Expulsion of Renal Stones Non-Surgically with Homoeopathic Remedies and An Appropriate Diet

Abstract

Kidney stone disease is a historical health concern that has evolved in terms of its prevalence and management due to various factors, including changes in lifestyle, diet, climate, and medical technology. Ureteric stones, in particular, require immediate attention due to the severe pain and potential complications they can cause.[1] Kidney stones are a common health issue nowadays and with Homoeopathic Medicines and appropriate diet, we can give safe, cost-effective and efficacious management options that can significantly benefit individuals suffering and reduce the overall burden. Cost-effectiveness is an essential aspect to consider as it not only helps improve treatment efficiency but also makes healthcare more accessible and affordable to a broader population. By researching and promoting Homoeopathic Medicines and appropriate diet, we can contribute to advancements in kidney stone management, potentially enhancing patient outcomes and quality of care. This approach aligns with the goal of providing more accessible and efficient healthcare solutions.[6]

Introduction

Kidney stone disease, also known as nephrolithiasis or urolithiasis, is a health concern that has been prevalent throughout history. People have recognized kidney stones as a condition for thousands of years with documented cases dating back to 1800 BC. Ancient civilizations like the Egyptians and Greeks have recorded instances of kidney stones often linking them to factors.[1.3]

Prevalence:

Calcium nephrolithiasis, often combined with oxalate or phosphate, is the most prevalent type, accounting for approximately 75% of all kidney stone cases. In contrast, uric acid nephrolithiasis is much less common, with a prevalence not exceeding 10%. The formation of calcium oxalate stones involves a multi-step process, including nucleation, crystal growth, and crystal aggregation. [6]

As time has passed the prevalence and occurrence of kidney stone disease have changed due to certain factors include shifts in lifestyle choices eating habits, climate fluctuations like warming and advancements in medical imaging technology.[1]

• Lifestyle and Diet:  Modern lifestyles characterized by behaviour, increased consumption of processed foods and reduced physical activity contribute to the growing number of kidney stone cases. Dietary factors such as salt intake, high consumption of animal protein combined with fluid intake can elevate the risk of developing stones.[1]
• Climate Changes: Warming and Climate variations can indirectly impact the likelihood of kidney stone formation. Higher temperatures can lead to increased dehydration which is a risk factor for stone development. Additionally environmental changes can influence the mineral content in drinking water which may potentially affect stone formation.[1]
• Advancements in Medical Imaging: The advancements in imaging technology such as CT scans and ultrasound have significantly enhanced the ability to diagnose and treat kidney stones. These advanced tools provide improved precision in locating and evaluating the size of the stones, which assists in making decisions regarding treatment options. [1]

The highest occurrence rate, for men typically happens between the ages of 40 and 49 while for women it tends to be between the ages of 50 and 59.[2]

Types:

1. Calcium Oxalate Stones
2. Calcium Phosphate Stones
3. Uric Acid Stones
4. Cystine Stones

1. Calcium oxalate stones, also known as mulberry stones, form due to calcium oxalate. They have sharp projections and may cause early bleeding. Typically, they are single and irregular, leading to early symptoms. These stones are very hard and exhibit a concentric layering when viewed in cross-section. The crystals resembling an envelope-like shape can be observed in urine.
2. Phosphate Stones can occur as calcium phosphate, ammonium phosphate, or triple phosphate (consisting of calcium, ammonium, and magnesium). These stones are smooth and have a dirty white appearance. They tend to enlarge in alkaline urine conditions and only cause symptoms when they reach a considerable size.
3. Uric acid stones are characterized by being hard, smooth, and radiolucent and they do not appear on X-rays. They tend to be multiple and have faceted surfaces. These stones typically range in color from yellow to reddish brown. In some cases, they can be soft and flexible.
4. Cysteine stones often develop in patients with cystinuria, a condition characterized by reduced reabsorption of cysteine from the kidneys. These stones are notably soft in texture. When exposed to air, they undergo color change, turning to green. This greenish hue results from the presence of sulfur within the stones. Cysteine crystals within these stones are typically hexagonal, translucent and tend to form in acidic urine.

Symptoms:

Kidney stones often cause a distinctive set of symptoms, especially when they begin to move from the kidneys into the ureters. These symptoms may include:

• Sharp, severe, and colicky pain: This pain is usually felt in the lower back or side and can radiate to the groin as the stone travels down the ureter. [2]
• Nausea and vomiting: The pain due to kidney stones can be extremely intense, leading to nausea & vomiting. [2]
• Hematuria: Blood in the urine is frequently seen due to irritation or injury to the genitourinary tract as the stone passes through. [2]
• During a Ureteric Colic Episode, when stones move from the lumbar region to the ureter and further to the groin causing intense pain is accompanied by vomiting and sweating.[3]
• Abdominal examination may reveals tenderness in the abdominal muscles.[3]
• If this condition leads to hydronephrosis, the kidney can become palpable.[3]

Diagnosis:[2]

• Non-contrast helical CT with 5 mm slices or fewer is considered ideal for individuals suspected to have kidney stones, as it accurately visualizes the size and position of stones within the urinary system.
• A plain radiograph of the abdomen and pelvis (KUB) can detect calcium-containing stones but may not be effective for radiolucent stones like uric acid or cystine stones.

Management and Treatment:

• The management of kidney stones depends on their size and location, as well as the severity of symptoms.

• Small stones (< 5mm) :[2]

Small kidney stones, typically those less than 5 mm in diameter, often have a good chance of passing spontaneously through the urinary tract without the need for invasive procedures.

• Pain Relief: Pain medications are prescribed to manage the discomfort associated with passing the stone.
• Hydration: Drinking plenty of fluids helps increase urine flow, which can aid in stone passage.
• Close Monitoring: Regular follow-up with a healthcare provider to track the stone’s progress and ensure it is passing without complications.

• Large Stones (5-10mm) :[2]

• For stones between 5 and 10 mm, medical expulsion therapy may be considered. This involves medications like tamsulosin (an alpha-blocker) to relax the muscles in the ureter, aiding the stone’s passage. 
• Extracorporeal Shock Wave Lithotripsy: ESWL involves using shock waves to break the kidney stones into smaller fragments that can be passed more easily through the urinary tract. 
• Ureteroscopy (URS):URS is a procedure where a thin, flexible scope is passed through the urethra and bladder into the ureter to directly visualize and remove the stone or break it into smaller pieces for easier passage.
• Percutaneous Nephrolithotomy (PCNL): PCNL is a surgical procedure where a small incision is made in the back to access the kidney and remove the stone often used for larger or more complex stones.

• Ureteric Stones, in Emergency Situations: [1]

• Ureteric stones refer to a kind of kidney stone that gets stuck in the ureter causing cramp like pain. This pain often starts in the side and Spreads to the abdomen. It may even be felt in the testicles or vulvar area. It’s crucial for individuals with stones to seek medical attention. If left untreated ureteric stones can lead to complications like kidney damage or infection making their prompt management a pressing matter, within the field of urology.

• Homoeopathic For Approach for Renal Stones:

Homoeopathy is a widely practiced holistic form of treatment, ranking second in popularity after Western orthodox medicine in many countries, including India. Distinguishing feature of homoeopathy is its individualized approach to treatment. Unlike conventional medicine, there is no single “Standard Medicine” for all cases of Renal Calculi (Kidney Stones) in homoeopathy. Instead, the selection of a remedy is based on the principles of individualization and a careful assessment of the totality of symptoms presented by each patient.[4]

Homoeopathy considers a range of factors, including the specific symptoms, the patient’s overall constitution, and their unique response to illness. “Individualization” refers to the principle that homoeopathic treatment should be tailored to the individual characteristics and symptoms of each patient, rather than providing a one-size-fits-all remedy. This individualized approach allows for the selection of the most appropriate homeopathic remedy for each case of renal calculi.[4]

Several homeopathic remedies have been claimed to have the ability to help dissolve or expel renal calculi. Some of these remedies include Berberis Vulgaris, Sarsaparilla Officinalis, Nux Vomica, Lycopodium Clavatum, Ocimum Canadensis, and Thuja Occidentalis. These remedies are chosen based on the patient’s symptom profile and constitution.[4]

Offering safe, cost-effective and efficacious treatment options with homoeopathic medicines can have several benefits, both for individual patients and the healthcare system as a whole. Some key advantages are:[5]

1. Affordability: Homoeopaty is often more affordable than other system of medicine, making healthcare more accessible to a broader population. This can significantly reduce the financial burden on patients.
2. Less Side Effects: Homoeopathic Medicines when used correctly, tend to have fewer adverse side effects compared to other system of  medicine. This can enhance patient safety and improve the overall quality of care.
3. Patient  Centered Care: Homoeopathy often aligns with a patient-centered approach to patients, where individual patient needs and preferences are considered. This can lead to more personalized and effective treatment plans.

• Dietary Modification to Prevent Renal Stones:

Dietary advice and nutritional modifications are widely recognized as essential factors in the management of kidney stones and in preventing their recurrence. Also, these dietary changes play a crucial role in preventing associated systemic disorders and reducing cardiovascular risk. Recent guidelines for the management of kidney stones typically categorize dietary and medical therapies into two main groups:

1. General Preventive Measures: These are nonspecific recommendations that aim to reduce the risk of stone formation across all types of kidney stones. Some of these general measures include:

1. Increased Fluid Intake: Maintaining adequate hydration is key in preventing kidney stones. Drinking plenty of water will dilute urine, reducing the concentration of minerals that form stones in the kidney.
2. Balanced Calcium Intake: Ensuring an appropriate and balanced intake of calcium from dietary sources is important. Calcium is essential for our body but should not be consumed in excess.
3. Reduced Sodium Intake: Lowering dietary sodium (salt) intake is crucial because excessive sodium can lead to increased calcium excretion in the urine thus increasing the risk of stone formation.
4. Reduce intake of Protein: Moderation in the consumption of animal proteins especially red meat and poultry, can help reduce the risk of certain types of kidney stones.
5. Maintaining BMI: Achieving and maintaining a healthy weight can contribute to kidney stone prevention.
6. Intake of Fiber: A diet rich in vegetables and fiber can be beneficial, as it may help to reduce stone factors.

1. Specific Phenotype-Based Indication: It is tailored to the specific characteristics of the kidney stone and the individual patient. They may include dietary modifications and in some cases, medical therapies that target the underlying factors contributing to stone formation.

Dietary Interventions:

• Fluid Intake:

Adequate amount of fluid intake is crucial for preventing kidney stones. For every 200 mL of fluids consumed per day, there is a 13% reduction in the risk of stone formation. Maintaining good hydration helps dilute urine and reduces the concentration of minerals that can form stones.

Beverages and their effects:

• Carbonated, Sugar-Added Soft Drinks (Soda): Associated with higher risk due to the fructose content that increases calcium, oxalate, and uric acid excretion. It is seen that there is an increased risk of kidney stones with regular consumption.

• Caffeine: Higher quantities of caffeinated coffee consumption linked to a significantly lower risk of kidney stones. Caffeine itself has an additional protective effect.

• Fruit juice: Grapefruit and apple juices show no harmful effects on kidney stone risk. Orange juice consumption is linked to a 12% reduction in stone risk  and Lemonade, with high citrate content, reduces stone formation rates.

• Oxalate is primarily found in plants, where it serves the purpose of eliminating excess calcium present in water. Plants accumulate oxalate in their leaves, fruits, and seeds and when these plant parts are consumed or detached, the excess calcium is eliminated along with oxalate. As a result, individuals typically ingest varying quantities of oxalate daily.Tea is a notable example of the high variability in oxalate content in foods. Black tea, for instance, has a higher oxalate concentration compared to oolong or green tea.

Factors influencing oxalate intake:

• Brewing Time 

• Quality of tea
• Preparation
• Geographic origin of tea leaves and the time of harvesting 

• Sodium: High dietary intake of sodium chloride (salt) is known to have several negative health effects, including:

• Excessive salt consumption can lead to an increase in blood pressure. This is a significant risk factor for heart disease and other cardiovascular problems.
• High salt intake is directly associated with an increased risk of heart disease. It can contribute to the development of conditions such as hypertension, which is a major risk factor for heart disease.
• Sodium intake is also directly associated with urinary calcium excretion which means that higher levels of salt in the diet can lead to increased calcium excretion through the urine.

• Animal & Plant Protein: Dietary protein intake, particularly non-dairy animal proteins like poultry, meat, fish, and eggs, can influence kidney stone disease:

• High intake of non-dairy animal proteins, especially when combined with low-alkali foods can lead to a negative calcium balance that is more calcium is excreted in the urine more it contributes in stone formation.
• Diets rich in animal proteins can result in a lower urinary pH causing an acidic environment in the urine which can promote the formation of certain types of kidney stones.
• High consumption of animal proteins is associated with reduced urinary excretion of citrate, potassium, and magnesium, which is an important factor in preventing stone formation.
• Animal protein increases purine metabolism, leading to hyperuricosuria causing elevated uric acid levels in the urine and is associated with both uric acid and calcium stones.

Conclusions

Homoeopathy provides safe, cost-effective and efficacious management for patients in the treatment of kidney stones, contributing to the individualized and holistic approach that is essential in treating Renal stones. Its application should be part of a collaborative and comprehensive treatment strategy aimed at improving the well-being and quality of life of individuals suffering from Renal stones.

References.

1. Neethu Vijai,  Rekha P, Lakshman Singh: Scope for management of big ureteric stones using classical Ayurveda medicines – A Single Case Study.
2. Susmita Kumari,  Mehadi Arif Billah,  Tanmoy Saha: Homeopathic Management of Nephrolithiasis with Hydroureteronephrosis: A Case Report.
3. Muhammad Akram and Muhammad Idrees: Progress and prospects in the management of kidney stones and developments in phyto-therapeutic modalities.
4. Hemanta Kumar Mukherjee, Debarsi Das, Debarsi Das, Debarsi Das, Jayanta Nandi, Bibhas Guha, Tathagata Sarkar, Tathagata Sarkar Khuda-Bukhsh: Non-surgical expulsion of renal stones (calculi) with homeopathic remedies: A dependable alternative option.
5. Muhammad Akram, Muhammad Idrees: Progress and prospects in the management of kidney stones and developments in phyto-therapeutic modalities.
6. Pietro Manuel Ferraro, Matteo Bargagli ,Alberto Trinchieri and Giovanni Gambaro: Risk of Kidney Stones: Influence of Dietary Factors, Dietary Patterns, and Vegetarian–Vegan Diets.