Background:
Urolithiasis is a highly prevalent condition with recurrence rates exceeding 50% within 10 years. Stone formation results from complex interactions involving crystal aggregation, tubular epithelial adhesion, and metabolic abnormalities. Despite advances in surgical management such as extracorporeal shock wave lithotripsy (ESWL), residual fragments and recurrence remain common challenges. Phyllanthus niruri (Chanca Piedra), a medicinal plant traditionally used in stone disease, has been investigated for its potential preventive and adjunctive therapeutic effects.
Objective:
To summarize experimental and clinical evidence evaluating the efficacy, mechanisms of action, and safety of Phyllanthus niruri in the prevention and management of nephrolithiasis, including its role as an adjunct to ESWL.
Methods:
This narrative review integrates data from in vitro studies, animal models, and human clinical trials assessing the effects of P. niruri on calcium oxalate crystallization, crystal–cell interactions, stone burden, urinary metabolic parameters, and post-ESWL outcomes.
Results:
Experimental studies demonstrated that P. niruri interferes with multiple stages of stone formation, including inhibition of calcium oxalate crystal aggregation, reduction in crystal adhesion and endocytosis by renal tubular cells, and modulation of crystal structure and composition. In animal models, P. niruri reduced stone growth and altered stone morphology by increasing incorporation of glycosaminoglycans into the organic matrix. Clinical studies showed improved stone elimination, reduction in urinary calcium excretion among hypercalciuric patients, and enhanced stone-free rates following ESWL—particularly for lower caliceal stones—without reported adverse effects. Across studies, P. niruri demonstrated an excellent safety and tolerability profile.
Conclusion:
Phyllanthus niruri exhibits multifaceted antilithogenic effects by modulating crystal aggregation, epithelial interaction, and stone clearance mechanisms. Clinical evidence supports its safe use as a complementary strategy for improving ESWL outcomes and potentially reducing stone recurrence. Larger, long-term randomized trials are required to confirm its preventive and therapeutic role in urolithiasis.
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