Phyllanthus niruri in the management of nephrolithiasis: A systematic review of the literature

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.