Phytotherapy For Urinary Tract Disorders PDF

Phytotherapy For Urinary Tract Disorders Dr. Kamel Mahmoud  Urinary system (renal system) consists of kidneys, ureters, bladder and the urethra. Functions of urinary system 1- Remove waste from the body. 2- Regulate blood volume, pressure & PH. 3-...

Phytotherapy For Urinary Tract Disorders Dr. Kamel Mahmoud  Urinary system (renal system) consists of kidneys, ureters, bladder and the urethra. Functions of urinary system 1- Remove waste from the body. 2- Regulate blood volume, pressure & PH. 3- Control levels of electrolytes & metabolites.  The urinary system works with the lungs, skin and intestines to maintain the balance of chemicals and water in the body. Your kidneys filter about 190 liters of fluid every day, enough to fill a large bathtub. Most people pee about two liters daily. Your body re-uses the other 188 liters of fluid. How do kidneys filter blood? Each kidney contains more than a million filtering units called nephrons. Each nephron consists of: Glomeruli: Glomeruli are groups of tiny blood vessels that perform the first stage of filtering blood. They then pass filtered substances to the renal tubules in a process called “glomerular filtration”. Renal tubules: These tiny tubes reabsorb and return water, nutrients and minerals your body needs (including sodium and potassium). The tubules remove waste, including excess acid and fluids through a process called “diffusion”. The remaining waste passes through kidneys’ collecting chambers & leaves body as pee.  I- Diuretic herbs These herbs help the kidney functions by increasing the urine volume through increasing blood supply to the kidneys.  Anthocyanins (Delphinidins & cyanidins) 1 main active constituents Hibiscus Organic acids (citric acid, hydroxycitric acid, (Hibiscus sabdariffa) hibiscus acid, malic and tartaric acids) Hibiscus sabdariffa (Malvaceae) is a popular herb used for medicinal purposes throughout the world. Side effect of excessive using It is traditionally consumed as tea to help treat high is hypotension. blood pressure, anemia, cancer and kidney stones. A 2017 clinical study involved 78 subjects Increased urine volume by 64% diagnosed with mild hypertension showed Increased creatinine clearance by 8% that receiving 150 mg/kg/weight of in comparison with placebo. hibiscus in a drink for one month.  Β-glucans (soluble fiber) 2 phenolic acids, flavonoids, lignans, phytosterols Barley (Hordeum vulgare) proteins, vitamins, minerals, & trace elements Traditionally, Barley was used for the relief of renal pains accompanied by kidney stones. 1) A potent diuretic activity of aqueous extract of barley. 2011 2) It reduced calcium deposition from renal parenchyma after in-vivo study 10 days of treatment. thereby, improvement in nephrocalcinosis severity. (Prophylaxis from calcium stones).  3 Essential oils (myristicin and apiole ) Parsley Flavonoids (Apigenin, luteolin, quercetin) (Petroselinum crispum) Historically, the seeds and leaves are used as diuretic for kidney stones and hypertension and has antimicrobial effects. showed oral administration with aqueous extract of seeds of 2009 in-vivo parsley exhibited a 20% increase in urinary flow, sodium and study potassium amount excreted, and decreased arterial pressure. normal amount in food is safe. But drinking parsley tea in medicinal Side dose may cause abortion. (It was used traditionally for menstruation). effects It may also affect liver and kidney in long term use..  4 Caraway (Carum carvi) (Fam. Apiaceae) A 2007 in-vivo study, Water extracts of Carum carvi (100 mg/kg) or the reference drug, furosemide (10 mg/kg) were administrated orally to male Wister Rats. After a single dose of caraway seeds extract, urine Results output was significantly increased at all-time points and at 24 h after the dose. The total volume of urine excreted was similar for the plant extract and furosemide. Family Apiaceae: contains Parsley, Dill, Coriander, Caraway, Cumin, Anise, Fennel; most of them have diuretic activity. 5- Citrus fruits 6- Halfa-bar 7- Ammi visnaga 8- Cornsilk are also diuretics, will be discussed in next topic. Marketed herbal diuretic drugs Rowatinex® Constituents: Each capsule contains: Pinene [α + β] 31.0 mg, Camphene 15.0 mg, Cineol 3.0 mg, Fenchone 4.0 mg, Borneol 10.0 mg, and Anethol 4.0 mg. Dose: One capsule 3 or 4 times daily before meals. Indications and Usage: For urolithiasis, nephrolithiasis and mild urinary tract infections. It has a diuretic effect with antispasmodic effect to ease the passage of stones from ureters.  II- Herbs for kidney stones Affect 10–12% of the population in industrialized countries. Once recurrent, the subsequent relapse risk is raised and the interval between recurrences is shortened. The etiology of this disorder is multifactorial and is strongly related to dietary lifestyle habits. Management of stone disease depends on the size and location of the stones. Stones larger than 5 mm or stones that fail to pass through should be treated by some interventional procedures: extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PNL). Types of Kidney Stones Calcium oxalate (CaOx) is the predominant component of most stones (> 80% of stones). Remaining 20% are composed of struvite, cystine, uric acid, and other stones. Kidney stones are classified according to their chemical composition. Levels of urinary supersaturation correlate with the type of stone formed, and lowering supersaturation is effective for preventing stone recurrence.  Metabolic abnormalities hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, and gout can change the composition or saturation of the urine to enhance stone formation. A high sodium intake increases stone risk by reducing renal tubular calcium re-absorption and increasing urinary calcium. Patients should be advised to limit their dietary sodium intake.  Nephrolithiasis and Urolithiasis Nephrolithiasis = Urolithiasis = Renal calculus = Kidney stones  How much pain kidney stones cause? VS In a study published in the Journal of Pain Research, Study author Saiful Miah, clinical lecturer in urology at Imperial College Healthcare NHS Trust, London, said: “We asked 19 women who had experienced both kidney stones and childbirth which was more painful. The majority thought their kidney stone pain was a lot worse than childbirth”. Symptoms of kidney stones  Herbs for Calcium oxalate or phosphate stones 1 Citrate (Citrocid magnesium® and Uralyt-U®) Citrate is a known inhibitor of calcium-based stones. Its presence in urine decreases the saturation of Potassium Sodium Hydrogen Citrate calcium oxalate and calcium phosphate by forming soluble complexes with calcium. Patients therefore could benefit from intake of dietary citrate. Citric acid  Citrate in Apple and Citrus fruits Citrus fruits and juices are natural source of dietary citrate. studies investigated their influence on urinary variables & risk of crystallization. Administration of a soft drink containing grapefruit juice 2002 clinical significantly increased urinary flow with significant increase study in urinary excretion of citrate, calcium and magnesium. Orange, grapefruit or apple juice: 2003 clinical (1) Increased pH value study (2) Increased citrate excretion after consumption of each juice (3) CaOx crystallization was significantly reduced by grapefruit and apple juice but not by orange juice. Citrate in lemon juice In comparison to orange and grapefruit juice, lemon juice contains the highest concentration of citrate, nearly 5 times that of oranges. So many studies have investigated lemonade therapy as a potential treatment for hypocitraturic nephrolithiasis consumption of lemonade significantly increased urinary citrate excretion and therefore could be a useful adjunctive therapy in patients with hypocitraturia.  2 Halfa bar (Cymbopogon schoenanthus) (Proximol®) It is locally known as Halfa-bar, or camel grass, is an aromatic grass growing wildly and widely in Egypt. Its tea is considered a refreshing beverage that is largely consumed in North Africa as a substitute for tea, due to its pleasant aroma and taste. Its leaves are used in cooking recipes. Traditionally, this herb has been used for renal colic, fever and as diuretic. Recent researches showed broad spectrum antibacterial, anthelmintic, antioxidant. It exerts unique antispasmodic properties as it dilates the ureters Mechanism through relaxation of the smooth muscle fibers without abolishing the of action propulsive movement of the tissue of the ureter, helping the extrusion of the calculi. Active Proximadiol is the main antispasmodic active constituent constituents  3 Ammi visnaga (Fam. Apiaceae) (coli urinal®) Traditionally, khella is used as antispasmodic for colic and abdominal cramps, kidney stones, menstrual pain, and as a diuretic. Main active constituents are khellin and visnagin. A 2005 study mentioned a case report of a 50-year-old man Case diagnosed with 3 renal calculi, two on right urethra (3–5 mm study diameter) and one on the left kidney (3mm diameter). Ammi visnaga seeds through boiling a teaspoon size Treatment (10g) in 200ml water for 10 days twice daily. 2 days after initiation of drinking A.visnaga seed extract, pain Results was relieved, and no hematuria was observed. Within 10 days, all the stones in kidney passed out through urine.  4 Tamarind (Tamarindus indica) Previous clinical studies reported an aqueous extract of tamarind fruit (10gm/day) was included in the diet of healthy adult volunteers for a week. 1- Complete disappearance of calcium oxalate crystal aggregates. 2- Fall in density and size of crystalluria. 3- Decreased excretion of oxalic acid.  5 Cornsilk (Stigma maydis) It has been used as traditional medicine in many parts of the world. It is used for the treatment of cystitis, edema, kidney stones, diuretic, prostate disorder, and urinary infections. A 2018 in-vivo study using cornsilk infusion with different concentrations, results showed: 1- Increase in calcium levels after incubation of kidney stone with corn silk infusions. The levels of Ca dissolved in the infuse of 2%, 6%, and 10%, respectively, were 2.2600 µg/ml, 7.9267 µg/ml, and 10.9233 µg/ml. 2- It exerted a diuretic effect by increasing the urine volume for 24h. Mechanism of action: It soothes and relaxes the lining of the bladder and urinary tubules, hence reducing irritation and increasing urine secretion.  Other marketed herbal drugs Cystone ® It is a mixture of a mixture of 9 east Indian herbs. Mechanism of action: 1- It has anti-inflammatory and antimicrobial activities. 2- It decreases stone forming substances like oxalic acid, calcium hydroxyproline ……etc. 3- It helps in stone disintegration by acting on mucin, the substance that binds particles together. Herbal anti-spasmodic for kidney stones: Hyoscine butylbromide (Buscopan®): A very potent antispasmodic drug for renal colic. It is available as injections and tablets.  Herbs for uric acid stones 1 Hibiscus (Hibiscus sabdariffa) A 2008 clinical study on 18 subjects with or without a history of renal stones. Treatment: receiving a cup of tea made from 1.5g of dry Roselle calyces twice daily (morning and evening) for 15 days. Results: It was reported an increased uric acid excretion and clearance. Also, the reported diuretic effect of hibiscus helps in dissolving uric acid and calcium oxalate crystals, thus preventing stone formation. 2 Parsley 2011, 2018 in-vivo studies showed the ability of parsley in reducing the elevated level of uric acid as well as improving renal and hepatic damages caused by hyperuricemia. They suggest the possible usage of parsley as an alternative for allopurinol, or at least in combination therapy to minimize the side effects of allopurinol to treat hyperuricemia.  Chronic Kidney Disease “Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then removed in your urine. Advanced chronic kidney disease can cause dangerous levels of fluid, electrolytes and wastes to build up in your body.” Mayo clinic. Diseases and conditions that cause chronic kidney disease include: Type 1 or type 2 diabetes High blood pressure Glomerulonephritis, an inflammation of the kidney's filtering units (glomeruli) Interstitial nephritis, an inflammation of the kidney's tubules & surrounding structures Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers.  Herbal treatments for Chronic Kidney Disease Grapes Increase GFR; decreased proteinuria, 1 (Vitis viniferae) depressed triglyceride and prevent anemia. Seeds powder (350 mg) Licorice Decreased serum potassium concentration 2 (Glycyrrhiza glabra) and frequency of severe hyperkalaemia Glycyrrhetinic acid (life-threatening problem in hemodialysis supplement (500 mg) patients). Silybum marianum Restored imbalance of thiols in patients with 3 end stage diabetic nephropathy. (Anti-oxidant) Silibinin (350 mg)  Beet roots Reduced peripheral systolic, diastolic, mean 4 (Beta vulgaris) arterial pressure and reduced renal resistive Roots (300 mg) index significantly. (Anti-hypertensive) Concentrated juice Curcuma longa & Decreased PGE2 and ameliorated Boswellia serrata 5 inflammation in patients with CKD. Extract (824 and 516 (Anti-inflammatory effect) mg) Renal resistive index is a sonographic index of intrarenal arteries to investigate arterial compliance and/or resistance. Thank You