Identification of medicinal plants for the treatment of kidney and urinary stones

Introduction: Kidney stones are the third most common urinary tract problems after urinary tract infections and prostate pathology. Kidney stones may cause extreme pain and blockage of urine flow. They are usually treated with medications that may cause a number of side-effects. Medicinal herbs are used in different cultures as a reliable source of natural remedies. Objectives: This study aimed to determine native medicinal plants used by traditional healers of Shiraz for the treatment of kidney stones. Materials and Methods: The ethno-medicinal data were collected between July and September 2012 through face-to-face interview with local herbalist. Results: A total of 18 species belonging to 19 botanical families were recorded in study area. Species with the highest frequency of mentions were Alhagi maurorum (51.58%), Tribulus terrestris (51.58%), and Nigella sativa (48.14). The most frequently used plant parts were aerial parts (38%), leaf (33%) and fruits (17%). Decoction (68%) was the most frequently prescribed method of preparation. Most of the medicinal plants recommended by Shirazian herbalists have not been investigated in animal and humane models of renal stone which provides a new area of research. Conclusion: In the case of safety and effectiveness, they can be refined and processed to produce natural drugs.


Introduction
Kidney stones are the third most common urinary tract problems, after urinary tract infections and prostate diseases. Most people with kidney stones suffer from severe colic pains that are not relieved by conventional pain killers and may require narcotic analgesics. In addition to pain, urinary tract obstruction, urinary tract infection, hydronephrosis and severe bleeding may occur and in some cases, surgery is required to remove or break stones (1). The introduction of ESWL in the 1980s revolutionized the treatment of urinary stones. Today, more than 90% of patients with upper urinary tract stones are treated based on the size, type and location of the stone, with a treatment success rate of 68%-86% (2). It is has been reported that increased dietary protein intake may elevate the rates of developing kidney stones. Kidney stones are common clinical disorders and have both high incidence and high prevalence in the world. The prevalence of kidney stones is influenced by geographic location, lifestyle, race/ethnicity and other factors. In different studies, its world prevalence has been reported to be about 1%-15%. Iran has a high incidence of kidney stones prevalence. Approximately 75% of all kidney stones are calcium stone which composed of calcium oxalate and/or calcium phosphate (3). It has been estimated that 80% of the world's population relies on traditional medicine to treat their diseases (4). Medicinal plants have a long history of use and are globally safer than synthetic drugs (5). They are a reliable source for drug discovery (6). Today, researchers have focused on the drug discovery from medicinal plants (7). It has been estimated that at least one third of all medicinal product have plant origin (8). Medicinal plants are regarded as an acceptable, cheap, easily available and safe source of active compounds for pharmaceutical (9). The therapeutic effects of medicinal plants on kidney and urinary tract disorders have been variously studied and their efficacy has been demonstrated (10).

Objectives
A wide variety of medicinal plants are used in Iranian traditional medicine to treat kidney disorders (11). This study aimed to determine the native medicinal plants used by traditional healers of Shiraz for the treatment of kidney stone.

Materials and Methods
The study area This study was conducted in Shiraz which is located in the southwest of Iran. Shiraz is one of the largest cities in Iran and is the capital of Fars province. The city has a length of 40 km, a width of 15-30 km and a total area of 1268 km 2 . The population of this city was 1 460 665 in 2009. It has a moderate climate and lies in the Zagros mountain range at an altitude of 1468 m. It is surrounded by Kuh-e Sabz Pushan, Kuh-e Bamu, Kuh-e Chel Magham in the north and Kuh-e Drak in the west. The coldest month of the year is January, with an average temperature of 5℃ and the warmest month is July with an average temperature of 30℃. The average annual temperature is about 18℃ and the average annual rainfall is 3378 mm (12).

The methodology of ethno-medicinal data collection
The ethno-medicinal data were collected between July and September 2012 through face-to-face interview with local herbalist and herbal healers. Herbalists were interviewed in their herbal stores with the aid of semi-structured questionnaires. Questionnaires were included herbalist personal information, plant local name, plant growth season, plant parts used, preparation methods, and traditional therapies. Questionnaires data were transferred to Microsoft Excel.

Ethical issues
The research followed the tenets of the Declaration of Helsinki. The research was approved by the ethical committee of Shahrekord University of Medical Sciences.

Statistical analysis
Data collected from local herbalist was analyzed using Microsoft Excel 2007.

Results
Ethno-medicinal information of plants used in the management of kidney stone in Shiraz are shown in Table 1. A total of 18 species belonging to 19 botanical families are used to treat kidney stone in Shiraz. The number of mentions of each plant spices for the treatment of kidney stone is shown in Table 2. Species with the highest frequency of mentions in the interview were Alhagi maurorum (51.58%), Tribulus terrestris (51.58%), Nigella Sativa (48.14%), Mangifera indica (44.44%), Prunus cerasus (37.03%), Prangos acaulis (DC.) Bornm (33.33%). Botani- Table 1. Medicinal plant recommended for the treatment of kidney stone; scientific name, common name, family name, plant parts used and preparation methods cal families recommended by Shirazian herbalist for the treatment of kidney stone are shown in Figure 1. Apiaceae was the most commonly recommended family. As shown in Figure 2 the most frequently used plant parts were aerial parts (38%), leaf (33%) and fruits (17%). Decoction (68%) was the most frequently prescribed method of preparation (Figure 3).

Discussion
We collected local knowledge of Shirazian herbal healers on medicinal plants used in the treatment of kidney stone. A total of 18 species belonging to 19 botanical families are used to treat kidney stone in Shiraz. The most frequency used plant Species were Alhagi maurorum (51.58%), Tribulus terrestris (51.58%), Nigella sativa (48.14%), Mangifera indica (44.44%), Prunus cerasus (37.03%) and Prangos acaulis (DC.). A wide variety of medicinal plants are used to treat renal stones in different parts of Iran. In ethno-botany of Kazeroon Nasturtium officinale (L.) R. Br., Alhaji camelorum, and Tribulus terrestris L. are used to treat kidney stone (13) (25). Most of the medicinal plants recommended by Shirazian herbalist have not been investigated in animal and humane models of renal stone which provides a new area of research. In the case of safety and effectiveness, they can be refined and processed to produce natural drugs.

Conclusion
In the case of safety and effectiveness, they can be refined and processed to produce natural drugs.

Limitations of the study
This study limited to a Shiraz city. The same study in various parts of Iran suggests.