Effect of phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention

Abstract

Phyllanthus niruri (P.niruri) or stone breaker is a plant commonly used to reduce stone risk, however, clinical studies on this issue are lacking.Objective:To prospectively evaluate the effect of P. niruri on the urinary metabolic parameters of patients with urinary lithiasis.Materials and Methods:We studied 56 patients with kidney stones <10mm. Clinical, metabolic, and ultrasonography assessment was conducted before (baseline) the use of P. niruri infusion for 12-weeks (P. niruri) and after a 12-week (wash out) Statistical analysis included ANOVA for repeated measures and Tukey's/McNemar's test for categorical variables. Significance was set at 5%.Results:Mean age was 44±9.2 and BMI was 27.2±4.4kg/m2. Thirty-six patients (64%) were women. There were no significant changes in all periods for anthropometric and several serum measurements, including total blood count, creatinine, uric acid, sodium, potassium, calcium, urine volume and pH; a significant increase in urinary potassium from 50.5±20.4 to 56.2±21.8 mg/24-hour (p=0.017); magnesium/creatinine ratio 58±22.5 to 69.1±28.6mg/gCr24-hour (p=0.013) and potassium/creatinine ratio 39.3±15.1 to 51.3±34.7mg/gCr24-hour (p=0.008) from baseline to wash out. The kidney stones decreased from 3.2±2 to 2.0±2per patient (p<0.001). In hyperoxaluria patients, urinary oxalate reduced from 59.0±11.7 to 28.8±16.0mg/24-hour (p=0.0002), and in hyperuricosuria there was a decrease in urinary uric acid from 0.77±0.22 to 0.54±0.07mg/24-hour (p=0.0057).Conclusions: P.niruri intake is safe and does not cause significant adverse effects on serum metabolic parameters. It increases urinary excretion of magnesium and potassium caused a significant decrease in urinary oxalate and uric acid in patients with hyperoxaluria and hyperuricosuria. The consumption of P.niruri contributed to the elimination of urinary calculi.

Evaluation of the efficacy of Phyllanthus niruri standardized extract combined with magnesium and vitamin B6 for the treatment of patients with uncomplicated nephrolithiasis

“…Another study, conducted by Pucci et al [14] used 4.5g of sun-dried P. niruri leaves, 2 times a day, for 3 months, followed by 3 months wash-out period. The study included 56 patients, with average stone size of 15.6 mm.…”

“…Singh et al [16] reported abdominal pain, hematuria and dysuria after using 1–2g/day Dolichous biflorus extract, symptoms which improved by the end of the 6-month period. Pucci et al [14] listed similar symptoms after 6 months of 4.5g/day sun-dried Phyllantus niruri leaves. Micali et al [13] used 2g/day of Phyllantus niruri extract, with no adverse effects to declare.…”

Urology highlights 2017 to 2018

“…Pucci et al reported that a herbal remedy, Chanca Piedra, reduces urinary oxalate and uric acid (good), increases urinary potassium and magnesium (also good) and reduces stone episodes (even better). 21 If confirmed, this has the potential to transform the lives of many.…”

Promising Medicinal Plants with Diuretic Potential Used in Brazil: State of the Art, Challenges, and Prospects

“…The alkaloids are related to antispasmodic activity, leading to smooth muscle relaxation, mostly evidenced in the urinary tract, which facilitates the elimination of urinary calculi, hence the main application of this species to treat kidney stones [86]. The effects of P. niruri on urolithiasis or nephrolithiasis were evidenced in both experimental [89][90][91] and clinical approaches [92,93]. Despite all the phytochemical and biological knowledge of this plant, a re-lated species, Phyllantus amarus Schumach., found in the Northeast region of Brazil and with the same popular use, was reported as having diuretic activity in a preclinical study [94].…”