In vitro studies reveal antiurolithic effect of Terminalia arjuna using quantitative morphological information from computerized microscopy

ABSTRACT Purpose: For most cases, urolithiasis is a condition where excessive oxalate is present in the urine. Many reports have documented free radical generation followed by hyperoxaluria as a consequence of which calcium oxalate (CaOx) deposition occurs in the kidney tissue. The present study is aimed to exam the antilithiatic potency of the aqueous extract (AE) of Terminalia arjuna (T. arjuna). Materials and Methods: The antilithiatic activity of Terminalia arjuna was investigated in vitro nucleation, aggregation and growth of the CaOx crystals as well as the morphology of CaOx crystals using the inbuilt software ‘Image-Pro Plus 7.0’ of Olympus upright microscope (BX53). Antioxidant activity of AE of Terminalia arjuna bark was also determined in vitro. Results: Terminalia arjuna extract exhibited a concentration dependent inhibition of nucleation and aggregation of CaOx crystals. The AE of Terminalia arjuna bark also inhibited the growth of CaOx crystals. At the same time, the AE also modified the morphology of CaOx crystals from hexagonal to spherical shape with increasing concentrations of AE and reduced the dimensions such as area, perimeter, length and width of CaOx crystals in a dose dependent manner. Also, the Terminalia arjuna AE scavenged the DPPH (2, 2-diphenyl-1-picrylhydrazyl) radicals with an IC50 at 13.1µg/mL. Conclusions: The study suggests that Terminalia arjuna bark has the potential to scavenge DPPH radicals and inhibit CaOx crystallization in vitro. In the light of these studies, Terminalia arjuna can be regarded as a promising candidate from natural plant sources of antilithiatic and antioxidant activity with high value.

Growth inhibition of struvite crystals by the aqueous root extract of Rotula aquatica.

Formation of urinary stone is a serious and debilitating problem throughout the world. In the present study, the inhibitory effect of aqueous extract of root of Rotula aquatica was investigated against struvite crystals (one of the components of urinary stone) grown in vitro using single diffusion gel growth technique. For setting the gel, sodium metasilicate solution (specific gravity 1.05) and 0.5 M aqueous solution of ammonium dihydrogen phosphate were mixed, so that the pH of the mixture could be set at 7.0. Equal amounts of supernatant solution of magnesium acetate (1.0 M) prepared with 0.0%, 0.5% and 1% concentrations of the extract were gently poured on the set gels. It was observed that the number, dimension, total mass, total volume, growth rate and depth of growth of struvite crystals decreased with the increasing extract concentrations in the supernatant solutions. The enhancement of dissolution rate and fragmentation of struvite crystals suggested potential application of the extract for inhibition of struvite type urinary stone.

Use of traditional Chinese medicine in the management of urinary stone disease: [review]

Objective: To assess the evidence-based literature supporting the use of traditional Chinese medicine Kampo herbal and Acupuncture in stone disease management. Materials and Methods: Four of the most commonly used herbal components of Kampo medicine in the treatment of stone disease are described according to their in vitro and in vivo effects. We also reviewed the role of Acupuncture in urologic clinical setting as well as its proposed mechanisms of action and results. Medline database was assessed using isolated and conjugated key words (Chinese Medicine, Kampo, Chinese Herbal, Calculi, Stone Disease, Kidney, Acupuncture, Herbal Medicine). Articles were reviewed and summarized. Results: Herbal medicine has been proven to be free from side-effects and therefore suitable for long term use therapy. Its antilithic beneficial effects include increased urinary volume, increased magnesium excretion (Takusya), inhibitory activity on calcium oxalate aggregation (Takusya, Wulingsan and Desmodyum styracyfolium), inhibition of calcium oxalate nucleation and hydroxyapatite internalization (Wulingsan). In contrast, acupuncture, has shown to be effective as a pre-treatment anxiolytic and analgesic during colic pain and extracorporeal shock wave lithotripsy treatment, reducing the need for complementary sedative drugs. Conclusion: Chinese traditional medicine is promising as regards its role in stone prevention. An effort must be made in order to standardize study protocols to better assess acupuncture results since each procedure differs in regards to selected acupoints, electrostimulation technique and adjunct anesthetics. Similarly, standardization of Kampo formulations and acceptable clinical endpoints (imaging vs. symptomatic events) is needed.

Effect of aloe (Aloe vera Linn.) on healthy adult volunteers: changes in urinary composition.

OBJECTIVE: 1. To investigate the amount of citrate and tartrate in aloe gel, and in the urine of healthy normal volunteers, before and after consuming fresh aloe gel. 2. To evaluate the changes in the chemical composition of urine among subjects after taking aloe gel. 3. To determine the value of consuming aloe gel for prevention of renal stone formation. DESIGNS: Experimental study; before and after experiment with no control group MATERIAL AND METHOD: Thirty one healthy male medical students between 18 and 23 years of age were enrolled (with informed consent) in the clinical trial. Subjects ingested 100 g of fresh aloe gel twice a day for seven consecutive days. The 24-hr urine was collected one day prior to taking the gel (Day 0), Days 2 and 5 of consumption, and Day 8 (one day after completion). The authors determined the urine volume, osmolality, potassium, sodium, phosphate, calcium, magnesium, uric acid, citrate, tartrate, oxalate, Permissible Increment in calcium (PI in calcium), Permissible Increment in oxalate (PI in oxalate), Concentration product ratio of calcium phosphate (CPR of CaPO4) and the citrate per creatinine ratio. RESULTS: The citrate and tartrate concentration in 100 g of fresh aloe gel was 96.3 and 158.9 mg, respectively. The urinary excretion of oxalate was significantly decreased (p < 0.05). The PI in calcium was significantly increased (p < 0.05), while the citrate excretion and PI in oxalate were consistently, albeit non-significantly, increased. The mean CPR values of CaPO4 were decreased non-significantly. The other measurements were unremarkable. CONCLUSION: Fresh Aloe vera gel (100 g) contains 96.3 mg of citrate and 158.9 mg of tartrate. This is mid-range for Thai fruits. Changes in chemical compositions of urine after aloe consumption shows its potential for preventing kidney stone formation among adults.

review of urinary stone analysis techniques

Knowledge of the chemical composition and structure of urinary stones is of great value in the choice of treatment and prevention of recurrence. This is a brief review and a comparative study of the principles and practical application of various chemical and physical techniques used for urinary stone analysis. The different methods of classifying and grouping urinary stones by results of chemical analytic techniques are, also, compared and evaluated. In addition to reviewing various techniques used for the in-vitro analysis of removed stone samples, the newly emerging physical and radiological techniques for the in-vivo intact-stone analysis are, also, evaluated. These in-vivo techniques, particularly the rapidly advancing unenhanced spiral CT scanning, represent an important step forward towards the notion of non- destructive analysis of urinary stones while still in situ before the choice of treatment modality

Chemical composition of urinary stones in Rahim Yar Khan and adjacent districts of Sindh and Baluchistan

To find out the constituents of the urinary stones, so that preventive measures would be taken against recurrence. A total No. of 200 consecutive patients with upper urinary tract calculi, that were operated in the urology and general surgical wards of Sh. Zayed Hospital Rahim Yar Khan were included in the study. In addition to Rahim Yar Khan the patients also came from adjacent districts of Sindh and Baluchistan. Qualitative Chemical analysis was carried out using Merchognost [Germany] urinary calculi analysis kit. All the tests were performed according to the instruction of manufacturers of the kit. Stone samples were collected from 200 patients, out of these 138 [69%] were male and 62 [31%] of patients were female with male to female ratio 2.2:1 age range was between 9-72 years. Results of stone analysis indicate that calcium oxalate is the most common ingredient found in 100% of the stone samples. In 83% of patients it was found mixed with other varieties of stones while in 17% samples it was seen in pure form. Uric acid was the second most common ingredient seen in 73% of patients mixe d with calcium oxalate and magnesium ammonium phosphate but it was not found as pure form. Magnesium Ammonium phosphate found in 13% of stones samples in mixed form only, not as isolated stone

Calculse de vias urinárias em ambulatório do sistema único de saúde - estudo de modelo de atendimento em saúde pública / Urolithiasis in public health services - a prevention protocol for outpatients

Objetivo :A calculose de vias urinarias apresenta altos níveis de incidência e recorrência, segundo dados de literatura, importando em gastos para o sistema de saúde. Métodos Foram analisadas retrospectivamente 2.648 consultas realizadas em ambulatório público desenhado para o atendimento de pacientes com litíase, no Ambulatório de Especialidades do Sistema único de Saúde em Ribeirão Preto, cidade de médio porte no interior do estado de São Paulo e que apresenta a maior concentração de médicos por habitantes do país. Resultados:Apresenta-se a prevalência, alguns aspectos epidemiológicos, clínicos, de tratamento e do seguimento da urolitíase. Discussão :Ressalta-se que, quanto ao estudo da doença, há o limite imposto pela atividade exercida em ambulatório público, considerando-se a pesquisa de calciúria, oxalúria e uricosúria. Enfatiza-se o alto nível de abandono e a pronta resolutividade do método. Conclusões :Propõe-se uma atividade que nao resulte em gastos adicionais para o Estado, exercida por neurologista e com enfoque na prevenção da doença, utilizando um protocolo de atendimento desenhado para o sistema público.

Tratamiento metafiláctico (preventivo) en los principales tipos de litiasis urinaria / Metaphilactic treatment (preventive) in types essential of urinary lithiasis

Este trabajo de investigación tiene como objetivo primordial, destacar la gran importancia que tiene el tratamiento metafiláctico (tratamiento preventivo), en la evolución clínica de los pacientes afectados de cálculos urinarios. Son una serie de medidas que persiguen un fin claro y útil, que es evitar en lo posible la reformación de cálculos dentro de las vías urinarias, con la posibilidad de complicaciones de variados grados, que comprometerían al final, la salud renal y la salud general del paciente afecto de este tipo de patología urológica. Con un fin didáctico y de fácil aprendizaje dividiré dichos tratamientos, de acuerdo al tipo de cálculo en particular. Se debe hacer hincapié que el tratamiento de los cálculos urinarios no empieza y termina con la remoción del cálculo. Por el contrario, se debe realizar una exhaustiva pesquisa de laboratorio (con sistemáticas especiales) para determinar con precisión, tanto a nivel sérico, como a nivel urinario, qué tipo de trastorno metabólico tiene el paciente, qué le está ocasionando el cuadro de litiasis urinaria, muchas veces a repetición. Y que después de la posible y necesaria extracción del cálculo en las vías urinarias, vendrá un aspecto que, sin duda alguna, es el menos conocido y por lo tanto el menos utilizado, como es el tratamiento preventivo o metafiláctico a través de una serie de argumentos médicos, dietéticos y de hábitos en general y que presenta en la mayoría de los casos, la diferencia entre un paciente "curado" y un paciente con episodios de litiasis recidivante, lo cual afectará negativamente la calidad de vida de dicho paciente

Steinstrasse, prevention and management

Four hundred patients who attended stone centre were chosen with inclusion criteria and randomly allocated in two groups. Group [I] in which JJ stent was inserted prior to extracorporeal shock wave lithotripsy [ESWL] and Group [II] without JJ stent insertion. Out of these 400 patients, 38 patients developed steinstrasse [group [I] 6% and group [II] 13%]. Presenting symptoms varied from symptomless up to obstruction and sepsis. Treatment programs were not predetermined but dependant upon the hotness of progression. Follow up, ESWL to leading stone, retrograde manipulation, precutaneous nephrostomy and open surgery were attempted in this series according to certain indications. In conclusion Certain measures must be fulfilled to prevent steinstrasse formation debulking of large stone, stenting and to do shaving of the stone from distal part to facilitate regular expulsion of stone debris

Diagnóstico, prevención y tratamiento de la litiasis renal y de vías urinarias / Diagnosis, prevention and treatment of renal lythiasis and the urinary tract

La litasis de riñón y vías urinarias representa un grave problema de salud pública, por tanto, merece un abordaje sistematizado para evitar su recurrencia mediante métodos de diagnóstico precisos que orientan terapia eficaz. En este trabajo se revisan los resultados de un protocolo que se diseñó para establecer las causas metabólicas responsables de litogenicidad en 626 pacientes estudiados en dos etapas: I (1979-1987) 185 casos. En la etapa I el protocolo incluyó determinaciones en suero y orina de 24 hs de electrolitos, iones divalentes, fosforo, ácido úrico, cistina, filtración glomerular, evaluación del funcionamiento paratiroideo con hormona paratiroidea, Tm fosfato y a partir de 1982 (Ia) con AMP cíclico antes y después de una carga oral de calcio. En la etapa II se añadieron determinaciones de inhibidores de la nucleación de cristales (magnesio y citrato) y de promotores de la misma (oxalato). En 185 casos de la etapa I se desmostró en el 88.2 por ciento de los pacientes alguna variedad de trastorno metabólico, en la etapa II se detectó alguna alteración metabólica en el 96.2 por ciento de los casos. El 55 por ciento de los casos acudieron dos años al seguimiento y el 39 por ciento acudieron hasta cuatro años. El número de cálculos expulsados por paciente por año antes del estudio fue de 2.8 y durante el tratamiento se redujo a 0.8. La elevada eficiencia diagnóstica y la vigilancia sistematizada del tratamiento durante los tres años que siguieron al diagnóstico, resultaron en un abatimiento significativo de la producción de cálculos en este nutrido grupo de pacientes, lo cual justifica la integración de este protocolo a la Clínica de Litiasis Renal y de Vías Urinarias

Incidência de litíase renoureteral em leituristas da regional de Säo José do Rio Preto, Companhia Paulista de Força e Luz

Foram estudados 36 "leituristas" de uma Empresa de Energia Elétrica, a Companhia Paulista de Força e Luz, onde encontramos alta incidência de litíase renoureteral (25%). Este grupo de empregados está sujeito a um tipo de trabalho que é realizado em ambiente externo, com altas temperaturas e com baixa ingesta hídrica. Com estas dificuldades e com a grande incidência, resolvemos estudar melhor este grupo, com o propósito de esclarecer sua etiologia. Entre as causas encontradas, as principais foram as alteraçöes metabólicas associadas a fatores próprios da funçäo, tais como sudorese excessiva e a baixa ingesta hídrica, sendo estes considerados como litogênicos. Com este quadro, a proposiçäo nossa é dar sequência para um melhor esclarecimento das causas metabólicas, bem como uma orientaçäo adequada da quantidade hídrica que deve ser ingerida durante sua jornada de trabalho