Urolithiasis Treatment

The treatment of kidney stones is mostly dependent on the symptoms of the patients. In symptomless cases, the patients are asked to wait for the stone to pass through the urinary system. Depending on the severity of the pain, oral or intravenous painkillers are administered to the patients.

If nausea or vomiting persists, patients are given anti-emetics to ease these symptoms. In case of persistent vomiting, IV fluids are given to prevent the risk of dehydration. 

The diagnosis of urolithiasis depends on endoscopy, an invasive procedure in which a tube with a camera is inserted into the body to determine the presence of kidney stones. The presence of larger stones or complications may require more intense medical attention (Thakore and Liang, 2020). In some cases, surgical methods may be required to operate on kidney stones. 

Shock-wave lithotripsy

This is the least invasive method for removing stones from the kidneys, ureter, and even gall bladder. It uses high-energy shock waves that break down the stones into small pieces so they can be easily excreted out of the body.

Ureteroscopy

Ureteroscopy is an endoscopic procedure of the urinary system in which a ureteroscope is inserted through the ureter. This procedure breaks down the kidney stones either manually or through a laser.

Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy is done for the removal of the stones that are present with complications. This procedure involves an incision in the skin to create an opening, and a catheter or tube is inserted into the tube to break down the kidney stones.

Treatment of Urolithiasis in Unani Medicine

Unani medicine has been used as a potent anti-urolithiasis for centuries. The success of Unani practices for renal health is attributed to the great perception of Unani scholars as they incorporated lifestyle interventions in their treatments instead of targeting kidney stones. 

Without proper management, urolithiasis is recurring and requires interventions to improve life quality. 

Fluid Intake

Fluid intake is the best anti-urolithiasis agent as it can prevent, delay, and treat kidney stones in patients. Unani practitioners put special emphasis on the consumption of fluid and recommend at least three litres of fluid every day to prevent the deposition of minerals. It is interesting to highlight that guidelines use the word ‘fluid’ and not water. Fluids include all beverages like water, fruit and vegetable juices, tea, and coffee (NHS.UK, 2017).

Another important fluid in the prevention of kidney stones is vinegar. Daily consumption of vinegar protects patients from recurring kidney stones by increasing the urinary excretion of citrate (Zhu et al., 2019). 

Dietary Interventions

Depending on the diet of the patients, Unani practitioners also recommend changes in the diet that can decline the rate of kidney stone deposition. A few interventions on the basis of the diet of the patients are discussed below:

Low Sodium Intake

Unani experts believe that consuming a diet low in salt is the best possible treatment for urolithiasis. The presence of sodium increases the urinary excretion of calcium leading to a high risk of oxalate deposition.

For the general population, a sodium intake of 2300mg per day is recommended, which translates to 6g of salt. A lower intake of 1500mg sodium (⅔ tsp of salt) per day is for the population suffering from diseases secondary to high salt intake (Pendick, 2013).

A few guidelines have been recommended to manage the intake of salt in everyday diet:

• Do not use salt shakers as sprinkling salt increases the intake of sodium
• Avoid canned or frozen foods as they have higher sodium content
• Read the nutrition label, and determine the sodium content of the food before buying

High Calcium Intake

Calcium intake reduces the risk of kidney stones by decreasing the availability of oxalate in the intestine and increasing the urinary excretion of oxalate. This effect was only seen when calcium is consumed with oxalate otherwise the intended effect on oxalate may not be observed (Bargagli et al., 2021).

Some commonly used calcium sources are as follows:

• Dairy products (milk, yoghurt, cheese, butter)
• Nuts (almonds)
• Calcium-fortified juices or cereals
• Leafy green vegetables (spinach, kale, mustard)

Lean Protein Diet

Higher intake of animal protein is associated with a higher risk of kidney stones. Animal protein has a higher percentage of saturated fats in the body which can increase the risk of comorbidities in the body.

Protein intake also increases the renal load and pH levels of urine which can be harmful to kidney health in the long term (Ferraro et al., 2020). 

Higher intake of lean protein especially from plant sources can help achieve the daily protein goal while minimising the effect on kidneys. 

Vitamin C

A Swedish study found that about 2% of the men that took vitamin C supplements over a long period developed kidney stones (Thomas et al., 2013).  Vitamin C has a large variety of health benefits that includes improving immune function, decreasing oxidant stress, and delaying ageing. Vitamin C is naturally present in many foods and should be obtained from these sources as supplementation of vitamin C increases the risk of renal insufficiency.

Some of the sources of vitamin C are mentioned below

• Citrus fruits (orange, lemon, lime, grapefruit)
• Cruciferous vegetables (broccoli, cabbage, cauliflower)

Low intake of oxalate

Oxalates are the naturally occurring compounds present in different food sources. Oxalates combine with calcium and form the most common type of kidney stones. Unani practitioners recommend a diet that is low in oxalate sources to prevent the onset of urolithiasis.

The richest source of oxalate is tomato seeds. When recommending dietary prevention of kidney stones, Unani scholars encourage patients to remove the seeds of tomatoes before using them in food. 

Some other sources of oxalates that should be restricted if a high risk of kidney stones is present are:

• Cruciferous vegetables (spinach, kale, rhubarb)
• Nuts (cashews and almonds)
• Potatoes (sweet potatoes, baked potatoes with skin, french fries)

Best Diet

From the above discussion, it is quite evident that Unani experts believe kidney stones can be prevented and managed with the help of diet. A natural, low-fat, moderate-protein diet, which is also low in salt can work wonders for susceptible populations.