Urinary stones affect 10–12% of the population in industrialized countries. There are only a few geographical areas in which stone disease is rare, e.g., in Greenland and in the coastal areas of Japan. The incidence of urinary stones has been increasing over the last years while the age of onset is decreasing. With a prevalence of > 10% and an expected recurrence rate of ~ 50%, the stone disease has an important effect on the healthcare system. Once recurrent, the subsequent relapse risk is raised and the interval between recurrences is shortened. Features associated with recurrence include a young age of onset, positive family history, infection stones and underlying medical conditions. Epidemiological studies revealed that nephrolithiasis is more common in men (12%) than in women (6%) and is more prevalent between the ages of 20 to 40 in both sexes. The etiology of this disorder is multifactorial and is strongly related to dietary lifestyle habits or practices. Increased rates of hypertension and obesity, which are linked to nephrolithiasis, also contribute to an increase in stone formation.
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, usually treated by some interventional procedures such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PNL). Unfortunately, the propensity for stone recurrence is not altered by removal of stones with ESWL and stone recurrence is still about 50%. In addition, ESWL might show some significant side effects such as renal damage, ESWL induced hypertension or renal impairment.
Although there are a few recent reports of beneficial effects of medical treatments in enhancing clearance of stones in the distal ureters, there is still no satisfactory drug to use in clinical therapy, especially for the prevention or the recurrence of stones. In this regard, many plants have been traditionally used to treat kidney stones and have been shown to be effective.
Citrate is a known inhibitor of calcium-based stones. Its presence in urine decreases the saturation of calcium oxalate and calcium phosphate by forming soluble complexes with calcium. By its conversion through bicarbonate citrate increases urinary pH which induces an additional citraturic response by slowing renal citrate metabolism and impairing citrate reabsorption. However, pharmacological potassium citrate supplementation requires a rigorous schedule of numerous tablets or liquid supplements taken routinely 3 to 4 times a day. Patient compliance significantly decreases when medications are administered more than once daily. Patients therefore could benefit from intake of dietary citrate. Citrus fruits and juices are a known natural source of dietary citrate. Several studies investigated the influence of orange and grapefruit juice on urinary variables and the risk of crystallization.
In comparison to orange and grapefruit juice, lemon juice [Citrus limon (L.) Burm. f.] contains the highest concentration of citrate, nearly 5 times that of oranges. So far many studies have investigated lemonade therapy as a potential treatment for hypocitraturic nephrolithiasis. The studies concluded that consumption of lemonade significantly increased urinary citrate excretion and therefore could be a useful adjunctive therapy in patients with hypocitraturia. Four ounces of lemon juice provide 5.9 g citric acid. When diluted in 32 oz (960 mL) of water, lemonade could not only promote dietary citrate but also fluids.
Cranberry (Vaccinium macrocarpon Ait.) juice is another juice that has been investigated in clinical trials for its ability to influence urinary biochemical and physicochemical risk factors associated with CaOx kidney stones. Since compounds in cranberry juice have been shown to inhibit the attachment of bacteria to the epithelial lining of the urinary tract, the same compounds could inhibit the attachment of CaOx crystals and stone-promoting bacteria to renal epithelial cells.
A unique herbomineral formulation of Aimil Pharmaceuticals, brand name NEERI, enriched with potent anti-calcifying herbs, rich source of citrates, other micronutrients and supplements stone inhibitors which prevents calcium from binding with oxalate or Phosphates. Neeri significantly increases excretion of stone inhibitor molecules which forms soluble complex with calcium which ultimately decreases the concentration of urinary calcium, this action inhibits the formation of kidney stones. Neeri inhibits calculogenesis by regularising the mineral balance and balancing the crystalloid-colloid imbalance. It prevents the accumulation, deposition and super-saturation of calculogenic chemicals like oxalic acid and calcium hydroxyproline in urine.