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Kidney Stones: Disease condition, Treatment and Ayurvedic View

A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract.

As the kidneys filter waste from the blood, they create urine. Sometimes, salts and other minerals in urine stick together to form small kidney stones. These range from the size of a sugar crystal to a ping pong ball, but they are rarely noticed unless they cause a blockage. They may cause intense pain if they break loose and push into the ureters, the narrow ducts leading to the bladder.

Image source — 128660567@N08

 

A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, you may experience these signs and symptoms:

 

  • Severe pain in the side and back, below the ribs
  • Pain that radiates to the lower abdomen and groin
  • Pain that comes in waves and fluctuates in intensity
  • Pain on urination
  • Pink, red or brown urine
  • Cloudy or foul-smelling urine
  • Nausea and vomiting
  • Persistent need to urinate
  • Urinating more often than usual
  • Fever and chills if an infection is present
  • Urinating small amounts

Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract.

Causes — Kidney stones often have no definite, single cause, although several factors may increase your risk.
Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.

 

Types of kidney stones — Knowing the type of kidney stone helps determine the cause and may give clues on how to reduce your risk of getting more kidney stones. If possible, try to save your kidney stone if you pass one so that you can bring it to your doctor for analysis.

Types of kidney stones include:

  • Calcium stones — Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food and is also made daily by your liver. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate content.
    Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine.
    Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain migraine headaches or with taking certain seizure medications, such as topiramate (Topamax).
  • Struvite stones — Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
  • Uric acid stones — Uric acid stones can form in people who don’t drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.
  • Cystine stones — These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).

Diagnosis – If your doctor suspects you have a kidney stone, you may have diagnostic tests and procedures, such as:

  • Blood testing — Blood tests may reveal too much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
  • Urine testing — The 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances. For this test, your doctor may request that you perform two urine collections over two consecutive days.
  • Imaging — Imaging tests may show kidney stones in your urinary tract. Options range from simple abdominal X-rays, which can miss small kidney stones, to high-speed or dual energy computerized tomography (CT) that may reveal even tiny stones.
    Other imaging options include an ultrasound, a noninvasive test, and intravenous urography, which involves injecting dye into an arm vein and taking X-rays (intravenous pyelogram) or obtaining CT images (CT urogram) as the dye travels through your kidneys and bladder.
  • Analysis of passed stones — You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what’s causing your kidney stones and to form a plan to prevent more kidney stones.

Risk factors — Factors that increase your risk of developing kidney stones include:

 

  • Family or personal history — If someone in your family has kidney stones, you’re more likely to develop stones, too. And if you’ve already had one or more kidney stones, you’re at increased risk of developing another.
  • Dehydration — Not drinking enough water each day can increase your risk of kidney stones. People who live in warm climates and those who sweat a lot may be at higher risk than others.
  • Certain diets — Eating a diet that’s high in protein, sodium (salt) and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.
  • Being obese — High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
  • Digestive diseases and surgery — Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the levels of stone-forming substances in your urine.
  • Other medical conditions — Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections.

Treatment – Treatment for kidney stones varies, depending on the type of stone and the cause.

Small stones with minimal symptoms — Most small kidney stones won’t require invasive treatment. You may be able to pass a small stone by:

  • Drinking water — Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
  • Pain relievers — Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
  • Medical therapy — Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.

Large stones and those that cause symptoms — Kidney stones that can’t be treated with conservative measures — either because they’re too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more-extensive treatment.

Procedures may include:

  • Using sound waves to break up stones —  For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).
    ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.
    ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract.
  • Surgery to remove very large stones in the kidney — A procedure called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.
    You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if ESWL was unsuccessful.
  • Using a scope to remove stones — To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter.
    Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.
  • Parathyroid gland surgery — Some calcium phosphate stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam’s apple. When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result.Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone. Removing the growth from the gland stops the formation of kidney stones. Or your doctor may recommend treatment of the condition that’s causing your parathyroid gland to overproduce the hormone.

 

Medication — There are prescription medications that can help the body pass a kidney stone. Drugs known as alpha-blockers relax the walls of the ureter. This widens the passages so a stone can fit through more easily. Side effects are generally mild and may include headache or dizziness. Other types of medications can help prevent new stones from forming.

Shock Wave Therapy — The most common medical procedure for treating kidney stones is known as extracorporeal shock wave lithotripsy (ESWL). This therapy uses high-energy shock waves to break a kidney stone into little pieces. The small pieces can then move through the urinary tract more easily. Side effects can include bleeding, bruising, or pain after the procedure.

Ureteroscopy — When a stone has made its way out of the kidney and is close to the bladder, the most common procedure is ureteroscopy. A thin tube is passed through the urinary tract to the location of the stone. A surgeon breaks up the stone and removes the fragments through the tube. No incisions are made in the body. For very large stones, surgical procedures may be needed.

Lifestyle changes —

You may reduce your risk of kidney stones if you:

  • Drink water throughout the day — For people with a history of kidney stones, doctors usually recommend passing about 2.6 quarts (2.5 liters) of urine a day. Your doctor may ask that you measure your urine output to make sure that you’re drinking enough water.
    If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you’re likely drinking enough water.
  • Eat fewer oxalate-rich foods — If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper and soy products.
  • Choose a diet low in salt and animal protein — Reduce the amount of salt you eat and choose nonanimal protein sources, such as legumes.
  • Continue eating calcium-rich foods, but use caution with calcium supplements — Calcium in food doesn’t have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise.

 

 

In Ayurveda –

In Ayurvedic literature it is referred as Mutrashmari. Mutra means urine, Ashmari means stone. It is a troublesome complaint which may become an emergency at any point of time. Though it is a structural condition, Ayurveda offers varieties of remedies and treatment regimen. Let us have a look.

 

Home remedies for kidney stones–

  • Mix 1 teaspoon of Basil leaves juice with 1 teaspoon of honey, mix, take it early in morning
  • Take 4 teaspoon horse gram, add half litre of water, hit his mixture up to it reduces to one fifth, collect soup, add 2 teaspoon crushed pomegranate seeds, mix, filter and take once a day.
  • Take glass of tomato juice with pinch of salt and pepper every morning.
  • Take watermelon juice daily.
  • Take glass of lemon juice 4 times a day.
  • Take 3 g Gokshura and 7 g Kulthi (horse gram), soak for 6 hours in a liter of water, in morning boil to reduce half, filter and take this in a day at regular intervals.
  • Boil 2 figs- Anjeer in a cup of water and take it in early morning.
  • Regularly take celery.
  • Drink plenty of purified water, coconut water, barley water every day.

Causes for Kidney stones as per Ayurveda –

In Ayurveda, since from the Dhanwantari it is known and illustrated well. Dhanwantari had explained it as a “Mutra Asmari” meaning urinary calculi. After him in the Ayurveda texts- Ashtanga Hridaya, Sushrut sanhita etc also explained in detail the causes, symptoms, diagnosis, precautions, and treatment.

 

As per these references the causes are determined by the factors like –

  • Apathya Aahara (unwholesome/ odd food)
  • Low water consumption.
  • Urinary tract infection.
  • Mutravirodh, Shodhana dosha (resistance in the urine elimination)
  • Chemical drugs.
  • Idiopathy etc.

Ayurvedic classical literature have emphasized two important factors as the reasons for urinary calculi.

Improper body detoxification(aamashodhana): If the person indulges in unwholesome food and habits for long and suppresses the natural urges like urination, bowel habits etc naturally the toxins are retained in the body. Ultimately they are sediment and precipitate in the bladder which is the organ related to the expulsion of kleda (moisture) from the body.

Improper food habits (apathya sevana): Untimely eating, over eating, indigestion, unwholesome food and beverages, sedentary lifestyle, less intake of water etc cause improper evacuation of the metabolic wastes. Thus they are deposited in the path way of excretory systems leading to kidney stones.

Other than this,
heavy exercise(ati vyayama) leading to dryness of the body,
spicy food(vidahi ahara),
strong medicines (teekshnoushadha),
dry food (rooksha ahara),
excess walking (ati adhwa),
riding the vehicles/horses(ashwa yana),
non vegetarian diet (mamsala ahara),
loss of sleep (nidra alpata),
salty food (lavana ahara) etc also stand as the supporting factors for Urinary calculi.

Line of treatment of Urinary calculi —

  • Mild oleation(snehana),
  • Medicines which are penetrative (teekshna ushna) and break the stones (ashmari bhedana),
    diuretics(mutrala dravyas) – to flush out the small sized kidney stones,
  • sufficient water intake, watery food intake,
  • coolants (sheetala upachara) and remedies to balance Vata (vatahara upachara) are helpful to relieve Ashmari (Urinary calculi).

According to the Dosha imbalance each variety of calculi is treated easily and successfully.

Single drugs useful in Urinary calculi —

  • Pashanabheda – Bergenia ligulata (Wall.) Engl.
  • Shunti – Ginger – Zingiber officinale Rose.
  • Varuna – Crataeva nurula Buch-Hem.
  • Shigru – Moringa – Drumstick tree – Moringa oleifera Lam.
  • Gokshura –Tribulus – Tibulus terrestris Linn.
  • Punarnava – Boerhavia diffusa Linn.
  • Kooshmanda –Winter Melon– Benincasa hispida (Thunb.) Cogn.
  • Shatavari – Asparagus racemosus Willd.
  • Kadali – Stem of banana – Musa paradisiacal Linn.
  • Kutaja– Holarrhena antidysenterica (Linn.) Wall. Ex. G. Don.
  • Sukshma Ela – Cardamom – Eletharia cardamomum Matom.
  • Trapusha – Cucumis sativus Linn.
  • Kulattha – Horse gram – Macrotyloma uniflorum (Lamk.) Verdc.
  • Shilajit – Asphaltum punjabinum
  • Shaka – Tectona grandis Linn. F.
  • Ervaru – Cucumis melo
  • Karpasa – Cotton tree – Gossypium herbaceum Linn.
  • Tinduka – Diospyrus peregrine (Gaertn.) Gurke.

Formulations useful in Urinary calculi —

1. Pashanabhedi kashaya
2. Varanadi Kashayam
3. Veerataradi kashaya
4. Chandraprabha Vati
5. Punarnavashtaka Kashayam
6. Punarnavadi kashaya
7. Punarnavadi Guggulu
8. Gokshuradi Guggulu
9. Elakanadi Kwatha
10. Trivikarma Rasa
11. Shilajatu vati
12. Jawaharmohra Pishti
13. Godanti (karpoora shilajatu) bhasma

 

Ideal diet for kidney stones –

  • Mushrooms, germinated beans, pulses, wheat, bajra, green peas, karela, sugar, jam, green chillies, papaya, mango, apple, wheat bran, bengal gram floor.
  • Ushnodaka (Warm water) – As per ayurveda, hot water relieves Vata and soothens the inner mucous membrane.
  • Phalgu (Ficus carica Linn.)
  • Draksha (Vitis vinifera Linn.)
  • Ervaru (Cucumis melo)
  • Purana shali (older rice)
  • Mudga yusha (green gram soup)
  • Sita (sugar candy)
  • Takra(buttermilk)
  • Peya (water) – drinking good amount of water throughout the day.
  • Kushmanda (ash gourd)
  • Narikela (coconut water)
  • Amalaki (goose berry) etc

Unwholesome diet and habits —

  • Milk, milk derivatives, vanaspati ghee, tea , coffee, eggs, green vegetables, non veg having bones, crabs, etc.
  • Heavy exercise (Ati vyayama), increases Vata and dryness of the body
  • Suppression of the natural urges (Vegadharana) – leads to urine retention in urinary bladder for a long period of time, leading to sedimentation.
  • Dry food (Shushkahara-Rukshahara)
  • Grain flour (Pishtaanna)
  • Exposure to breeze (Pravata sevana)
  • Working in sunshine (Arkatapa)
  • Excess of sexual indulgence (Ati vyavaya)
  • Kapittha( Limonia elephantianum (Correa) Panigrahi.)
  • Jamboo – Jamun seeds – (Syzygium cumini (Linn.) Skeels.)
  • Bisa (Nelumbo nucifera Gaertn.)
  • Excess of astringent food (Kashaya rasa sevana)

Ashmari (Urinary calculi) is a dreadful disease and its pain is intolerable and often it is irritant and disturbs normal day-to-day activities. After manifestation of urinary calculi, the victim should be very careful about his/her food and habits.

The altered food habits, busy life schedules and less intake of water or consumption of salty and packed foods are the true reasons for the kidney stones as well as worsening of the disease.

The sedentary lifestyle and intake of chilled water is the another major reason for this complaint. Even though role of chilled water in the causation of calculi is evident, much scientific explanations are not available in this regard. But Ayurvedic classics have emphasized that warm water acts as Basti shodhaka (clear the bladder) and hence it is worth to take luke warm water in case of Urinary calculi.

Ayurvedic medicines for kidney stones —

Ayurvedic remedies are given as per situations considering the stages.

First stage – ( sever pains in the abdomen region- Vatahar chikitsa)
Second stage– (burning at urination – Pittahara chikitsa)
Third stage – ( Obstructed urination– Kaphahara chikitsa)

First stage remedies —
At this stage diuretics and analgesic remedies are given. These are Gokhru- Gokshura powder (puncturepine), Varuna powder (caper tree), Kulthi powder (Dolichos biforus linn) Safed Musli powder, , etc.

Second stage remedies –
Along with first stage remedies, punarvasa, varnadav, pashan bhedi, kolilaksh, mako- solenum nigrum, , etc.

Third stage remedies –
At this stage remedies for bursting the stones are given are- Kokilaksh, punarnava, avipathi, hingavasad, ardhbilva, balpunarnava, chandraprabha, gomutraharitaki, vatsamayantaka, dantaharitaki, pravalbhasma, abhrak bhasma, shilajit, chandanasava, kalyankshar. Etc.

Conclusion:-

  • Kidney stones are formed due to the worse lifestyle, uncontrolled diet.
  • Water quality is also responsible.
  • More than 95% of calculi can be bursted and expel out without surgery by Ayurvedic remedies.
  • In the emergency for acute cases only surgery may be recommended because it is very expensive for poor peoples.
  • Balanced diet can protect from calculi formation.
  • Regularly panchakarma in every year keeps away from kidney stone.
  • Also after any surgery, regularly intake of Ayurvedic remedies can avoid chances of repetitions of calculi formation

 

 

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