Kidney stone and Ayurveda

Modern view

The prevalence of kidney stone (urolithiasis) is approximately 2 to 3 % in the general population, and the estimated lifetime risk of developing a kidney stone is about 12 percent for white males. Approximately 50 % of patients with previous urinary calculi have a recurrence within 10 years.

Stone disease is two to three times more common in males than in females. It occurs more often in adults than in elderly persons, and more often in elderly persons than in children. Whites are affected more often than persons of Asian ethnicity, who are affected more often than blacks. In addition, urolithiasis occurs more frequently in hot, arid areas than in temperate regions.

Decreased fluid intake and consequent urine concentration are among the most important factors influencing stone formation. Certain medications, such as triamterene (Dyrenium), indinavir (Crixivan) and acetazolamide (Diamox), are also associated with urolithiasis. Dietary oxalate is another possible cause, but the role of dietary calcium is less clear, and calcium restriction is no longer universally recommended.

Symptoms

The classic presentation of renal colic is

>>excruciating unilateral flank pain or

>>lower abdominal pain of sudden onset that is not related to any precipitating event and is not relieved by postural changes or nonnarcotic medications.

>>With the exception of nausea and vomiting secondary to stimulation of the celiac plexus, gastrointestinal symptoms are usually absent.

Most of the kidney stones will pass spontaneously and will not require surgical treatment. Whether a stone can pass successfully primarily depends on the size of the stone. Based on several studies of stone patients, a size criteria of 5mm  or less (about 0.2 inches) is generally felt to predict a reasonable chance (50-70%) for spontaneous passage.

Stones that are more distal (closer to the bladder) are more likely to pass than stones that are more proximal (closer to the kidneys).

The decision to allow a stone to pass spontaneously will also take in account the amount of pain you are experiencing, your medical health, the possibility of infection, and other factors. Typically, a period of 4-6 weeks is allowed to give stones a chance to pass.

                                                                  Ayurvedic view

In ayurveda also there is mention of this calculus.Most of the acharya has mentioned about it.It is stated as Asmari in ayurvedic texts.

Ashmari as a Maharoga :

The diseases, which are difficult to cure due to their ashraya in marma sthana, involvement of bahu dosha. etc. These maharogas are 8 in number explained by all bruhatrayees, but Sushrutha and Vagbhata considered ashmari under mahagada. 
They are Vatavyadhi, Prameha, Kusta, Arsha, Bhagandara, Ashmari, Moodagarbha and Udara roga.

Samprapthi Ghatakas: Pathophysiology
• Dosha : Tridosha
• Dushya : Mootra
• Agni : Jataragnimandya
• Ama : Jataragnimandyajanya ama
• Srotas : Moothravaha srotas
• Udbhava sthana : Amashaya and Pakvashaya
• Sanchara sthana : Siras, Amashayapakvashayagatha moothravahasrotas 
• Adhistana : Moothravaha srotas and Basti
• Vyaktha sthana : Moothravaha srotas and basti
• Dustiprakara : Sanga
• Rogamarga : Madhyama
• Vyadhi swabhava : Chirakari 
• Sadhyasadhyatha : Krichrasadhya, Sasthrasadhya 

Treatment

For the treatment there should be sodhana therapy (panchkarma) followed by samana.

The prognosis and effective management of renal calculi depends mainly on the position , size and duration of the stone.Mainly a stone <5mm is easy to treat which may pass easily even without any medicaitons.As the size is >5mm the chance of drain through urine with medicines decreases exponentially.A stone of size 4mm has 80% chance while that of 9mm it is 20%.Also as the position of the stone become more distal in the urinary pathway prognosis is better.For a stone of 1cm or greater it will be difficult to treat(may require ESWL or open surgery).Any way ayurvedic medications have to be continued to 2 months for better results,also ask the pt to take KUB Xray monthly.