Kidney stones: Mechanism of formation, pathogenesis and possible treatments

With a very high recurrence rate in both males and females, kidney stones also called as urolithiasis (nephrolithiasis) are affecting a remarkably significant population around the globe. As kidney stones formation largely depends on urine’s oxalate content rather than the calcium concentration of the urine, kidney stones are predominantly made up of oxalate and also there are multiple steps involved in the pathogenesis of calcium oxalate including nucleation, crystal growth, crystal aggregation and crystal retention. Although there are several therapies such as thiazide like diuretic, allopurinol, painkillers, dietary modifications or in severe conditions shock-wave treatment, ureterenooscopic and percutaneous nephrolithotomy are being presently used for kidney stones treatment, however, the side effects that these treatments possess and reoccurrence of the disease have motivated researchers to search for better and safer options. Herbal drugs as well as several medicinal plants display antiurolithiatic activity and thus perform an important role in treatment of kidney stone disease. Studies in both humans and animal models of hyperoxaluria-associated calcium oxalate kidney stone disease indicated that oxalate-degrading microorganisms, in particular the more widely-studied Oxalobacter formigenes are both capable of and important in regulating urinary levels of oxalate. Such regulation of oxalate levels in the body have displayed prominent reductions in hyperoxaluria followed by diminished rate of recurrent stone formation. The present work discusses the mechanism of stone formation, several forms of kidney stones as well as the various therapeutic measures for treatment of urinary stones including many medicinal plants as herbal option as well as oxalate degrading enzyme.