean J Urol 2013; 54(4): 252-7.
[] [PMID: 23614063]
Prabhu VV, Sathyamurthy D, Ramasamy A, Das S, Anuradha M, Pachiappan S. Evaluation of protective effects of diosmin (a citrus flavonoid) in chemical-induced urolithiasis in experimental rats. Pharm Biol 2016; 54(9): 1513-21.
[] [PMID: 26799954]
Pastukhov AV, Levchenko LA, Sadkov AP. Spectroscopic study on binding of rutin to human serum albumin. J Mol Struct 2007; 842: 60-6.
Ghodasara J, Pawar A, Deshmukh C, Kuchekar B. Inhibitory effect of rutin and curcumin on experimentally-induced calcium oxalate urolithiasis in rats. Pharmacognosy Res 2010; 2(6): 388-92.
[] [PMID: 21713144]
Zhu W, Xu YF, Feng Y, et al. Prophylactic effects of quercetin and hyperoside in a calcium oxalate stone forming rat model. Urolithiasis 2014; 42(6): 519-26.
[] [PMID: 25085199]
Park HK, Jeong BC, Sung M-K, et al. Reduction of oxidative stress in cultured renal tubular cells and preventive effects on renal stone formation by the bioflavonoid quercetin. J Urol 2008; 179(4): 1620-6.
[] [PMID: 18295251]
Amengual-Cladera E, Nadal-Casellas A, Gómez-Pérez Y, et al. Phytotherapy in a rat model of hyperoxaluria: the antioxidant effects of quercetin involve serum paraoxonase 1 activation. Exp Biol Med (Maywood) 2011; 236(10): 1133-8.
[] [PMID: 21893570]
Saremi J, Kargar Jahromi H, Pourahmadi M. Effect of Polygonum Aviculare L. on Nephrolithiasis Induced by Ethylene Glycol and Ammonium Chloride in Rats. Urol J 2018; 15(3): 79-82.
[PMID: 29256188]
Kumar BN, Wadud A, Jahan N, et al. Antilithiatic effect of Peucedanum grande C. B. Clarke in chemically induced urolithiasis in rats. J Ethnopharmacol 2016; 194: 1122-9.
[] [PMID: 27825989]
Novaes AdaS, da Silva Mota J, Barison A, et al. Diuretic and antilithiasic activities of ethanolic extract from Piper amalago (Piperaceae). Phytomedicine 2014; 21(4): 523-8.
[] [PMID: 24252339]
Gandhi M, Aggarwal M, Puri S, Singla SK. Prophylactic effect of coconut water (Cocos nucifera L.) on ethylene glycol induced nephrocalcinosis in male wistar rat. Int Braz J Urol 2013; 39(1): 108-17.
[] [PMID: 23489503]
Ahmed A, Wadud A, Jahan N, Bilal A, Hajera S. Efficacy of Adiantum capillus veneris Linn in chemically induced urolithiasis in rats. J Ethnopharmacol 2013; 146(1): 411-6.
[] [PMID: 23333749]
Xiang S, Zhou J, Li J, et al. Antilithic effects of extracts from different polarity fractions of Desmodium styracifolium on experimentally induced urolithiasis in rats. Urolithiasis 2015; 43(5): 433-9.
[] [PMID: 26123751]
Bashir S, Gilani AH. Antiurolithic effect of Bergenia ligulata rhizome: an explanation of the underlying mechanisms. J Ethnopharmacol 2009; 122(1): 106-16.
[] [PMID: 19118615]
Mittal A, Tandon S, Singla SK, Tandon C. In vitro studies reveal antiurolithic effect of Terminalia arjuna using quantitative morphological information from computerized microscopy. Int Braz J Urol 2015; 41(5): 935-44.
[] [PMID: 26689519]
Mittal A, Tandon S, Singla SK, Tandon C. In vitro inhibition of calcium oxalate crystallization and crystal adherence to renal tubular epithelial cells by Terminalia arjuna. Urolithiasis 2016; 44(2): 117-25.
[] [PMID: 26424092]
Khan A, Khan SR, Gilani AH. Studies on the in vitro and in vivo antiurolithic activity of Holarrhena antidysenterica. Urol Res 2012; 40(6): 671-81.
[] [PMID: 22622371]
Rodgers AL, Webber D, Ramsout R, Gohel MD. Herbal preparations affect the kinetic factors of calcium oxalate crystallization in synthetic urine: implications for kidney stone therapy. Urolithiasis 2014; 42(3): 221-5.
[] [PMID: 24648109]
Trinchieri A, Montanari E. Prevalence of renal uric acid stones in the adult. Urolithiasis 2017; 45(6): 553-62.
[] [PMID: 28258472]
Kirdpon S, Nakorn SN, Kirdpon W. Changes in urinary chemical composition in healthy volunteers after consuming roselle (Hibiscus sabdariffa Linn.) juice. J Med Assoc Thai 1994; 77(6): 314-21.
[PMID: 7869018]
Kieley S, Dwivedi R, Monga M. Ayurvedic medicine and renal calculi J Endourol 2008; 22(8): 1613-6.
Premgamone A, Sriboonlue P, Disatapornjaroen W, Maskasem S, Sinsupan N, Apinives C. A long-term study on the efficacy of a herbal plant, Orthosiphon grandiflorus, and sodium potassium citrate in renal calculi treatment. Southeast Asian J Trop Med Public Health 2001; 32(3): 654-60.
[PMID: 11944733]
Grases F, García-Ferragut L, Costa-Bauzá A, March JG. Study of the effects of different substances on the early stages of papillary stone formation. Nephron 1996; 73(4): 561-8.
[] [PMID: 8856252]
Grases F, Ramis M, Villacampa AI, Costa-Bauzá A. Uric acid urolithiasis and crystallization inhibitors. Urol Int 1999; 62(4): 201-4.
[] [PMID: 10567882]
Onaran M, Orhan N, Farahvash A, et al. Successful treatment of sodium oxalate induced urolithiasis with Helichrysum flowers. J Ethnopharmacol 2016; 186: 322-8.
[] [PMID: 27085940]
Costa-Bauza A, Grases F, Calvó P, Rodriguez A, Prieto RM. Effect of Consumption of Cocoa-Derived Products on Uric Acid Crystallization in Urine of Healthy Volunteers. Nutrients 2018; 10(10): E1516.
[] [PMID: 30332783]
Grases F, Rodriguez A, Costa-Bauza A. Theobromine inhibits uric acid crystallization. A potential application in the treatment of uric acid nephrolithiasis. PLoS One 2014; 9(10): e111184.
[] [PMID: 25333633]
Heilberg IP. Treatment of patients with uric acid stones. Urolithiasis 2016; 44(1): 57-63.
[] [PMID: 26645868]
Odvina CV. Comparative value of orange juice versus lemonade in reducing stone-forming risk. Clin J Am Soc Nephrol 2006; 1(6): 1269-74.
[] [PMID: 17699358]
Seltzer MA, Low RK, McDonald M, Shami GS, Stoller ML. Dietary manipulation with lemonade to treat hypocitraturic calcium nephrolithiasis. J Urol 1996; 156(3): 907-9.
[] [PMID: 8709360]
Tosukhowong P, Yachantha C, Sasivongsbhakdi T, et al. Citraturic, alkalinizing and antioxidative effects of limeade-based regimen in nephrolithiasis patients. Urol Res 2008; 36(3-4): 149-55.
[] [PMID: 18560820]
Wabner CL, Pak CY. Effect of orange juice consumption on urinary stone risk factors. J Urol 1993; 149(6): 1405-8.
[] [PMID: 8501777]
Goldfarb DS, Asplin JR. Effect of grapefruit juice on urinary lithogenicity. J Urol 2001; 166(1): 263-7.
[] [PMID: 11435883]
Haleblian GE, Leitao VA, Pierre SA, et al. Assessment of citrate concentrations in citrus fruit-based juices and beverages: implications for management of hypocitraturic nephrolithiasis. J Endourol 2008; 22(6): 1359-66.
[] [PMID: 18578663]
Baia LdaC, Baxmann AC, Moreira SR, Holmes RP, Heilberg IP. Noncitrus alkaline fruit: a dietary alternative for the treatment of hypocitraturic stone formers. J Endourol 2012; 26(9): 1221-6.
[] [PMID: 22500592]
Taylor EN, Curhan GC. Fructose consumption and the risk of kidney stones. Kidney Int 2008; 73(2): 207-12.
[] [PMID: 17928824]
Grases F, Costa-Bauzá A. Fitoterapia de la litiasis renal: entre el mito y la realidad. Medicina Clínica (Barcelona) (Med Clin (Barc)) 2000; 115: 779-82.
Morán E, Budía A, Broseta E, Boronat F. Fitoterapia en Urología. Evidencia científica actual de su aplicación en urolitiasis, dolor pélvico crónico, disfunción eréctil e infecciones urinarias. Actas Urol Esp 2013; 37(3): 174-80.
[] [PMID: 23058994]
Butterweck V, Khan SR. Herbal medicines in the management of urolithiasis: alternative or complementary? Planta Med 2009; 75(10): 1095-103.
[] [PMID: 19444769]
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993; 328(4): 246-52.
[] [PMID: 8418405]
Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998; 280(18): 1569-75.
[] [PMID: 9820257]
Johnston B. One-third of nation’s adults use herbal remedies: Market estimated at $3.24 billion. HerbalGram 1997; 40: 52.
Farnsworth NR. The role of ethnopharmacology in drug development. Bioactive compounds from plants (Ciba Symposium 154) Eds: Chadwick D   J Marsh, NY Wiley.
Fine JK, Pak CYC, Preminger GM. Effect of medical management and residual fragments on recurrent stone formation following shock wave lithotripsy. J Urol 1995; 153(1): 27-32.
[] [PMID: 7966783]
Cicerello E, Merlo F, Gambaro G, et al. Effect of alkaline citrate therapy on clearance of residual renal stone fragments after extracorporeal shock wave lithotripsy in sterile calcium and infection nephrolithiasis patients. J Urol 1994; 151(1): 5-9.
[] [PMID: 8254832]
Soygür T, Akbay A, Küpeli S. Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis: a randomized controlled trial. J Endourol 2002; 16(3): 149-52.
[] [PMID: 12028622]
Sarica K, Erturhan S, Yurtseven C, Yagci F. Effect of potassium citrate therapy on stone recurrence and regrowth after extracorporeal shockwave lithotripsy in children. J Endourol 2006; 20(11): 875-9.
[] [PMID: 17144854]
Lojanapiwat B, Tanthanuch M, Pripathanont C, et al. Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy. Int Braz J Urol 2011; 37(5): 611-6.
[] [PMID: 22099273]
Monti E, Trinchieri A, Magri V, Cleves A, Perletti G. Herbal medicines for urinary stone treatment. A systematic review. Arch Ital Urol Androl 2016; 88(1): 38-46.
[] [PMID: 27072174]
Miller NL, Evan AP, Lingeman JE. Pathogenesis of renal calculi. Urol Clin North Am 2007; 34(3): 295-313.
[] [PMID: 17678981]
Park S, Pearle MS. Pathophysiology and management of calcium stones. Urol Clin North Am 2007; 34(3): 323-34.
[] [PMID: 17678983]

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy