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Kidney stones

MagazineOctober 2000 (Vol. 11 Issue 7)Kidney stones

Q-My mother, aged 85, has one or two kidney stones lodged in one kidney

Q-My mother, aged 85, has one or two kidney stones lodged in one kidney. She has been to see a urologist, who advised her that lithotripsy is not suitable in her case due to the size of the stones and possibly their position.

The stones do not cause her any pain or hardly any other effects except perhaps one. It is suspected that the stones may be involved in her need to go to the toilet frequently, including several times at night. This affects her sleep and, consequently, her energy levels. She has slight urinary incontinence and has to wear pads every day. This problem seems to affect her life considerably as her days have to be planned around access to the toilet wherever she goes.

I recently read about Quebra pedra and understand that it has been found to have the ability to dissolve stones. My only worry is whether this could cause more problems in an 85 year old. Could stone fragments block her ureters and are there likely to be any other potential problems? Does your panel have any experience of using herbs like this and how long would it take? What is the best dosage in this case?

My mother is basically in very good health apart from the above and takes reasonable care over her diet as well as takes supplements of magnesium and B6 along with a range of other nutrients. I'm wondering whether it is worth trying this herb or something similar, or simply leaving well enough alone.

While she has tried pelvic floor exercises, I'm afraid she doesn't do them regularly, despite reminders from me. TS, Croydon, Surrey....

A-Kidney stones are deposited in the kidneys or the ureter and range in size from a tiny grain of sand to a golf ball. These stones consist mainly of calcium, where lime salts form around some small mass of mucus or other tissue fragment.

Most kidney stones form through an overly acidic diet, usually due to too much protein (both animal and plant) or sugar (Prac Eur Dial Transpl Assoc, 1983; 20: 411-6; Br J Urol, 1991; 67: 230-6; Br J Urol, 1986; 58: 353-7). Kidney stone patients tend to have a lower intake of fibre in their diet as well as low levels of vitamin B1 (Urol Res, 1986; 14: 75-82.

But it's also associated with taking medicines like stomach powders for stomach upsets or ulcers and even soft tap water. Studies have shown that areas high in stone formation usually have soft water (fewer minerals in the water) and areas low in stone formation have hard water.

This doesn't necessarily mean water that contains more calcium. In one study comparing soft and hard waters, calcium content was the same (J Urol, 1982; 128: 422-5). It may be that low levels of other minerals cause more calcium to be excreted into the kidneys. Indeed, a high intake of carbohydrate and fat, and a low intake of calcium does increase stone formation (Br J Urol, 1995; 76: 692-6).

There's also evidence of stones caused by chronic heavy metal poisoning, particularly from the mercury in dental fillings. In one study of cadavers at autopsy, far more mercury was found to have accumulated in the kidneys of patients with amalgam fillings than in those without metal fillings (Swedish Dent J, 1987; 11: 179-87). But too high levels of lead and also cadmium can also lead to stones (Br J Urol, 1982; 54: 584-9; Toxicology, 1992; 73: 127-46), so it's good to rule them out too.

Finally, people can develop kidney stones by not drinking enough fluids (less than two litres per day). This is because when urinary output is reduced, the minerals in urine that make up stones are more concentrated (Freed D, ed, Health Hazards of Milk, London: Bailliere Tindal, 1984).

It doesn't appear to be true that vitamin C causes kidney stones, as is commonly believed, particularly when taken with B6, which prevents oxalate in urine. In one study, there was no significant increase in urinary stones among patients who took up to 10 g of vitamin C per day (J Urol, 1994; 151: 834-7).

As your mother is no doubt aware judging from her choice of supplements stones can also be caused by deficiencies of magnesium and vitamin B6.

Quebra pedra which literally means 'the stone breaker' in Portuguese is a herb with a long folk history in North and South America of helping to dissolve kidney and gallstones. The plant, Phyllanthus niruri, of the family Euphorbiaceae, grows in Brazil and is classed as a weed, but

traditional medicinal use has found it to be antibacterial, anti inflammatory and antispasmodic.

We spoke to the manufacturers of Quebra pedra, Rio Health Direct, who claim that their herbal tea not only dissolves kidney stones by breaking them up into minute crumbs that can be passed, but also that it numbs the pain associated with them. They also claim their product helps cystitis.

Three heaped teaspoonfuls of the herb are added to three cups of water, boiled and simmered for 10 minutes. These three cups should be drunk hot or cold throughout the day. The manufacturers then suggest that, after the last stone has been passed, the product be used at a maintenance level to prevent recurrence. Although they don't know of any contraindications, they also couldn't say how an 85 year old might be affected by the herb nor could any studies, other than proprietary ones for this product.

Rio Trading supplied us with evidence of the herb's effectiveness. One study showed that it contains a potent antispasmodic, and the researchers guessed that smooth muscle relaxation in the urinary tract would help expel stones. However, this was an animal study and may not apply to humans (Brazil J Med Biol Res, 1984; 17: 313-21).

There is a long history of using herbs to dissolve stones. The British Herbal Pharmacopoeia lists marshmallow leaf, couchgrass, parsley piert, bearberry (uva ursi), wild carrot, stone root, wild carrot, sea holly, gravel root, hydrangea and pellitory of the wall.

Fresh dried styles of corn corn silk can also help to soothe and heal kidneys, and dissolve stones (Bartram T, Encyclopedia of Herbal Medicine, Christchurch, Dorset: Grace Publishers, 1995).

There is also evidence that cleavers (Galium aparine), often combined with buchu leaves (Barosma crenata) and uva ursi (Arctostaphylos uvaursi) can eliminate gallstones and kidney stones (Felter HW, The Eclectic Materia Medica, Pharmacology and Therapeutics, Portland, OR: Eclectic Medical Publications, 1983). Uva ursi has been used in folk medicine around the globe to dissolve kidney stones, largely through its diuretic effect.

As passing kidney stones can be extraordinarily painful if the pieces are large, we suggest that you pursue the herbal route only by working with a qualified herbalist and, if you decide to use the tea, do so only with professional guidance.

Besides herbal remedies, if your mother experiences pain while passing stones, acupuncture has been shown to alleviate pain as effectively as drugs (J Urol, 1992; 147: 16-8).

You've already indicated that your mother has a good diet. You may wish to make certain changes

to help avoid the creation of more stones. Make sure that she drinks two to two and a half litres of fluid a day, increases her dietary fibre, which can lower calcium excretion, and restricts dietary fat, sugar and alcohol. She might also consider limiting protein, particularly from milk and dairy products, as high levels of calcium oxalate are linked with a high content of sulphur containing amino acids in these foods (J Nutr Sci Vitaminol (Tokyo), 1990; 36: 105-16). She should also limit salt, which causes a rise in calcium excretion (Kidney Int, 1982; 22: 292-5).

It's vital that she also avoid foods high in oxalates, particularly as people who form stones may have greater absorption and excretion of these salts (Urol Int, 1980; 35: 309-15; Clin Chim Acta, 1969; 25: 1-10). These include instant coffee, tea, cocoa, parsley, rhubarb, spinach and beans. Other foods relatively high in oxalates include chocolate, celery, beet tops, carrot, cucumber, grapefruit, kale, peanut, pepper and sweet potato (Werbach M, Nutritional Influences on Illness, Tarzana, CA: Third Line Press, 1996). Have her also avoid caffeine of all varieties, which increases urinary calcium excretion (Fed Proc, 1985; 44: 1149).

Besides magnesium and B6, it's important for your mother to determine if she is deficient in calcium as the lower the intake, ironically, the higher the excretion (Br J Urol, 1982; 54: 590-3). She may also need supplementing with vitamin A, phosphorus and potassium, low levels of which also predispose to stones.

WDDTY panel member and nutritional expert Melvyn Werbach recommends that stone formers get hold of potassium citrate, as they are often found to excrete less citric acid than non stone formers (Am J Clin Nutr, 1960; 8: 812).

The amino acid l-glutamic acid can also be low, or absent altogether, in the urine of many people with kidney stones and is worth taking as a supplement (Clin Sci, 1950; 18: 185). Try supplementing with glyco saminoglycan (a large molecule of several different sugars), as stone formers excrete less of this than normal. These substances are potent inhibitors of calcium oxalate, which forms crystals in the urine (Kidney Int, 1989; 36: 1022-8). The amino acid lysine also helps decrease urinary calcium, at least in laboratory studies (Gerontol, 1982; 28: 156-62).

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