Urinary calculi/ kidney stone and its Ayurveda management

Urinary Calculi/ Kidney Stone

Urinary calculi/ Kidney Stone

Calculi or stone is a solid/ crystal sedimentation formed in the urinary system. It is also called as Urolithiasis. It is mainly formed from the dietary minerals and waste materials found in the urine. It is usually comprised as a compound called Calcium oxalate or Phosphate. These are result of an accumulation of dissolved minerals on the inner surface of urinary system like Kidneys etc. It may have different sizes. Some of them have the size of a pin head and may be pass unnoticed through urine without causing any symptoms. Some of them have enough size to obstruct urinary passage and can cause symptoms like pain,etc. These can be grouped and classified according to the location and chemical composition.

Signs and Symptoms of Kidney stones:

Kidney stones are leave the body by the passage of the urine and not causes any symptoms if they are in small size. But if it is great in size (size more than 3mm), they can cause obstruction of the ureter. If they obstruct the ureter may cause symptoms like pain,etc.

colic pain

• Intermittent pain that radiates from the flanks to the groins or to the genital area or inner thigh (known as renal colic). It is commonly accompanied by urinary urgency, restlessness, hematuria, nausea, sweating,etc. It is typically comes in waves like manner and lasting 20 to 60mts beginning in the lower back and often radiating to the groin or genitals. The site of the pain depends upon the site of the obstruction.
• There may be burning sensation or urgency while urinating.
• It it is large enough it will bleeding through urinary tract.
• Fever and chills also associated.
• Pain in the bladder at the time of running, and jumping,etc.

What are the causes and risk factors?

• Poor fluid intake: Poor fluid intake and hot climate will lead to dehydration and further concentration of the urine and allowing forming calculi. Dehydration and less fluid intake also reduce urine volume.
• Alcohols:  Chronic alcoholism will lead to dehydration and further increase the cause for stone formation. Beverages like brandy, beer, etc will lead to increasing the level of purine, etc.
• Use of medicines: Use of excess diuretics, calcium containing antacids, excess vitD and A.
• Due to some diseases: Like reflux, medullary spongy kidney, UTI, renal tubular acidosis, etc.
• Animal protein: High intake of dietary animal proteins, sodium, refined sugars, fructose, and high fructose corn syrup, grape fruit juice, etc.
• Oxalate: High intake of oxalate's and low fluid intakes.
• Fluoridation of drinking water.
• High calcium intake: The majority of the kidney stones are made up of calcium. So high level of calcium in the urine also a risk factor. Persons who takes supplementary calcium have high risk of developing kidney stones.

(Ref: Wikipedia -Unlike supplemental calcium high intake of dietary calcium do not appear to cause kidney stones and may actually protect against their development. This is because of the role of calcium in binding ingested oxalate in the gastrointestinal tract. As the amount of calcium intake decreases the amount of oxalate available for absorption into the blood stream increases, this oxalate is then excreted in greater amount in the urine by the kidneys. In the urine oxalate is very stronger promoter of calcium oxalate precipitation, about 15 times stronger than calcium. In fact current evidence suggests that the conception of diets low in calcium is associated with higher overall risk for the development of kidney stones.).

• Improper diet and sedentary life style.
• Working for long periods in direct sunlight.
• Excess physical work.
• drinking little water.
• Suppressing the urge to pass stools,and urine,etc.
•  A diet high in meat, fish, and poultry, etc.
• Idiopathic, etc.

Types and Classifications:

Urinary calculi are typically classified according to the location and chemical composition.

According to location:

1. Nephorlithiasis: Calculi in the kidney.
2. Urolithiasis: Calculi originating anywhere in the urinary system including kidneys and bladder.
3. Calyceal calculi: Calculi in minor or major calyxes.
4. Ureterolithiasis: Stones in ureter.
5. Cystolithiasis: stones in bladder.

According to chemical composition:

1. Calcium oxalate crystals: From dietary oxalate- vegetables, fruits, and nuts. Urine become acidic and low pH.
2. Calcium phosphate: Urine is alkaline and high pH.
3. Uric acid crystals: from diet rich animal proteins, and purines, meat, fish, etc. urine is acidic and high pH.
4. Struvite crystals: Due to infections in the kidneys. Diet has no effect.
5. Cystine crystals: It is a rare case cystine leak through the kidneys and into the urine to form crystals.

Pathophysiology:

Most common crystals are made up of calcium oxalate and phosphates. Due to many reasons explained above leads to calcium and oxalate unit to form crystal nucleus. Super saturation of urine promotes the situation. Waste metarials and other sediments from the urine aggregate on this nucleus and form bigger ones. These finally lead to stone. Normally urine contain factors that inhibit some building substances from forming crystals like Mg, etc. deficiency of these and changes in urine pH will lead to stone formation.

Inhibition of stone formation:

Normal urine contain chelating agents like citrate, prothrombin, etc that inhibit nucleation, growth and aggregation of calcium containing crystals. When these substances fall below their normal properties stones can form from an aggregation of crystals. Kidney stones often results from a combination of factors rather than a single well defined causes.

Investigation and Labs: 

• KUB plain radiograph.
• Axial CT scan of abdomen without contrast.
• Urine analysis-RBC in urine, Bacteria, leukocyte, casts and crystals.
• Urine culture.
• USG - abdomen and Pelvis.
• Complete blood count- (increased neutrophil and granulocytes), suugest bacterial infection.
• RFT (Renal Function Test) - High blood calcium level.
• 24 hour. urine culture.

How to diagnose the condition?

Diagnosis is mainly made on the basis of the information obtained from the history, nature of the pain, or other details from the patient. Many tests are used for proper diagnosis. Even a simple physical examination may reveal pain and LBA.

Treatment:

Two types of treatments are there- 1-Symptomatic management, 2-Surgical management.

1. Synptomatic treatment:

• Anti inflammatory drugs: Main symptoms of these diseases are pain itself, and urinary symptoms. So for curing these using analgesic is the first option. For less sever conditions oral administration of NSAID are using otherwise IV methods are suitable.
•  Anti emitic medicines.
• Medical Expulsive Therapy- Speeds up the passage of calculi, etc.

 2.Surgical management:

1. Lithotripsy: Extra corporeal Shock Wave Lithotripsy (ESWL) is a non invasive technique. Type of treatment that will break the kidney stones in to smaller pieces and allow it to pass. This technique is used when the stone is near pelvic areas. Even though these technique results some complications especially in diabetic patients

If the stone is large the patient may referred to surgical procedures like precutaneous nephrolithiotomy-PCNL(by making an incision in the back), ureteroscopic stone removal (removal through thin tube via urethra) or Ureterorenoscopy-URS, Conventional open surgery Laser lithotripsy, etc

Mutra asmari (Urinary Calculi) and its Ayurveda Management

Decades of years ago, it is clearly explained about Mutra asmari (Urinary Calculi), causes, Symptoms, diagnosis, diet and life style, how to prevent, etc in Ayurveda by Dhanwantari etc. It is beautifully explained in Ayurveda texts like Ashtanga Hridaya, Susrutha Samhita, etc. In Ayurveda also the treatment for asmari are explained as 1.First stage – good prognosis can manage with medicines and diet managements, and 2. Surgical Removal.

Causes according to Ayurveda:

• Apathya ahara (unwhisome food).
• Low fluid intake.
• Urinary Tract Infection.
• Drugs.
• Non elimination of vitiated Dosha through proper shodhana (elimination therapy).
• Idiopathic, etc.

 Pathogenesis:

It is a tridoshaja vyadhi (kapha predominant). The disease process can be explained in following ways.

1. Dute to above reasons (causes) vata dosha aggravated in vasthi (Urinary bladder). Vata has the qualities like Ruksha guna (rough),khara etc. By virtue of these qualities it dries up the locally available mutra (Urine), Sukra and Pitta to convert them into sarkara or gravels.
2. Kapha dosha by its Snigdha, Guru, etc binds those gravels together to make a soft stone like structure.
3. Pitta dosha by its paka karma completes the stone formation.

Prodromal Symptoms:

Aadmana(beltching), Pain in Vasthi(bladder) region. Urine smell resembles likes that of goat urine, Dysuria, jvara (fever), Anorexia-aruchi, etc. Urine is stopped at intervals, in its outflow. Urine flows out twisted or scattered like spray, leaving sediments of clear sand. More pain on bladder while jumping,playing,swimming,etc.

Common Syptoms:

• Pain over Nabhi, Vasthi (bladder), siras, etc.
• Obstructed Urination- "viseerna dhara mutram".
• Irritation in urinary system.
•  Urine resembling comes urine- "gomedhakopamam".
• Rakthayuktha mutram- urine containg blood, etc.

Types and its Features:

1. Vataja Asmari.
2. Pittaja Asmari.
3. Kaphaja asmari.
4. Sukraja asmari.

1.Vataja asmari symptoms/ Lakshanas:

Vataja asmari

• The pain will be excruciating. The patient constantly under sever pain gnashes his teeth or presses his umbilical region.
• Burning sensation is experienced in the penis, and while urination, belching. and defecation become difficult and painful.
•  hematuria may seen.
• Ashmari are found to be a dusty colour, rough, uneven shape, etc.
• In Ayurveda texts the shape of the stone described as hard faceted and nodular like Kadamba Flower.
• Resembles Uric acid stone.

2. Pittaja asmari:

• Sucking,drawing,burning sensation of pain experienced in this condition.
• Stone is found to be reddish, yellowish black, like seed of the Bhallathaka fruit or like the color of the honey.
• Resembles to calcium oxalate, uric acid, and cystine stone.
• Urine- color yellowish red.
• sometime chills, fever also associated.

Pittaja Asmari

3.Kaphaja Asmari:

Kaphaja Asmari

• Pain in the bladder region like that of "Suchi birava", like needile prick.
• Have the pain but it is not sever as Vataja type. Kind of crushing pain, bursting in the organ which become cold and heavy. May feel stiffness on that region.
• Urine color is white.
• Stone is white,glossy and attain to large size to that of Hens egg. And has the color of Madhuka flower.
• Resembles to Calcium Phosphate stones.

 4.Sukraja Asmari:

• It is seminal origin due to sudden or abrupt stoppage of sexual act or excessive coitus tends to discharge the semen and sediment in abnormal place. Leads to formation of stone.
• Associated with pain in the bladder, dysuria, swelling in the scrotum.

Complications:

Acute renal failure, recurrent or persistent urinary tract infection.

Ayurvedic Treatment for Urinary calcui/ Mutra asmari:

In Ayurveda treatment is explained in two ways.

1. Medical management (Samana and Sodhana).
2. Surgical management.

1.Medical management:

Treatment mainly based on the characters of Dosha, condition of the disease, and patient. It consist of diet and drug designed to reduce the risk factors of stone production. It is indicated in all patients for preventing recurrence after stone is passed or removed by surgery.

Treatment principle: Nidana parivarjana (removal causative factors), diet management, surgery etc.

While doing treatment and selecting medicines mainly focuses on, Ashmari bhedana oushadas, Mutrala medicines (diuretics), soolahara (analgesic), acc to dosha etc. if the size of the stone is large and obstructive type, then it is better to avoid diuretic drugs and select asmari bhedana (cutting) medicines.

Shodhana therapy: Snehana and Swedana, Snehapanam, local Dhara, Avagaha sweda, Virechana, etc.

We can also treat according to the stages of the disease:

1. Stage-1 : Sever pain in the Kukshi and Kati region.(Vatahara treatment).
2. Stage-2 : Burning urination (Pittahara).
3. Stage-3 : Obstruction of urinary flow (Kaphahara treatment).

Medicines commonly Using:

Kashaya :                                                                       Arishta/ Asava:

1.Balapunarnavadi kashaya (V,P,K)                                 1.Punarnavasavam (P,K).
2.Brihatyadi Kashaya (P).                                                2.Chandanasava (P).
3.Kokilaksham (V,K).etc                                                 3.Varanasavam (V,K), etc.

Tablets/ Gulika:                                                           Churnam:

1.Chandraprabha (P,K).                                                  1.Avipathy churnam (P,K).
2.Punarnava Gulgulu (K,V).                                            2.Gokshura churnam (P).
3.Hinguvachadi (K,V).                                                    3.Ardhawilva. (V,K), etc.
4.Tab. Cystone.
5.Tab Altarin, etc.

Ghritham:                                                                    Lehya:

1.Brihatyadi (P,K).                                                         1.Gomutrahareethaki.
2.Sathavaryadi.                                                              2.Danteeharrethaki, etc.
3.Vatsyamayantakam, etc.

Kshara:

1.Kalyana ksharam.
2.Abraka basmam.
3.Kanmada basmam, etc.

Home remedy:

1. Decoction of onion with sugar.
2. Drink cocnut water, barley water.
3. Decoction prepaired with Kulatha daal.
4. Lemon juice mixed with honey or sugar.
5. Pashana bheda swarasa in empty stomach.
6. Add gokhura, punarnava, chrula roots in drinking water, etc.

Diet and Life style:

What can have?

• Increase fluid intake up to 2 liters/ day xcept in obstructive case).
• Drink kulatha daal, soup made with old rice, kulatha, wheat,kusmanda swarasa etc.
• Proper exercise and work management.
• Consume food rich vitamin A, Mg, etc.
• Limit salt intake.
• Consume diet rich in fiber, etc.

What don't?

• Avoid milk, ghee and other milk products.
• Leafy vegetables like spinach, tomato, cauliflower, cabbage, peas, etc.
• Avoid excess animal protein, red meat.
• Getting exposed to heat.
• Withholding physical urges like urine, stool, semen, etc.
• Beer, chocolate, soft drinks, etc.

Yoga for Urinary calcui/ asmari patiens:

It is advisable to practice yoga along with medicines to relieve the symptoms of calculi. Some of the Asana useful to reduce the conditions are,

1. Dhanurasana (Bow pose).
2. Pawanamuktasana (Wind releaving pose).
3. Uttana padasana (raised leg pose).
4. Pranayama.
5. matsyasana.
6. Vajrasana, etc.

By: Dr. Rimin Razak.

Ref from: Wikipedia, medical texts, images from internet,Ashtanga hridaya, etc.