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Iregui-Parra J. et al., 2025: Phyllanthus niruri in the management of nephrolithiasis: A systematic review of the literature.

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J Iregui-Parra 1, V Rojas Ossa 2, C M Arias Salazar 1, A D López Estupiñán 3, D Díaz Varela 1, L M Sinisterra Parra 4, L Diéguez 5, E Emiliani 6
1Grupo Colombiano de Investigación en Urología (GCIU), Colombia; Departamento de Epidemiología, Facultad de Ciencias de la Salud, Universidad Libre, Cali; Grupo Interdisciplinario de Investigación en Epidemiología y Salud Pública (GIESP), Santiago de Cali, Valle del Cauca, Colombia.
2Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Departamento de Urología, Hospital del Salvador, Universidad de Chile, Santiago de Chile, Chile.
3Grupo Colombiano de Investigación en Urología (GCIU), Colombia.
4Departamento de Epidemiología, Facultad de Ciencias de la Salud, Universidad Libre, Cali; Grupo Interdisciplinario de Investigación en Epidemiología y Salud Pública (GIESP), Santiago de Cali, Valle del Cauca, Colombia.
5Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain. 
6Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Departamento de Urología, NYU Langone Health, NYU Grossman School of Medicine, Nueva York, NY, United States.

Abstract

Introduction and objectives: Nephrolithiasis is one of the most prevalent urological pathologies worldwide, with an increasing incidence and multifactorial etiology, particularly influenced by diet. Surgical interventions or extracorporeal shock wave lithotripsy (ESWL) are the cornerstone treatments. However, as emphasized by the EAU and AUA guidelines, post-surgical medical management is recommended to reduce recurrence risk. Phyllanthus niruri (PN), widely used in traditional medicine, has been extensively researched, yielding mixed results and presenting an opportunity to explore its role further. This review aims to evaluate PN's potential in enhancing treatment efficacy and reducing stone recurrence.

Materials and methods: A systematic literature review was conducted, encompassing articles published from January 1994 to September 2022 in English and Spanish. The review included studies on humans and rats accessible through the authors' institutional affiliations. Titles and abstracts were screened, and relevant studies were selected for in-depth analysis.

Results: Out of the 16 selected studies, various mechanisms of action for PN were identified, such as promoting glycosaminoglycan (GAG) aggregation, inhibiting nucleation processes, and altering stone density to favor a stone-free state (SFR). Evidence consistently supports PN's long-term safety, confirmed by serial measurements of serum electrolytes and liver function. Novel applications, such as PN as an adjuvant to ESWL, show benefits for lower renal pole stones.

Conclusions: Growing evidence suggests that PN, when used alongside traditional interventions, is safe, without significant adverse effects, and may improve SFR outcomes after ESWL.

Actas Urol Esp (Engl Ed). 2025 Jul-Aug;49(6):501791. English, Spanish.
doi: 10.1016/j.acuroe.2025.501791. Epub 2025 Jun 4. PMID: 40480426

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Comments 1

Hans-Göran Tiselius
Hans-Göran Tiselius on Friday, 24 October 2025 11:00

Modern methods for stone removal are commonly associated with residual stones or fragments. The remaining stone constituents might cause development of new and sometimes larger stones. Also, for patients who have become stone-free is there a substantial risk for new stone formation. Accordingly, there is need for methods that either counteract formation of new stones or facilitate passage/removal of residuals.
In this regard different methods are available which are beyond the scope of this comment. But interestingly there are positive reports on the value of Phyllanthus niruri, commonly used for various purposes in traditional medicine. The mechanism of this agent in stone disease has been ascribed to the aggregation of glycosaminoglycans and inhibition of nucleation. These two mechanisms were analyzed in this systematic review. There were, however, only two studies in which SWL was used. Although the stone-free rates were superior in patients treated with Phyllanthus niruri compared with controls the demonstrated differences were small, and their clinical significance doubtful.
Another mechanism of action mentioned in this review is, however, that Phyllanthus niruri might modify the density of residual stones. This specific property is not further detailed or discussed in the report, but it is mentioned that this effect might increase stone/fragment passage and stone-free rates.
Treatment with Phyllanthus niruri was in all cases carried out after SWL, but much more interesting had it been to see if pre-treatment with Phyllanthus niruri could improve stone fragmentation.
It is my suggestion that colleagues who routinely use Phyllanthus niruri try to see whether altered stone density might be beneficial for the outcome of SWL.
Phyllanthus niruri is not commonly used in Sweden and therefore I cannot comment on the health economic effects.

Hans-Göran Tiselius

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Modern methods for stone removal are commonly associated with residual stones or fragments. The remaining stone constituents might cause development of new and sometimes larger stones. Also, for patients who have become stone-free is there a substantial risk for new stone formation. Accordingly, there is need for methods that either counteract formation of new stones or facilitate passage/removal of residuals. In this regard different methods are available which are beyond the scope of this comment. But interestingly there are positive reports on the value of Phyllanthus niruri, commonly used for various purposes in traditional medicine. The mechanism of this agent in stone disease has been ascribed to the aggregation of glycosaminoglycans and inhibition of nucleation. These two mechanisms were analyzed in this systematic review. There were, however, only two studies in which SWL was used. Although the stone-free rates were superior in patients treated with Phyllanthus niruri compared with controls the demonstrated differences were small, and their clinical significance doubtful. Another mechanism of action mentioned in this review is, however, that Phyllanthus niruri might modify the density of residual stones. This specific property is not further detailed or discussed in the report, but it is mentioned that this effect might increase stone/fragment passage and stone-free rates. Treatment with Phyllanthus niruri was in all cases carried out after SWL, but much more interesting had it been to see if pre-treatment with Phyllanthus niruri could improve stone fragmentation. It is my suggestion that colleagues who routinely use Phyllanthus niruri try to see whether altered stone density might be beneficial for the outcome of SWL. Phyllanthus niruri is not commonly used in Sweden and therefore I cannot comment on the health economic effects. Hans-Göran Tiselius
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Tuesday, 09 December 2025