Iregui-Parra J. et al., 2025: Phyllanthus niruri in the management of nephrolithiasis: A systematic review of the literature.
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. Electronic address:
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
Comments 1
I admit that I did not look up two references (1,2) dealing with pH-changes in rat urine, quoted as having an effect on stone density: ”PN alters stone density, making them more susceptible to the passage and increasing stone-free rate.”
One reference focus on ESWL: “In 2006, Micali et al. conducted a prospective study of 150patients with calcium oxalate kidney stones who underwent ESWL. One group was given a PN extract for at least 3 months after the procedure, whereas the other group served as control. The SFR at 180 days was 93.5% for patients treated with PN extract, compared to 83.3% in the control group (p = 0.48). A benefit was also observed in the subgroup of patients with lower calyx stones, with an SFR of 93.7% vs.70.8% in the control group (p = 0.01). The retreatment rate was 39.7% versus 43.3% in the control group (p = 0.2), with no reported side effects.” (3).
1 Udupa AL, et al. Diuretic activity of Phyllanthus niruri (Linn.) in rats. Health.2010;2:511-2,
http://dx.doi.org/10.4236/health.2010.25076.
2 Castillo SF, et al. Diuretic effect of Phyllanthus niruri chanca Piedra in rats. Dialnet - UCV- SCIENTIA. 2011;3:11-7.
http://dx.doi.org/10.18050/revucv-scientia.v3i1.892.
3 Micali S, et al. Can Phyllanthus niruri affect the efficacy of extracorporeal shock wave lithotripsy for renal stones? A randomized, prospective, long-term study. J Urol. 2006 Sep;176(3):1020-2. doi: 10.1016/j.juro.2006.04.010. PMID: 16890682.
Peter Alken