2. Definition
The term Urolithiasis refers to the formation or presence of
stony concretions or crystal aggregation in the urinary tract
Stones may be present in
• Kidney (Nephrolithiasis),
• Ureter (ureterolithiasis),
• Bladder(cystolithiasis), or
• Urethra
3. Factors contributing to Urinary Stone formation
• Reduced fluid intake resulting in reduced urine output
• Exercise causing dehydration
• Intake of drugs causing Hyperuricemia
• History of Gout
• Urinary stasis due to inadequate drainage of urine
• Decrease in urinary citrate level leading to increased
deposition of calcium
• Deficiency of Vitamin A & C
• Diseases like Ulcerative Colitis, Sarcoidosis,
Hyperparathyroidism
• Excessive intake of Proteins
4. Types of Urinary Stones
Struvite
These type of
stones are usually
associated with
urinary infection.
They can grow very
rapidly forming cast
in the urinary tract
(Staghorn calculus).
Left untreated
these may cause
chronic infection
and permanent
kidney damage
Calcium stones
These are
composed of
calcium compounds
mostly calcium
oxalate. Sometimes
other minerals such
as calcium
phosphate may also
form stones.
Calcium Stones may
be caused by high
calcium level such
as in
Hyperparathyroidis
m. High oxalate
level can also cause
increased risk for
calcium stones
Uric Acid Stones
Uric Acid Stones are
formed due to low
urine output,
excessive intake of
proteins especially
red meat, alcohol
intake,
inflammatory bowel
disease, Gout.
These form in acidic
urine and are not
visible in a plain X-
RAY
Cystine Stone
These occur due to
an inherited defect
in amino acid
transport, manifests
as recurrent stones
in young patients
5. Clinical Features
Nephrolithiasis
Recurrent episodes of severe colicky pain in
flanks may be due to stone obstructing the
ureteropelvic junction. Pain at costovertebral
angle, haematuria
Ureteric stone
Stone passing through the ureter may cause ureteric colic i.e. sharp
intermittent pain radiating from flank to umbilical region or perineum .
This may be accompanied by nausea, vomiting, tachycardia
Bladder stone
Characterised by dysuria( pain or burning during micturition),
frequency and urgency
7. Investigations
Plain X-ray
Useful in detecting radio-opaque calculi such as calcium oxalate and calcium
phosphate but it is not suited for radioluscent stone like uric acid and
cystine. Also non urologic radio-opacities like calcified mesenteric lymph
nodes etc may be misinterpreted as calculi
Sonology
Ultrasound can detect calculi and also visualize hydronephrosis
Intravenous pyelography
Gives information about anatomy and functioning of urinary system as well
as visualization of calculi as filling defects
Non contrast helical CT
Most sensitive and specific investigation
8. Management
• Extra corporeal shock wave
lithotripsy- non invasive
technique using acoustic
pulse to break down calculi
• Ureteroscopy- endoscopic
removal of calculi
• Uretero- renoscopy
• Percutaneous
nephrolithotomy
• Increase fluid intake, this helps in flushing
out concretions as well as prevents
further build up
• Salt intake should be restricted
• Depending on composition of stone,
dietary restriction may be advised
• Intake of animal proteins i.e. meat, eggs,
fish should be restricted especially for
persons who have hyperuricemia
• Oxalate rich foods such as spinach, nuts,
tomato, Brinjal, coffee etc. should be
avoided especially by persons who have
oxalate stones
• Persons with hypercalciuria should avoid
dairy products like milk, cheese etc.
• Avoid large doses of Vitamin D AND
Vitamin C supplementation
• Increasing Citric acid intake from natural
sources like lemon will reduce formation
of stones .Acidic urine reduces formation
of Calcium oxalate stones
Interventional General Management
9. Homoeopathic Management
Remedy Indications
BERBERIS VULGARIS Wandering, radiating pain < on motion, standing. Pain in thighs and loins on
urinating. Urethra burns when not urinating. Urine with bright red sediment.
Bubbling sore sensation in kidneys. Renal colic usually left sided.Sensation as if
some urine remained after urinating
CALCAREA RENALIS prevents recurrence of renal calculi formation, usually used in 6c potency
CANTHARIS Intolerable, constant urging to urinate. Urine scalds, passes drop by drop.
Burning, cutting pain before, during and after urination
COLCHICUM AUTUMNALE Uric acid diathesis, burning sensation urine, urine dark turbid
EPIGEA REPENS Q Burning in neck of bladder while urinating and tenesmus after wards. Fine sand in
urine of a brown colour. Indicated in Uric Acid calculi.Muco purulent and Uric acid
deposit
FRAGARIA prevents the formation of renal calculi. Used in 6c potency
HEDEOMA PULEGIOIDES Q Left sided calculi, pain along left ureter. Burning pain from left kidney to bladder.
Urging to urinate even after passing urine
1
10. Homoeopathic Management
Remedy Indications
HYDRANGEA
ARBORESCENS Q
Calculus with renal colic. Usually left side. Spasmodic stricture. Sharp pain in the
loins. Haematuria. Urine hard to start, burning in urethra, frequent desire to pass
urine, profuse deposits of white salts in urine
HYGROPHILIA SPINOSA Renal calculus associated with hydronephrosis
LYCOPODIUM Renal colic usually right sided. Heavy red sediment. Pain before urination. Pain
relieved after passing urine. Also for uric acid calculi
MILLEFOLIUM Stone in bladder, retention of urine, bloody urine
NUX VOMICA Frequent, ineffectual urging to pass urine. Fastidious, irritable patient. Desire for
stimulants, like fat foods
OCIMUM CAN Q Renal colic usually right sided. Red sand in urine. Formation of spike crystals of
uric acid
PAREIRA BRAVA Violent pain in glans penis, pain down thighs during micturition. Constant urging
with great straining. Can pass urine only when he goes on his knees, pressing head
firmly against the floor
2
11. Homoeopathic Management
Remedy Indications
SARSAPARILLA Renal colic, pain from right kidney downwards. Urine dribbles while sitting, uric
acid calculi. Urine scanty and bloody. Severe pain at the conclusion of urination.
Urine dribbles while sitting. Cystitis. Prevents build up of stones
SOLIDAGO V Renal colic extends forward to the abdomen and bladder. Difficult and scanty
urine. Offensive urine with reddish brown thick sediment
STIGMATA MAYDIS Q Medicine for renal lithiasis. Uric acid diathesis, blood and red sand in urine.
Tenesmus after urination
TABACUM Renal colic usually left sided. Violent pain along the ureter. Sometimes associated
with vertigo and vomiting
THUJA OCCIDENTALIS Renal calculus usually left sided. Frequent urination accompanying pain
3
12. Case History: Renal Calculi, Male, 55 years
Submitted by Dr. Anubha Sikka
Indications
• Patient c/o left renal pain with mild burning micturition
• Investigations- USG abdomen
• Left ureterovesical junction causing mild hydroureteronephrosis, 7mm in
size at lower end of left ureter
Prescription
Berb vulgaris 30 /tds & colocyth 200 / sos for 1wk.
The patient was advised lots of fluids & less spicy food. The patient did not
c/o pain .The prescription was repeated and he was advised USG which
shows no calculi. Resolution took two months.
1
15. Case History: Uric Acid Calculus, Male, 28 years
Submitted by Dr. Deepti Chawla
Indications
A 28 Year old male patient c/o recurrent episodes of pain in lumbar region both left and right
since many years. Patient underwent many types of treatments , resulting in passage of a
stone few years back.
The biochemical analysis of this stone revealed that it was a Uric acid Calculus.
Since then patient has been having episodes of pain in left lumbar region at times radiating to
lower abdomen, he has been taking symptomatic allopathic treatment with temporary relief.
Notable generals
• Appetite- increased but eating small amount causes sensation of bloating
• Desires - sweets2+, milk 1+
• Urine- occasional dysuria
• Past h/o haematuria
• Mental general were unremarkable
• Previous USG reports are attached, these showed mild to moderate Hydronephrosis L
kidney, with Hydroureter, one calculus 9mm at lower pole of Left Kidney and one 11.5 mm
calculus at left lower ureter
2
16. Case History: Uric Acid Calculus, Male, 28 years
Submitted by Dr. Deepti Chawla
Treatment
27 August
Started treatment as under
• Lycopodium 200/ 3 doses
• SL 30 /TDS/ 5 DAYS
• Berberis Vulgaris mother tincture/ 10 drops / tds / 5 days
Investigation advised
• Serum Uric Acid
Lab Report indicated raised Serum Uric Acid level-- 7.6 mg/dl
symptoms were same
Prescription was as follows:
Lycopodium 200/ 3doses
Colchicum 30/ tds/7days
Berb Vulg tinct./ 10 drops /TDS/ 7 days
30 August
06 September
Condition same, prescription was repeated
2
17. Case History: Uric Acid Calculus, Male, 28 years
Submitted by Dr. Deepti Chawla
Patient complained of sharp pain left loin
Prescription:
Lycopodium 1M/ 3 Doses
Colchicum 30/tds/7days
Berberis Vulg tincture/ 10 drops /tds/7 days
Hydrangea Tincture/ 10 drops/ tds/ 7 days
Patient reported passage of stone with urine few days back with
relief in complaints
Prescription and advise
SL 30 / TDS / 7days
ADVISED USG ABDOMEN
23 September
30 September
USG Report
Mild Hydronephrosis left kidney
No report of any calculus
13 September
2
18. Case History: Uric Acid Calculus, Male, 28 years
Submitted by Dr. Deepti Chawla
2
19. Case History: Uric Acid Calculus, Male, 28 years
Submitted by Dr. Deepti Chawla
2
20. Case History: Uric Acid Calculus, Male, 28 years
Submitted by Dr. Deepti Chawla
2
21. Contributors:
Dr Jithesh T.K., C.M.O
Dr Pradip Kumar Roy, S.M.O
Dr Abakash Barik, M.O.
Dr Anubha Sikka, M.O.
Dr Sanjeev Aggarwal, M.O.
Compiled & Edited by:
Dr Deepti Chawla
C.M.O, Dte. of AYUSH
