HasÄh al-Kulya (Nephrolithiasis), or kidney stone disease, is a common, painful condition, having a substantial economic impact. Each year, billions of dollars are spent on the nephrolithiasis-related activity, with the majority of expenditures on surgical treatment of existing stones. Infectious stones, if not appropriately treated, can have devastating consequences and lead to end-stage renal disease. Globally, its incidence is increasing; an analysis from India shows an increase from 0.9% to 9.0% over 20 years. Once an individual has had a stone, the prevention of a recurrence is essential. 1 The goals of nephrolithiasis treatment are to remove the stone, reduce the
3 damage incurred by growth and spread of stones, and prevent its recurrence. Therapies in modern system of medicine for expulsion and prevention of recurrence of nephrolithiasis are ineffective. Certain drugs may help the stone to pass, but they have frequent and serious adverse effects. Treating nephrolithiasis with thiazides may induce hypokalaemia, hypomagnesaemia, hyperuricaemia, hyperglycaemia, and hyperlipidaemia. Thiazide-induced hypokalemia will reduce urine citrate, an important inhibitor of calcium crystallization (secondary hypocitraturia), and leading to stone formation. Moreover, the drug (thiazide) effect requires a slight contraction of the extracellular fluid volume, and high dietary NaCl intake reduces its therapeutic effect. Acetohydroxamic acid, an inhibitor of urease is used to treat struvite stones, but it has many side effects, such as headache, tremor, and thrombophlebitis, that limits its use. Although penicillamine or tiopronin are effective in the treatment of cystine stones, but the ability of these treatments to reduce stone frequency is not quantitatively known. However, they exhibit a high rate of intolerance due to severe side effects, such as abdominal pain, loss of taste, fever, proteinuria, and, nephritic syndrome. Allopurinol is used in calcium and uric acid stones, but it inhibits xanthine oxidase leading to xanthine stone formation. 2 Currently, surgical procedures and extra-corporeal shock wave lithotripsy (ESWL) are commonly employed in the management of nephrolithiasis. With lithotripsy, residual stones are left in 35-50% of cases having stones of >2 cm, or >1 cm in the lower poles; and lithotripsy disrupts cystine stones poorly. 2 Moreover, the major drawback of these procedures is a recurrence of renal calculi. Most of the patients who undergo a surgical procedure for removal of renal calculi refuse to undergo a similar procedure again and again. For them, drugs that would remove renal calculus and would prevent recurrence are required. Unani drugs having lithotriptic activity as such may not replace surgically procedures but may help in preventing the recurrence of nephrolithiasis. Unani Pharmacopoeial formulation – Dawa-e-Gurda has been used by the Unani physicians since decades for the treatment of HasÄh al-Kulya (Nephrolithiasis), but no scientific data regarding its safety and efficacy are available. Keeping this in view, this study has been planned to evaluate the safety and efficacy of an Unani Pharmacopoeial formulation – Dawa-e-Gurda in the treatment of HasÄh al-Kulya (Nephrolithiasis). |