In vitro litholytic activity of extracts and phenolic fractions of some medicinal plants on urinary stones

Objective: This study was carried out to evaluate the efficiency of plant extracts used in traditional medicine on the dissolution of oxalo-calcic and cystine stones. Also, the efficiency of phenolic fractions (Tannins and Flavonoids) for the plants that gave us the best stone dissolution rate. Subjects and methods: Kidney stone of oxalo-calcic and cystine stones were incubated in vitro for 8 weeks in the presence of five plants extracts (hydro-ethanolic and aqueous extracts). NaCl solution (0,9 %) used as negative control and sodium citrate solution at 3 mM/L as a positive control. The studied plants were Herniaria hirsuta L. aerial parts, Opuntia ficus-indica L. flowers, Zea mays L. stigmata, Ammi visnaga L. seeds and Ziziphus lotus L. fruits. After 2, 4, 6 and 8 weeks the stones were weighed after 18 h drying at 40°C and the dissolution rate of the stones and the pH of the solution were measured.Results: After eight weeks, all the plant extracts and phenolic fractions had revealed a significant effect to dissolve oxalo-calcic and cystine stones in comparison to the control solutions. The best result of cystine stones was showed with aqueous extract of H. hirsuta aerial parts which had a dissolution rate of 88,91 %. Concerning the dissolution rate of oxalo-calcic stones the aqueous extract of Z. mays had the best results with 68 % against 19 % for the sodium citrate solution. The dissolution rate of the fractions studied showed a better result for Z. mays flavonoids fraction toward oxalo-calcic stones, and Z. mays tannins fraction for cystine stones. The pH undergoes a non-negligible linear increase over the eight weeks for all extracts and phenolic fractions and both kidney stones.Conclusion: The tested plants' extracts and the phenolic fractions for the plants that gave us the best stone dissolution rate were able to dissolve oxalo-calcic and cystine stones. To confirm the efficiency of these plant extracts on the treatment of oxalo-calcic and cystine stones multiple in vivo tests could be made.

Diagnosis and management of uric acid nephrolithiasis

The aim is to provide an account of the diagnosis & management of uric acid stones. Material & methods: A search was made on the topic of uric acid stones with regard to the diagnosis & management of uric acid stones. Results: The incidence of uric acid stones varies between countries and account for 5% to 40% of all urinary calculi. Uric acid stone cannot be seen on x-ray. Intra venous uroghraphy, CT scan or sonoghraphy is required for their diagnosis. This is the only stone that can be reliably dissolved by urinary alkalization with alkali (Bicarbonates, citrate). This medical treatment is highly effective resulting in dissolution of existing stones & prevention of stones. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotripsy can be used successfully for uric acid stones. Open surgery is still performed especially for large complicated staghorn stones. Conclusion: Medical management with urinary alkalization for uric acid stone dissolution and prevention of recurrence is effective.

Effect of Ursodeoxycholic Acid Alone and Ursodeoxycholic Acid Plus Domperidone on Radiolucent Gallstones and Gallbladder Contractility in Humans

Background/Aims. The aim of this study was to compare the effects of ursodeoxycholic acid (UDCA) alone and UDCA plus domperidone on dissolution of solitary or multiple gallstones.Methods. Fifty-three patients with cholesterol gallstones were randomized into three treatment groups: group I () was given UDCA (15 mg/kg/day) alone and group II () was treated with domperidone (30 mg/day) in addition to UDCA. The control group () was followed without a medical treatment. Gallbladder volumes and ejection fractions were measured sonographically in all patients before and after treatment.Results. After 12 months of treatment, stone dissolution was found in 9 (40.9%) of the patients in group I and 7 (38.8%) of the patients in group II. The difference was statistically significant compared to controls in both treatment groups () but the two groups did not show a difference between each other (). All the patients that achieved dissolution had multiple gallstones except for one patient with a solitary stone in group I. Neither monotherapy of UDCA nor the combination with domperidone affected the ejection fraction of gallbladder.Conclusions. Combination with domperidone did not potentiate the efficacy of UDCA. It has been observed that both UDCA alone and UDCA plus domperidone treatment did not affect ejection fraction of gallbladder.

A diet with a struvite relative supersaturation less than 1 is effective in dissolving struvite stones in vivo

Magnesium ammonium phosphate (struvite) is one of the most common minerals found in feline uroliths. Previous studies have shown the efficacy of acidifying calculolytic diets (inducing urine pH < 6·5), in dissolving struvite stones in cats. Recent work in our laboratory found that wet and dry test diets induce a struvite urinary relative supersaturation (RSS) < 1 and that the urine of healthy cats fed the dry test diet dissolved feline struvite stones in vitro. The objective of the present study was to demonstrate the efficacy of those test diets on naturally occurring struvite urocystoliths in cats. A total of twenty-one cats were used, of which seventeen completed the study. Of the seventeen cats, eight were fed the wet test diet and nine the dry test diet. Uroliths dissolved in a median of 18 (10–55) d. In the remaining four cats, uroliths failed to dissolve and were removed surgically. Quantitative analysis showed that these uroliths contained either calcium oxalate or calcium phosphate. The present study demonstrates that diets that induce a struvite RSS < 1 result in struvite stone dissolution in vivo.