Effect of Cystone® on urinary composition and stone formation over a one year period

Cytochrome P450 inhibition activities of non-standardized botanical products

ETHNOPHARMACOLOGICAL RELEVANCE

R-tab, H-tab and E-cap botanical products are used for the treatment of various ailments. R-tab is traditionally prescribed for improving urination, H-tab is for relieving piles, hemorrhoids, fissures, and rectal inflammation and E-cap is for regulating menstruation.

AIMS OF THE STUDY

To extract the botanical products and determine their potential interaction with the cytochrome P450 (CYP1A2, CYP2D6 and CYP3A4) enzymes.

MATERIALS AND METHODS

R-tab, H-tab and E-cap botanical products were first extracted using solvents and analyzed using HPLC and LC-MS/MS. The effects of methanol extracts on the cytochrome induction and inhibition activities were determined using a series of in vitro assays, including multiplex RT-qPCR, CYP activity assays (P450-Glo™) and LC-MS/MS-based assays. For the CYP induction assay, omeprazole, rifampicin and dexamethasone were used as CYP1A2, CYP2D6 and CYP3A4 inducers, respectively. Ketoconazole and acetaminophen were used as positive and negative controls for the CYP3A4 inhibition assay, whereas furafylline and ketoconazole were used as positive and negative controls for the CYP1A2 inhibition assay.

RESULTS

All three botanical products did not show any significant induction in CYP1A2, CYP2D6 and CYP3A4 mRNA expression. By contrast, R-tab inhibited the mRNA expression of CYP1A2 significantly from the lowest concentration of 0.01 μg/mL, while, H-tab inhibited the mRNA expression of CYP1A2 and CYP3A4 from 0.1 μg/mL. Based on the P450 Glo assays, E-cap extract inhibited the metabolic activity of CYP1A2 with an IC₅₀ value of 37.24 μg/mL. On the other hand, R-tab, H-tab and E-cap showed inhibitory effects on the CYP3A4 enzymatic activity with IC₅₀ values of 17.42, 18.20 and 20.60 μg/mL, respectively. However, using the LC-MS/MS-based methods, the concentration-dependent effects of R-tab and H-tab extracts on the metabolism of testosterone appeared to be more prominent, with IC₅₀ values of 51.90 and 56.90 μg/mL as compared with the rest of the results, which were all above 100 μg/mL CONCLUSION: The CYP3A4 mRNA and enzymatic activity were moderately inhibited by R-tab and H-tab. Methanol extract of botanical products in solid dosage forms can be evaluated for their herb-drug interaction risks using in vitro assays and may provide the minimum data required for safety labeling.

Efficacy of Ficus tikoua Bur. extract in ethylene glycol-induced urolithiasis model in SD rats

The development of new herbal preparations for the treatment of urolithiasis is an urgent task of medical science. Ficus have attracted the attention of pharmacologists due to a wide range of biological properties, including antioxidant, anti-inflammatory, antibacterial and antifungal activity. We studied the effectiveness of Ficus tikoua Bur. in SD rats in which urolithiasis was induced by 6 weeks of oral administration of ethylene glycol 0.5% ad libitum instead of drinking water. Administration of the extract of Ficus tikoua Bur., as well as comparative drug Cystone® after modeling of urolithiasis lead to the restoration of diuresis and the concentration of inorganic phosphates starting from the 6th week of the experiment. The use of the Ficus tikoua Bur. extract for 6 weeks, both during the modeling of urolithiasis and during the recovery period, led to the restoration of the percentage of lymphocytes in the blood, content of sodium, chlorine and inorganic phosphates in the blood to the control level. Thus, the extract of Ficus tikoua Bur. seems to be a promising drug for effective treatment of the initial stages of the development of urolithiasis.

Efficacy of cystone versus tamsulosin in treatment of stent-related lower urinary tract symptoms

Objective:

Double-J stent is a common tool used in urological procedures that is inserted for 2–6 weeks, but it may induce abdominal and flank pain, incontinence and irritative urinary symptoms. Alleviation of such symptoms would be useful to improve the patients’ quality of life. Accordingly, in this study, the efficacy of cystone versus tamsulosin in the treatment of double-J stent-related lower urinary tract symptoms was determined.

Materials and methods:

In this randomised clinical trial, 128 patients who required double-J stent insertion after transureteral lithotripsy during 2018–2019 were enrolled. They were randomly assigned to receive either cystone, tamsulosin, both, or placebo. The international prostate symptom score and visual analogue score data were recorded at baseline, after 2 and 4 weeks across the groups.

Results:

The international prostate symptom score and visual analogue score factors were statistically different across the case groups receiving cystone, tamsulosin and both drugs versus placebo ( P=0.001). Two weeks after drug administration, the visual analogue score and international prostate symptom score were not statistically different in the tamsulosin, cystone and dual therapy groups; however, after 4 weeks the cystone group had the lowest symptoms.

Conclusion:

Both tamsulosin and cystone are efficient drugs which would relieve stent-related lower urinary tract symptoms. The administration of cystone with or without tamsulosin for 4 weeks may have the best result in reducing the visual analogue score and international prostate symptom score. Level of evidence: Level I, 1b, therapeutic study, randomised controlled trial

Acceleration of Wound Healing in Diabetic Rats through Poly Dimethylaminoethyl Acrylate-Hyaluronic Acid Polymeric Hydrogel Impregnated with a Didymocarpus pedicellatus Plant Extract

Wound is the major health problem associated with skin damages and arises because of various types of topical injuries. Furthermore, wounds in patients with diabetes take a relatively long time to heal. Currently, herbal medicines have been extensively used for wound care and management. Here, we engineered polymeric hybrid hydrogel of dimethylaminoethyl acrylate and hyaluronic acid (pDMAEMA-HA), which was impregnated with a herbal extract of Didymocarpus pedicellatus. The developed polymeric hybrid hydrogel system can be used for effective therapy of incurable wounds. Therefore, the development of D. pedicellatus-impregnated pDMAEMA-HA (pDPi-DMAEMA-HA) hybrid hydrogel was accomplished by the synthesis of pDMAEMA-HA hydrogel via the optimization of various reaction parameters followed by impregnation of herbal drugs D. pedicellatus. The developed hydrogel composite was well characterized via various techniques, and swelling kinetics was performed to analyze the water uptake property. The swelling ratio was found to be 1600% in both types of hydrogels. To evaluate the wound healing of these polymeric hydrogels, the Wistar rats full-thickness excision wound model was utilized. The healing strength of hydrogels was determined using measurement of wound contraction and histopathological study. The results of wound healing by these polymeric hydrogels revealed that animals treated with the pDPi-DMAEMA-HA hybrid hydrogel group were found to have a higher level of wound closure as compared to marketed formulation as well as polymeric hybrid hydrogel. The histopathologic examinations implied that pDPi-DMAEMA-HA hybrid hydrogel and polymeric hybrid hydrogel-treated groups exhibited enhanced cutaneous wound repair as well as high level of cellular repair and maintenance compared to the standard group because of hyaluronic acid roles in various stages of wound repair.

Effect of Herbal Formulation “Cystone®” on Urolithiasis

Context: The study aimed to systematically review the clinical data on the efficacy of Cystone® as an herbal treatment for urolithiasis. Methods: Full text randomized clinical trials comparing Cystone® with placebo or citrate in patients with urolithiasis for urinary stone prevention or treatment were evaluated. Three databases, including PubMed, Scopus, and Cochrane Library, were searched from January 2000 to December 2017. The main outcomes were the reductions in calculi number/size and urinary excretion rate of calcium, oxalate, and urate. The secondary outcome was the adverse effects of Cystone®. Documents were screened by two reviewers for eligibility. The Jadad score was used for quality assessment. The data were analyzed using the comprehensive meta-analysis version 2.2.064 software. Results: Of 532 relevant studies, five were finally included. Cystone® was effective in the decrement of stone size in comparison with placebo (95% CI: 0.63, 9.13). There was a significant difference in the excretion rate of uric acid but not calcium compared to the placebo. Cystone® had no significant side effects. Conclusions: Cystone® is more effective than a placebo in the treatment of urinary tract stones. It significantly induces stone size decrement and clearance compared to placebo. The low quality of reports is a major limitation in the applicability of these results.

Anti-urolithiatic and anti-inflammatory activities through a different mechanism of actions of Cissus gongylodes corroborated its ethnopharmacological historic

ETHNOPHARMACOLOGICAL RELEVANCE

Species Cissus gongylodes has been used in the traditional medicine in South America and India for the treatment of urolithiasis, biliary and inflammatory problems without any scientific evidence.

AIM OF THE STUDY

This work was developed to investigate for the first time the anti-inflammatory and anti-urolithiatic activities of leaf decoction of C. gongylodes.

MATERIALS AND METHODS

Decoction was subjected to anti-inflammatory evaluation by the in vivo assay of ear oedema and quantification of the main mediators of inflammation PGE₂ and LTB₄, and the cytokine TNF-α. The decoction's anti-urolithiatic activity was determined by different in vitro assays to evaluate the inhibition and dissolution of the most prevalent types of kidney stones: calcium oxalate (CaOx) and struvite. Diffusion in gel technique and fresh urine of a patient with renal stone were used to investigate the inhibition and dissolution of CaOx, respectively, and the single diffusion gel growth technique was used to evaluate the inhibition and dissolution of struvite crystals. The decoction was chemically characterized by UHPLC-ESI-HRMS analysis.

RESULTS

Decoction showed in vivo anti-inflammatory activity by potent decreasing the level of both the main mediators of inflammation and dose-dependent in vitro anti-urolithiatic action by inhibition and dissolution of both type of crystals, CaOx and struvite.

CONCLUSIONS

Results obtained corroborate the reports of the traditional use of the decoction of Cissus gongylodes. Besides, it showed multi-target mechanisms actions, inhibition of the main inflammatory pathways, and inhibition/dissolution of the most prevalent types of crystals on urolithiasis. These actions make the decoction a promissory source to the development of new and more efficient drugs.

Antiurolithiatic effects of pentacyclic triterpenes: The distance traveled from therapeutic aspects

Globally, approximately 12% of the population is inflicted by various types of urolithiasis. Standard treatments are available both to avert and treat urolithiasis, but with significant adverse side effects. Pentacyclic triterpenes represent a group of naturally occurring compounds which holds immense potential as therapeutic for treating kidney stone. This review aims to provide an integrative description on how pentacyclic triterpenes can effectively treat calcium oxalate urolithiasis through various mechanisms such as antioxidant, anti-inflammatory, diuretic, and angiotensin-converting enzyme inhibition. Some of the pentacylic triterpenes which shows promising activities include lupeol, oleanolic acid, betulin, and taraxasterol. Moreover, future perspectives in the development of pentacyclic triterpenes in formulations/drugs for urinary stone prevention are highlighted. It is anticipated that compiled information would serve as a scientific baseline to advocate further investigations on the potential of pentacyclic triterpenes in urolithiasis remediation.

Compound Characterization and Metabolic Profile Elucidation after In Vitro Gastrointestinal and Hepatic Biotransformation of an Herniaria hirsuta Extract Using Unbiased Dynamic Metabolomic Data Analysis

Herniaria hirsuta L. (Caryophyllaceae) is used for treatment of urinary stones and as a diuretic. Little is known about the active compounds and the mechanism of action. The phytochemical composition of H. hirsuta was comprehensively characterized using UHPLC-UV-HRMS (Ultrahigh-Performance Liquid Chromatography-Ultraviolet-High Resolution Mass Spectrometry) data. An in vitro gastrointestinal model was used to simulate biotransformation, which allowed the monitoring of the relative abundances of individual compounds over time. To analyze the longitudinal multiclass LC-MS data, XCMS, a platform that enables online metabolomics data processing and interpretation, and EDGE, a statistical method for time series data, were used to extract significant differential profiles from the raw data. An interactive Shiny app in R was used to rate the quality of the resulting features. These ratings were used to train a random forest model. The most abundant aglycone after gastrointestinal biotransformation was subjected to hepatic biotransformation using human S9 fractions. A diversity of compounds was detected, mainly saponins and flavonoids. Besides the known saponins, 15 new saponins were tentatively identified as glycosides of medicagenic acid, acetylated medicagenic acid and zanhic acid. It is suggested that metabolites of phytochemicals present in H. hirsuta, most likely saponins, are responsible for the pharmaceutical effects. It was observed that the relative abundance of saponin aglycones increased, indicating loss of sugar moieties during colonic biotransformation, with medicagenic acid as the most abundant aglycone. Hepatic biotransformation of this aglycone resulted in different metabolites formed by phase I and II reactions.

Evaluation of Diuretic and Antioxidant Properties in Aqueous Bark and Fruit Extracts of Pine

OBJECTIVE

The present study has been carried out to evaluate the diuretic and antioxidant properties of pine herb in an animal model.

MATERIALS AND METHODS

45 adult male rats were randomly divided into nine groups including: groups I (the negative control), groups II (positive control, furosemide 10 mg/kg), groups III to VIII (treatment groups received 100, 200, 400 mg/kg of the aqueous extracts of bark and fruit) and group IX received the combination of aqueous extract of bark (100 mg/kg) and the fruit (100 mg/kg). The urine output, glomerular filtration rate (GFR), electrolytes, urea, and creatinine levels were evaluated. Furthermore, the phenolic content and antioxidant activity of both extracts were also assessed using 2, 2-diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP) and Folin-Ciocalteu methods.

RESULTS

The aqueous extracts of the pine bark and fruit increased the urinary output in a dosedependent manner. The combination of the two extracts compared to the other extracts alone significantly increased the serum potassium level. This study also showed each extract increase creatinine clearance in a dose-dependent manner (p<0.01 and p<0.05). The increase of GFR in the combination group was not significant. The current data showed a significant increase in the total phenolic content in pine bark extract in compared with the fruit extract.

CONCLUSION

The pine bark and fruit can be useful in the prevention and treatment of kidney stones due to the high diuretic properties and antioxidant activity.

Hajrul yahood (Lapis judaicus): An important mineral drug of Unani system of medicine for the management of urolithiasis

ETHNOPHARMACOLOGICAL RELEVANCE

Hajrul yahood (Lapis judaicus) is a mineral drug used in different dosage forms in Unani system of medicine and claimed to be effective in the management of urolithiasis.

AIM OF THE STUDY

To explore the role of Hajrul yahood in the management of urolithiasis along with determination of its morphological, ethnomedicinal, physicochemical and pharmacological attributes.

MATERIALS AND METHODS

A review of literature on Hajrul yahood was undertaken using the bibliographic database viz. Pub Med, Google Scholar, Science Direct and Scopus. The search was conducted using the terms 'Hajrul yahood', 'Lapis judaicus', 'Majoon Hajrul yahood' and 'Kushta Hajrul yahood'. Further books, monographs and reports on Lapis judaicus published in Urdu and English were used to compile the information.

RESULTS

Hajrul yahood as such and as an ingredient in multidrug formulations has been used for the treatment of kidney and bladder stones since ancient times mainly by the practitioners of traditional medicines. Literature of Unani medicine clearly indicated that Hajrul yahood and its different formulations are safe and have antilithiatic effect. Sufficient information in respect of morphological, physicochemical and ethnomedicinal properties of Hajrul yahood are available but very few pharmacological and clinical studies have been conducted. The available reports on Hajrul yahood and its products mainly Cystone® though has shown varying results but on the whole indicated possible antilithiatic effect. The studies conducted so far have been limited by small patient numbers, weak methodology, and poor study design therefore a conclusive result cannot be arrived at.

CONCLUSION

Hajrul yahood and its formulations have been claimed by Unani medicine to be useful in the management of urolithiasis. Some of the scientific reports also suggest the possibility of such an effect however further elaborate and comprehensive studies are required to validate such a claim.

Formation of struvite urinary stones and approaches towards the inhibition-A review

BACKGROUND

Struvite is one of the most common urinary/kidney stones, composed of magnesium ammonium phosphate (MgNHPO₄·H₂O). They are also termed as infection stones as these are associated with urinary tract infections. Numerous studies have been carried out to examine the growth and inhibition of struvite stones.

OBJECTIVE

This review summarizes various reports on the factors responsible for inducing struvite stones in the kidney and gives a detailed account of studies on inhibition of growth of struvite crystals.

RESULTS

The presence of urea-splitting bacteria such as Proteus mirabilis and alkaline pH plays a crucial role in struvite formation. In vitro inhibition of struvite stones by various chemical agents were examined mainly in artificial urine whereas inhibition by herbal extracts was studied in vitro by gel diffusion technique. Herbal extracts of curcumin, Boerhaavia diffusa Linn, Rotula aquatica and many other plants, as well as some chemicals like pyrophosphate, acetohydroxamic acid, disodium EDTA and trisodium citrate, were reported to successfully inhibit struvite formation.

CONCLUSION

The present review recapitulates various factors affecting the growth of struvite urinary stones and the inhibitory role of certain chemicals and herbal extracts. Most of the tested plants are edible hence can be easily consumed without any adverse effects whereas the side effects of chemicals are unknown due to lack of toxicity studies. Thus, the use of herbal extracts might serve as an alternate and safe therapy for prevention of struvite stones.

Herbal remedies for urinary stones used in India and China: A review

ETHANOPHARMACOLOGICAL RELEVANCE

The process of formation or appearance of a urinary stone anywhere in the renal tract is known as urolithiasis. It is a longstanding health problem, known to exist since early age of civilization. Records about symptoms, signs and treatment strategies of urinary stones diseases are found in the several ancient texts of traditional medicines such as Ayurveda, Traditional Chinese Medicine (TCM), Siddha and Unani. In Ayurveda, urolithiasis has been considered as one of the eight most troublesome diseases. Ayurvedic management and cure of urinary stone involves herbal formulas, alkaline liquids and surgical procedures. Whereas, TCM recommends polyherbal drugs, acupuncture and mexibustion for treatment of the urinary stones. Among these therapies, herbal remedies are in practice till today for the treatment and cure urinary stone diseases.

MATERIALS AND METHODS

A comprehensive review of the scientific literature about pathophysiology of urinary stones and antiurolithiatic plants was undertaken using the following bibliographic databases: MEDLINE/PubMed, Scopus, Web of Knowledge and Google Scholar. The search was conducted from publications from all years until Dec., 2015 by combination of the search terms and Boolean operators; 'urinary stone' OR 'kidney stone' AND 'plant' OR 'medicine' OR 'antiurolithiatic plants'. Outputs were restricted to those completed studies only published in English. In this review, literatures about plants which are used as diuretic and/or in treatment urinary tract infections have not also been considered. The Plant List and Royal Botanical Garden, Kew databases were used to authenticate botanical names of plants. Books and monographs published in English were used to collect information about historical records of antiurolithiatic plants.

RESULTS

Recent pharmacological interventions accredited ancient antiurolithiatic claims to several plants and their formulations. The majority of antiurolithiatic plants were found to either dissolve the stones or inhibit the process of urinary stone formation. Plants such as Phyllanthus niruri L. and Elymus repens (L.) Gould, as well as herbal products including 'Wu-Ling-San' formula, 'Cystone' and 'Herbmed' have been proved their utility as promising antiurolithiatic medicines in the different phases of clinical trials. In addition, some of the isolated phytochemicals such as berberine, lupeol, khelin, visnagin, 7-hydroxy-2',4',5'-trimethoxyisoflavone and 7-hydroxy-4'-methoxyisoflavone were reported to have potent antiurolithiatic activity.

CONCLUSION

In ancient medicinal texts, antiurolithiatic potential has been ascribed to several plants and their formulations. Present scientific studies provide scientific evidences for few of these claims however, they are insufficient to establish many of these plants and herbal formulations as therapeutic remedies for the treatment and management of urinary stones. Conversely, findings of pre-clinical and clinical studies about some plants and herbal formulations are promising, which underlines the utility of herbal remedies as alternative medicines for the treatment and management of urinary stones in the future.

Evaluation of antiurolithiatic and antioxidant potential of Lepidagathis prostrata: A Pashanbhed plant

CONTEXT

Oxidative stress acts as an essential mediator in the pathophysiology of urolithiasis. Lepidagathis prostrata Dalz. (Acanthaceae) is a Pashanbhed plant that is recommended for the management of urolithiasis; however, no scientific validation has been reported.

OBJECTIVES

To evaluate the antiurolithiatic and antioxidant potential of L. prostrata.

MATERIALS AND METHODS

Methanol extract (LPM) and fractions; petroleum ether (LPPE), ethyl acetate (LPEA), n-butanol (LPBU) and aqueous (LPAQ) were prepared. In vitro antiurolithiatic activity was evaluated by the capacity to inhibit calcium oxalate (CaOx) nucleation and aggregation at different concentrations of extract/fractions (0.04-3 mg/mL) for 30 min. Total phenol and flavonoid content and antioxidant potential were determined. A validated HPTLC method was performed to quantify lupeol and β-sitosterol.

RESULTS

LPEA exhibited the highest dose-dependent inhibition of CaOx nucleation (IC50: 336.23 ± 30.79 µg/mL) and aggregation (IC50: 149.63 ± 10.31 µg/mL), which was significantly (p < 0.05) better than standard Cystone®. The polar LPBU fraction was enriched with phenols (47.34 ± 0.19 mg GAE/g) and flavonoids (20.38 ± 0.05 mg QE/g), which correlates with its highest antioxidant potential in DPPH, ABTS, nitric oxide scavenging and iron chelating activities (IC50: 1.18-87.34 µg/mL). To our knowledge, this is the first study reporting the presence of lupeol and β-sitosterol in L. prostrata.

CONCLUSION

The antiurolithiatic activity of L. prostrata is probably mediated through the inhibition of CaOx crystallization. In addition to its free radical scavenging and antioxidant activities, it would act as an excellent agent for the prevention of urolithiasis.

The protective effects of an herbal agent tutukon on ethylene glycol and zinc disk induced urolithiasis model in a rat model

To evaluate protective effects of Tutukon^®, a plant derived herbal product, on the development of rat urolithiasis model. A total of 45 rats were divided into three groups namely; Group 1 (control group; drinking water + zinc disk), Group 2 (0.5 % ethylene glycol [EG] to drinking water + zinc disk) and Group 3 (study group-0.5 % EG + Tutukon + zinc disk). Moreover, zinc disks were placed into bladder of rats to serve as a nidus for stone development. Five rats from each group were killed at the end of the 1st, 2nd and 4th week. The level of bladder inflammation, the disk weights and the urine oxalate, calcium and pH values and were evaluated and compared. The inflammation scores of the pathological evaluation were not significantly different among three groups. At the end of the 28th day, weights of the zinc disks were significantly higher in Group 2 (394.4 ± 41.2) when compared to Group 1 (1517.5 ± 367.3) and Group 3 (386.2 ± 26.9) (p = 0.016). The disk weights increased gradually at 7th, 14th and 28th days in Group 1 (p = 0.018) and Group 2 (p = 0.009) while remained stable in Group 3 (p = 0.275). Urine calcium levels were not affected among three groups throughout the study period. At the end of the 28th day, while the urine oxalate levels of rats in Group 1 was lower than that of both Group 2 (p = 0.046) and Group 3 (p = 0.008); Group 2 and Group 3 had similar oxalate excretion levels (p = 0.701). However, the difference was not significant. Tutukon seems to decrease stone deposition on zinc disks implanted in the bladder of rats. The exact mechanism of this preventive effect is, however, not well understood.

Randomized and double-blinded clinical trial of the safety and calcium kidney stone dissolving efficacy of Lapis judaicus

ETHNOPHARMACOLOGICAL RELEVANCE

Kidney stones are one of the most common disorders of the urinary tract and cause a great deal of morbidity and economic loss. Because of the side effects and costs of current interventional procedures, researchers are interested in finding medicinal therapies. In this regard, some reports have focused on traditional medicines as a drug discovery resource. Iranian scholars in the medieval era recommended Lapis judaicus for the prevention and treatment of kidney stones. The present study assessed the efficacy and safety of Lapis judaicus on the size of calcium kidney stones and some related biochemical factors in blood and urine.

MATERIALS AND METHODS

Sixty patients with kidney stone disease were included in this double-blind randomized clinical study. Thirty patients received 2g of Lapis judaicus powder in hard capsules per day for 10 weeks, and another 30 patients received a placebo for the same period. Ultrasonography was performed on patients, and blood and urine samples were collected before and after the study to evaluate the efficacy and safety of Lapis judaicus in calcium kidney stone patients.

RESULTS

The size of the kidney stones was reduced significantly (p<0.001) in the drug group. In 9 patients from the drug group, the stone was completely dissolved. Moreover, urine calcium concentration and specific gravity were reduced and urine magnesium was increased (p<0.05). Lapis judaicus did not affect BUN, creatinine, ALT, or AST.

CONCLUSION

Contrary to the placebo group, the size of kidney stones was reduced significantly in the treatment group after oral administration of Lapis judaicus. This preliminary study confirms traditional knowledge of the efficacy and safety of Lapis judaicus in kidney stone diseases and suggests a new method to treat calcium kidney stones. Further detailed in vitro and in vivo studies aimed at discovering the mechanism of action of Lapis judaicus and clinical studies involving a larger population of patients will be necessary to fully explain and confirm the results obtained in the present study.

Diuretic and antilithiasic activities of ethanolic extract from Piper amalago (Piperaceae)

OBJECTIVE

Piper amalago is used in Brazilian folk medicine as diuretic and for the treatment of urinary calculus disease, although no scientific data have been described to support these effects. Thus, this study aims to evaluate the diuretic effects and antilithiatic activity of the ethanolic extract of P. amalago (EEPam).

MATERIALS AND METHODS

Ethanolic extracts of P. amalago (125, 250 and 500mg/kg) were orally administered in male Wistar rats (n=5) and urinary excretion was measured at intervals of up to 24h after administration. The antilithiasic effect of EEPam on calcium oxalate urolithiasis crystallization was examined in a turbidimetric model.

RESULTS

The oral administration of all doses of EEPam significantly increased urine output after 24h when compared to control group. Moreover, the application of EEPam, induced an inhibitory effect on calcium oxalate crystallization.

CONCLUSIONS

According to results, P. amalago extracts showed diuretic and natriuretic activity and antilithiasic effects.