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Urology and Nephrology - Health is Easy to Reach

Herbal way to fight Urinary Stone

March 7th 2010 06:39
Preface
In My previous post about urinary stone disease, i had already told about what cause urinary stone and it prevention by consuming lime.

Now, i'm gonna share my knowledge about another traditional way to treat urinary stone.
The topic is about Sonchus arvensis.

What is Sonchus Arvensis?

Sonchus Arvensis or Tempuyung is a kind of composite plant that lived well in open area, exposed to sunlight. This plant can be found at tropical area at 50-1650 m from the sea.
There are still lot of information about the Tempuyung.


i'm not gonna discuss about the plants, but about its benefits.
The part of this plant that give benefit for human health is its leaves.
Just like others herbs, the main benefits comes from the secondary metabolites.
In Tempuyung leaves, we can find flavonoid substances, kalium, manitol, and inositol.
Tempuyung


The Benefits
Kalium and Flavonoid from tempuyung leaves offer a benefits for human health.
In urinary stone disease, high kalium content from tempuyung leaves, being excreted in urine and compete the calcium to bind oxalate, then make the crystal solute.
This effects has been verified in vitro trial.
And the practice of consuming tempuyung leaves for curing urinary stone disease has been done since ancient time in my country (indonesia).
Another mechanism tempuyung cure urinary stone disease, is by diuretic.

Of course more water, crystal is easier to solute and be excreted.

And because it's effects on diuretic, it can be used for treatment of hypertension.

Flavonoid, is organic substance, like riboflavin (vitamin B2) it can be used to maintain our health and as antioxidant, anti-inflammation as well.
Tempuyung Leaves

Summary
Herbal medicine offer an alternative beside the western medicine.
People believe that herbal is less toxic or less side effects compare to modern drugs.
Not only that, some herbs can offer a multibenefits compare to modern drugs that being designed for specific purpose.

Tempuyung (Sonchus arvensis), has multibenefits for human health such as:
- lowering hypertension through diuretic
- relieving urinary stone through kalium and diuretic
- anti-inflammation and anti-oxidant through flavonoid substances.

In my opinion, tempuyung extract should only used in small size stone and in uncomplicated condition. Tempuyung leaves has a bitter taste, so maybe children don't like it.

Don't you about how to extract it.
Because there are some pharmacy industries done that for us.
Tempuyung Tablet

So, i hope you can try it.
Eventhough, i'm not sure that you can find tempuyung in your country.




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Lime for urinary stone prevention

April 23rd 2009 05:09
Introduction
in my previous blog, i have already explained about urinary stone disease. Now i will give you another information about it, especially about prevention.
As you know, about 60-80% of urinary stones are calcium stones, especially Calcium oxalate.
So, What is the impact?
To prevent the disease for who that has the risk factors, or to prevent the recurrence, we should take care of two components, calcium and oxalate.

Alternatives
As i explained before in my previous blog, principle of stone formation involved supersaturation, inhibitors, pH, and nucleation.
Calcium and oxalate ions, will form insoluble crystal in urine, that can be inhibited by citric acid.
In simple words, citric acid is like beautiful young lady for calcium (more attractive) so it will lose it bound against oxalate, then form Calcium-citric that more soluble in urine, the rest oxalate also will soluble too, and then being secreted in urine.

Naturally, human body can produce citric acid doing Kreb's cycle, but it not sufficient enough for inhibit stone formation.
Based on clinical trials that have been done by my lecturer, taking lime is effective to prevent recurrence of urinary stone.
Lime

Western medicine already know about this, then they invent Potassium-citrate as prevention.
But, it too expensive. Our nature has provide a simple solution that is lemon/lime/citrus (citrus aurantifolia).

Why? because based on the experiment, some fruits contain citric acid, but lime contains highest. So instead of taking Potassium citric pills, you can just taking two lime a day.
Based on the researches that have been done, citric acid concentration is lowest at midnight. So, it's better to have it before sleep or at dinner. Also it's prefer to have it squeeze than juice.
In my country, lime is four time cheaper than potassium citric. So, will you try?
Lime itself also contain vitamin C.
Lime again




New approaches on Calcium restriction
Nowadays, calcium diet restriction is no longer recommended because no proven benefit for stone prevention. But, changing calcium intake by schedule is more prefer. Calcium is recommended to be took during meal. Because it will limit the absorption, especially if you take calcium with spinach (other vegetables) meal.
Because spinach contains oxalate that will insoluble material in your gut, so calcium and oxalate won't be absorp optimally.

But, you should consult with your doctor about those alternatives.


Thank you.


References
1. Prof. sja'bani Lecture in Faculty of Medicine in Gadjah Mada University
2. other references is same with my previous blog.

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Urinary Stone Diseases

April 22nd 2009 16:05
Introduction
Urinary stone disease is a disease that caused by formation of crystal (stone) in urinary tract.
The symptoms depend on location, size, duration, etc.
adapted from XiaoBianTai

Up to 12% of population have this disease. Men have a higher incidence than women, but incidence seems to be same in older ages and children. Peak incidence is around 20-30 years.
White men also have higher incidence. 50% of people who has the disease, will experience recurrence. Family history will increase the risk by factor of three.

Classification and Pathophysiology
Kidney Stones broadly classified to calcareous (calcium containing) stones, which are radio-opaque, and non-calcareous stones.

Kinds of Urinary Stone
1. Calcium (Calcium oxalate, Calcium Phosphate) 60-80%
2. Struvite (associated with infection) 10-15%
3. Uric acid 5-10%
4. Cystine 1%
5. Other (xanthine, indinavir, indigo, etc.) 1%

Principle of crystal formation is supersatured of mineral components in urine or in simple words, the minerals is no longer soluble in urine. Some important factors involved in crsytal formation are mineral components itself, inhibitors, pH, and nucleation.

General concepts of crystal formation
Adapted from Prof. Sja'bani


We can see from figure above, that many factors involved in.
Men have higher incidence because physiologically women secrete less oxalate and more citrate influence by estrogen. Renal morphology also involved because abnormal morphology gives chances for minerals to accumulate and reach its saturation level, also difficult to excrete crystal that has been formed. Hot climate decreased urine volumes, mineral more fast to reach saturate level.
Ones a nucleus (nidus) or core of crystal is formed, minerals is easier to crystallized because saturate level is lower.
Metabolic abnormalities also play role in this, such as: hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitriuria. Because it will cause abnormal concentration of stone forming minerals in urine. In general, any kind of hyper is more difficult to treat than hypo.
Some of patients may have genetic disease of cystine excretion in urine, cystine is insoluble in urine. Infection of urinary tract, especially by urease producing bacteria, because it will lead to struvite stone formation.
You should consult your doctor if you have those disease.

Signs and symptoms
You should consider urinary stone disease if you feel pain around flank (lower abdominal) region that radiates to gonad region (scrotum/ major labia), intermittent pain (colic pain). And the pain is not related to any precipitating event and is not relieved by postural changes or nonnarcotic medications. Those are the classical signs.
Good news is usually pain is unilateral, so crystal is formed in one side only. Why this happen still unknown.
But the symptoms are related to location of crystal. Owing to the shared splanchnic innervation of the renal capsule and intestines, hydronephrosis and distention of the renal capsule may produce nausea and vomiting. Thus, acute renal colic may mimic acute abdominal or pelvic conditions.
As the stone approaches to bladder, lower-quadrant pain radiating to the tip of the urethra, urinary urgency and frequency, and dysuria are characteristic, mimicking the symptoms of bacterial cystitis.

Signs that can be recognized such as blood in urine, often writhing in distress, trying to find a comfortable position, tenderness of lower quadrant may be present.

Diagnosis
The doctor will asked several question about your symptoms, habits, family history to form constructive hypothesis. Then he/she will conduct physical examination to exclude other possibilities. He/she will palpate, touch your belly and area around it. If you feel pain just say it, don't hide it.
To confirm the diagnosis, you will have to follow supporting examination, such as USG, X-ray, IVP, CT-Scan or Renogram. You can discuss about modalities that can be used. USG is the cheapest, but less specific. IVP is no longer recommended for diagnosis because potential of renal toxicity. CT-Scan is more recommended, but it more expensive.
Besides imaging exam, sometimes you will have Laboratory analysis of stone, of course it is being done after the stone is out. The important of stone analysis is to confirm diagnosis and for prevention for recurrence.
Also maybe several check up for metabolic abnormalities.

Treatment
The doctor will exclude emergency situation first, if you don't have it, he/she will go to next step.
If your stone isn't big enough (<5mm), you can have conservative therapy, because chance of self passage is high. But if your is big enough you will be referred to urologist.
Then you will be manage depend on location, density of the stone, and size.
Some of modalities are Extracorporeal Shock Wave Lithotripsy, Uretroscopy, Ureterorenoscopy, Percutaneus Lithotomy, and maybe some case need laparotomy.
Discuss the benefits and risks of each modalities.
ESWL Illustrative




I'm sorry, if my english isn't well. Maybe some words miss-spell. That's the information that i could give.

References
1. Parmar, M.S., Kidney Stones. 2004. BMJ;328; 14-20
2. Teichman, J.M.H. Acute Renal Colic from Ureteral Calculus. 2004. NEJM;350; 684-93
3. Portis, A.J., Sundaram, C.P., Diagnosis and Initial Management of Kidney Stones. 2001. AAFP; 63;7: 1329-38
4. Prof. Sja'bani Lecture in Faculty of Medicine Gadjah Mada University 2009
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The Use of Golden Snail in Chronic Renal Failure

April 21st 2009 09:59
Introduction
Kidney is a vascular organ that has multiple functions, such as:
- maintain water and electrolytes balanced


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Jengkol Intoxication

April 20th 2009 09:25
Definition
Jengkol intoxication is a kind of food intoxication. Food intoxication itself means intoxication that occurs after ingestion of food contaminated or containing toxin.
Jengkol intoxication is not well for people outside indonesia, because not many cultures that used jengkol as food ingredients. Jengkol itself is a kind of beans (Pithecolobium lobatum
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