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Management of Renal Calculi through Naturopathy & Yoga

Authors:
  • Sona Medical College of Naturopathy & Yoga
  • Sona Medical College of Naturopathy and Yoga

Abstract

Kidney stones are small hard mineral deposits that are formed in the kidney. The stone may be small like a sand grain or large like a pearl. Most kidney stones are eliminated from the body without much assistance and trouble. Recurrence of stone formation is also more common nowadays. Disturbance in the fluid metabolism of the formed urine due to an unbalanced diet, injury caused due to the passions or overload of the system by any drugs creates renal stones. The development and nature of the disease in each individual is different. Hence its management also needs personalized care. That is what discussed in this chapter with the help of naturopathy and yogic interventions.
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CHAPTER
40
Renal Calculi
Madan Kumar S and Kalpana Devi M
Definition
Kidney stones are small hard mineral deposits that are formed in the kidney. The
stone may be small like a sand grain or large like a pearl. Most kidney stones are
eliminated from the body without much assistance and trouble. But sometimes the
stones may get blocked in the urinary tract and cause severe pain.
Epidemiology
Kidney stones are one of the most common conditions of the urinary system
affecting people aged between 30 to 60 years. Men are more affected than women.
About 12% of the population in India is expected to have kidney stones and out of
them nearly 50% end up with severe renal complications like renal damage or
complete renal failure. Recurrence of stone formation is also more common
nowadays.
Causes and Risk factors
Familial factors: The incidence of kidney stones is high in individuals with a
family history of kidney stones. This may be due to the tendency of eating protein-
rich food and obesity. Recurrence of renal stones is also higher in such patients.
Demographic factors: People living in tropical areas with high temperature and
humidity are at greater risk of developing kidney stones. Formation of kidney
stones is higher during summer probably due to low urine volume.
Occupational factors: Formation of kidney stones is more common in affluent
industrialized nations. White-collar workers have a high incidence of kidney
stones as compared to manual laborers. This finding is related not only to diet but
also to physical activity.
Dietary factors: A diet rich in sodium, fat, sugar and meat and low in unrefined
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carbohydrates, vegetable protein and fiber increase the risk of formation of kidney
stones. Consuming oxalate-rich food items like green beans, nuts, tomatoes,
chocolate, tea, coffee, etc. increases the risk of kidney stones. Vegans are at low risk
of getting kidney stones. Among non-vegans, those who consume more fresh
fruits and vegetables are at low risk of getting kidney stones.
Consuming more sodium will cause increased sodium and calcium excretion, and
increased monosodium urate saturation, which acts as a nidus (site of origin) for
the stone formation. This leads to increase in the relative saturation of calcium
phosphate and decrease in the urinary citrate excretion. Average daily urine
output in individuals with kidney stones is 1.6 liters. Low fluid intake with
subsequent low volume of urine production leads to high concentration of stone-
forming solutes in the urine. Regular high fluid intake not only prevents solute
aggregates but also prevents plaque formation.
Coffee, tea and cola drinks are the richest source of caffeine. Caffeine acts as
diuretic and drives the body to lose fluids faster which leads the urine to get highly
saturated. This results in stone formation in the kidneys. Moreover, the coffee and
tea also contains high level of oxalate, which is a chief component of kidney stones.
Diets rich in animal proteins like meat, chicken, fish, etc., may lead the body to
eliminate more calcium, uric acid and citrate in the urine. Canned fish, red meat
and meat extracts are rich sources of purine, which in turn increases uric acid
production. So protein intake should be restricted to 1gm/kg/day.
White sugar stimulates the pancreas to release insulin and directs extra calcium to
be excreted in the urine. People with excess weight, insulin resistance and more
sugar in diet are prone to hypercalciuria and at high risk of developing kidney
stones.
Lifestyle factors: Sedentary lifestyle and obesity increases the incidence of kidney
stones. Persons with high waist-to-hip ratio or central obesity appear to have the
highest risk of developing kidney stones. The prevalence and incidence of kidney
stone is directly associated with body mass index (BMI). However, persons who
reduce their weight rapidly have an increased incidence of uric acid stones in their
kidneys.
Smoking is an independent risk factor for the formation of kidney stones. One of
the major factors that contribute to the formation of stones in smokers is the high
levels of cadmium and lead in the body. Also, smoking decreases urinary flow.
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A stressful lifestyle increased urinary stone constituents like calcium, oxalates, uric
acid, etc. within 24 hours of exposure to the stress. Stress also increases production
of parathyroid hormone which leads to increase in serum calcium levels and
hypercalciuria. Another study states that stressful events raise vasopressin levels,
which decreases urinary output and results in greater tendency to form stones.
Systemic diseases and kidney stones
Type 2 diabetes mellitus patients have acidic urine, which may result in
kidney stones, mainly uric acid stones.
Hypertensive patients have a higher risk of developing kidney stones.
Gouty arthritis is a condition in which monosodium urate and
monohydrate crystals are deposited in the tissues.
In case of bowel disorders, particularly inflammatory bowel disease,
bowel resection and bowel bypass, the resultant hyperoxaluria may
result in kidney stones.
Estrogen increases excretion of citrate in urine and helps in reducing the
risk of stone formation in women, particularly during pregnancy. In
postmenopausal women, low estrogen level results in higher risk of
kidney stones. Women who undergo oophorectomy are also at greater
risk of developing kidney stones.
Signs and symptoms
Urinary system symptoms
Severe pain between ribs and hip (flank) on the side of the obstructed
renal stone, which may radiate to the groin
Hematuria
Dysuria
Strangury (severe pain and a strong desire to urinate due to blockage or
irritation at the base of the bladder.)
Systemic symptoms
Restlessness
Nausea, vomiting or both
Fever and chills in case of associated infection
Asymptomatic
Incidental renal stones (found on imaging for investigation of some
other condition)
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Types of kidney stones
Kidney stones may be classified according to their composition. They are made up
of both organic and inorganic crystals combined with proteins.
Calcium stones
Uric acid stones
Struvite stones
Cystine stones
xanthine and drug-forming stones (less common)
Calcium stones: Hypercalciuria can result in the formation of calcium stones.
Hypercalciuria occurs due to many reasons such as
Increased intestinal calcium absorption
Decreased renal calcium reabsorption
Enhanced calcium mobilization from bone
Increased serum concentration of calcitrol or Vitamin D3
Calcium oxalate stones: This is the most common form of kidney stones. They are
formed due to the supersaturation of calcium oxalate crystals in urine in the
alkaline environment of the collecting duct system.
Calcium phosphate stones: Most of the calcium stones originate as calcium
phosphate stone in the form of Randall plaques, which is the calcification of the
sub-epithelium of renal papilla. These stones are formed in the alkaline
environment.
Uric acid stones: Uric acid is the final oxidation product of purine metabolism.
Uric acid stones comprise about 10 percent of renal stones. Uric acid is found to be
more soluble in an alkaline pH than an acidic pH.
Struvite (magnesium ammonium phosphate) stones: These are also called
infection stones because they are formed as a result of urinary infection by urease-
producing microorganisms. Triple phosphate (calcium magnesium ammonium
phosphate) stones are formed in such infections, which is less soluble in alkaline
pH than in acidic pH. Under microscope, they appear as staghorn-shaped stones.
Cystine stones: Cystine stones are caused due to a rare disorder called cystinuria
in which cystine to leaks into the urine. Excessive cystine in the urine can cause
formation of kidney stones. Most people with cystinuria may develop recurring
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stones. Cystine is found to be soluble in acidic pH than in alkaline pH. Under
microscope, cystine stones appear hexagonal.
Differential diagnosis
Abdominal Abscess
Appendicitis
Cystitis
Pancreatitis
Diverticulitis
Gallstones
Inflammatory bowel disease (IBD)
Small and large bowel obstruction
Pelvic inflammatory disease (PID)
Splenic abscess
Liver abscess
Testicular torsion
Urinary tract infection (UTI)
Urinary tract obstruction
Diagnosis
Kidney stones should be always considered in the differential diagnosis of
abdominal pain. The classic presentation of renal colic is agonizing unilateral pain
between ribs and hip (flank) or lower abdominal pain of sudden onset that is not
related to any precipitating event and is not relieved by postural changes or non-
narcotic medications. Usually gastrointestinal symptoms are absent except for
nausea and vomiting, which occurs secondary to stimulation of the celiac plexus. A
thorough physical examination can rule out unnecessary investigations.
The pain of renal colic often begins as pain between ribs and hip (flank) and
progresses into waves of severe pain. The usual cause is partial obstruction of the
ureter by the stone/s. The pain commonly radiates to the lower abdomen and to the
groin on the same side as the stone. As the stone moves down the ureter, the pain
tends to migrate downwards and medially.
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Physical examination:
General physical examination such as weight, temperature and palpation of
abdomen and back to check for pain or any fluid buildup. Groins can be checked
for any lymph node enlargement.
Investigations
Following are the common investigations for diagnosing kidney stones:
Radiological
Simple abdominal X-ray is a readily available tool to diagnose kidney
stones. However, very small stones may be missed.
Renal ultrasound should be sufficient for clearer visualization of
kidney stones.
Urine Tests
Urine test: Specific gravity of the urine may be raised (concentrated
urine), in case of volume depletion, which may increase risk of stone
formation. Stones containing calcium and phosphate are more likely to
be formed in alkaline urine and uric acid or cystine stones are more
likely to be formed in acidic urine. In addition, presence of protein may
be indicative of renal dysfunction and presence of glucose may indicate
diabetes.
Location of the stone
Associated symptoms
Kidney
Mild pain between ribs and hip (flank) , hematuria
Proximal ureter
Renal colic, pain between ribs and hip (flank), upper
abdominal pain
Middle part of ureter
Renal colic, anterior abdominal pain, pain between ribs
and hip (flank)
Distal ureter
Renal colic, dysuria, urinary frequency, anterior abdominal
pain, pain between ribs and hip (flank)
Table 1: Relationship of location of stone to symptoms
(Adapted from Portis AJ et al., 2001)
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Microscopic examination may reveal crystals indicating type of renal
stone. Presence of pus cells points towards urinary tract infection and
may require urine culture to identify the causative organism and its
antibiotic sensitivity.
Blood Tests
Serum creatinine and urea to assess renal function. Serum uric acid and
calcium.
Pathophysiology of kidney stones
The pathophysiology of formation of kidney stones is not yet understood fully. The
probable mechanism of stone formation is described in the flow chart.
When the concentration of two ions exceeds
their saturation point in the solution (supersaturated urine)
Nucleation
Crystallization occurs
Crystals adhere to the uroepithelium
Creates nidus
Enhances subsequent stone growth
Naturopathic understanding of kidney stones
One of the most basic and powerful principles of naturopathy, which explains the
cause of disease, is accumulation of morbid matters. This principle explains
kidney stones very well. Kidney stones are nothing but morbid accumulation in
the urinary system, which disturbs the normal homeostasis of the individual when
not eliminated out of the body properly.
Figure 1: Pathophysiology of kidney stones
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Unbalanced diet
Internal injury by passion
Affects digestive function of
spleen and stomach
Disharmony of mental activities
and passions
Endogenous dampness in lower warmer
Qi Stagnation
Persistent dampness
Damp heat will be created in lower warmer
Dampness and heat
Heat evaporates fluid, dampness condenses
Precipitation
Formation of kidney stones
Traditional Chinese Medicine understanding of kidney stones
Disturbance in the fluid metabolism of the formed urine due to unbalanced diet,
injury caused due to the passions or overload of the system by any drugs creates
dampness, heat or qi stagnation, which is the major etiology for the formation of
renal stones.
Toxemia of the body
(Supersaturation of the urine)
Accumulation of morbid matter
(Formation of crystals in the kidney)
Poor hydration
Improper diet
Reduced physical activity
Unhealthy habits and lifestyle
Figure 2: Schematic representation of stone formation
Figure 3: Traditional Chinese medicine concept of stone formation
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When a person has an unbalanced diet (foods that are too spicy, deep-fried, oily,
stale, too much food or too little food), it will affect the spleen energy function of
transformation and transportation. This may lead to the formation of endogenous
dampness in lower warmer (Overall feeling of heaviness, sluggishness and
lethargy can be linked to dampness. Dampness formed in the body leads to fuzzy
feelings, memory problems and difficulty in concentration.). When such
dampness is created in lower warmer, precipitation occurs leading to the
formation of stones. Dampness is also created by disharmony of mental activities
which leads to Qi stagnation. Passion here is meant for the emotion or stress.
Taking medications for a long period can also produce similar damage as
unbalanced diet.
Management
The development and nature of the disease in each individual is different. Hence
its management also needs personalized care. Proper history, clinical examination,
and laboratory tests will help to decide the selection of treatment methods.
Naturopathic intervention for kidney stone consists of:
Re-establish the basis of health
Stimulate the healing power of nature (vis medicatrix naturae)
Stimulate the immune system
Decrease toxicity
Tonify weakened systems
Normalize inflammatory processes
Balance regulatory systems
Optimize metabolic function
Enhance regeneration
Effective Naturopathic interventions for kidney stones are as follows:
Hydrotherapy
During acute attacks, repeated application of hot and cold pack, ice pack or
mud pack on the renal region is highly beneficial.
Alternate hot and cold fomentation 3 to 4 inches below or above the painful
area will be beneficial. After the hot and cold fomentation, a cold pack
on the same region can be given to obtain more benefits.
Hot enema followed by hot bath of temperature 100 °F, which is gradually
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increased to 112 °F reduces the pain occurring due to kidney stones.
During this procedure, the head should be cooled with the help of cold
compress on the head.
Hot fomentation across the renal region will also relieve the pain
effectively.
Diet Therapy
Plantain pith juice is a common prescription for renal stones. The plantain pith
should be grated or cut it into small pieces and then grinded with little water and
should be strained with a wet cloth. This juice is recommended either in plain form
or added with little buttermilk or tender coconut water.
This juice improves the functional quality of the kidneys and urinary tract. It
removes the toxins from the abdominal organs, particularly kidneys, in the form of
urine. Thus it is highly effective in case of kidney stones. Similarly ash gourd juice
also helps to remove kidney stones. These juices are best consumed in small
quantity i.e., one glass in the early morning on empty stomach and one glass again
in the late evening. Cumin seeds are beneficial if added in these juices.
Patients with kidney stones should take low-protein diet, restricting the intake to 1
gm/kg body weight. High intake of fluid up to three liters/day is essential to
prevent the formation of concentrated urine, which in turn prevents the
precipitation of salts in the urine. Kidney beans, also known as French beans or
common beans improve renal function. During acute attack, fasting is an effective
solution.
Herbal remedy
Selaginella Imbricata (Pashanbhedi in Hindi) is used widely for renal calculi.
Anecdotal experience states that it helps in dissolving kidney stones.
Preparation:
Ingredients : Selaginella Imbricata -100 gms, Water - ½ litre, Shilajith powder -
2gm, Jaggery/rock sugar-30gm
Pieces of the herb should be mixed and boiled in water and condensed to 1/4th
quantity. Filter the water and add Shilajith powder and jaggery/rock sugar should
be mixed. It should be taken every day on empty stomach. After consumption of
this herbal decoction nothing should be consumed for one hour.
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Yoga Therapy
Yogic asanas like Pavanmuktasana, Uttanpadasana, Bhujangasana and Dhanurasana
are highly beneficial as they stimulate and improve the functions of the kidneys. A
recent study suggested the following practices to improve renal function.
Tadasana, Uttanasana, Padahastasana, Ardha Kati Chakrasana, Paschimottanasana,
Ardha Matsyendrasana, Shashankasana, Bhujangasana, Sethu Bandhasana, Naukasana,
Baddhakonasana, Dhanurasana, Makarasana, and Shavasana, followed by pranayamas
like Nadishuddhi, Chandra Anuloma Viloma, Bhramari, Sitali, and abdominal
breathing. They also advocate yogic relaxation technique for 20 minutes daily.
Acupuncture
Treatment principles in acupuncture:
Clear heat
Drain dampness
Clear obstructions
Expel stones
Commonly used points are
BL -22 (Sanjiaoshu) Drains dampness from the lower warmer.
ST-28 (Shuidao) – Promotes transformation of fluid in lower warmer.
SP-9 (Yinlingquan) – Drains damp heat from lower warmer.
REN-6 (Qihai) – Moves Qi in lower warmer. Moving Qi helps to
transform fluid and drain dampness.
REN-3 (Zhongji) and BL-28 (Pangguangshu) – Front collecting and
back transporting point of bladder respectively. Drain dampness from
the bladder.
BL-63 (Jinmen) – Removes obstruction from bladder channel.
BL-39 (Weiyang) – Lowers sea point of triple warmer.
KI-2 (Rangu) – In combination with BL-39, removes obstruction from
bladder and frees the water passage.
Follow-up Measures
Following a healthy balanced diet, hydrating the body cells by drinking adequate
water, maintaining proper elimination by following nature calls at appropriate
times and regular practice of yoga.
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