Introduction of

Medical supplies

・ JIN ・Management of Kidney Stone

Kidney stone disease-1

Developed Asian Countries suffer changes from traditional to industrialized diet, due to lifestyle changes and globalization with the spread of Western culture. Accompanying these changes in food consumption at a global and regional level have been considerable health consequences such as obesity, diabetes, cardiovascular disease and cancer. These lifestyle diseases are the most common cause of death in the world and a great burden for society.

One of the lifestyle disease “Obesity” has been considered a major contributor to the increased frequency of Urolithiasis(kidney stone)seen in recent years.Urolithiasis is one of the common problems in countries in tropical Asia. It accounts for 40% of renal problems in Pakistan, which is a country in the “stone belt.” The hot climate and dietary factors play important roles.Evidence also suggests association of kidney stones with diabetes and cardiovascular diseases.

The Middle EastUric acid stones are more common than calcium-containing stones.[2]

The worldThe number of deaths due to kidney stones is estimated at 19,000 per year being fairly consistent between 1990 and 2010.[3]

North America and Europe The annual number of new cases per year of kidney stones is roughly 0.5%.

The United StatesAbout 9% of the population has had a kidney stone.[4] The frequency in the population of urolithiasis has increased from 3.2% to 5.2% from the mid-1970s to the mid-1990s.[5]

Kidney stone disease-2

The life time risk: 10 to 15% in the developed world20 to 25% in the Middle East

The increased risk of dehydration in hot climates, coupled with a diet 50% lower in calcium and 250% higher in oxalates compared to Western diets, accounts for the higher net risk in the Middle East.[1]

Kidney stone disease-3

Urolithiasis (urinary tract calculi or stones) and nephrolithiasis (kidney calculi or stones) a disorder that involves the process of stone formation in any part of urinary tract/kidney. The supersaturation of urine with stone forming elements like calcium oxalate, struvite, uric acid, and cystine tends to be a key pathological event in stone formation. Most kidney stones are made from calcium such as Calcium Oxalate and Calcium Phosphate.

Studies show that renal epithelial exposure to high oxalate and crystals of calcium phosphate generates excess Reactive Oxygen Species, causing injury and inflammation. Major markers of Oxidative Stress and inflammation are detectable in urine of stone patients with induced Calcium Oxalate nephrolithiasis.

Furthermore, lower serum levels of antioxidants have been found in individuals with a history of kidney stones. Studies shows that antioxidant treatments may reduce crystal and oxalate induced injury in tissue culture and animal models. A diet rich in antioxidants has been shown to reduce stone episodes.

References

<Kidney stone disease-1>1.)Akl C. Fahed, Abdul-Karim M. El-Hage-Sleiman,Theresa I. Farhat,and Georges M. Nemer,Journal of Nutrition and Metabolism Volume 2012 (2012),Diet, Genetics, and Disease: A Focus on the Middle East and North Africa Region2.)Vamsi Sodimbaku, Latha Pujari,UROLITHIASIS–AN UPDATED REVIEW OVER GENETICS, PATHOPHYSIOLOGY AND ITS CLINICAL MANAGEMENT3.)John Michael DiBianco,T.W Jarrett,Patrick Mufarrij,Metabolic Syndrome and Nephrolithiasis Risk: Should the Medical Management of Nephrolithiasis Include the Treatment of Metabolic Syndrome?Rev Urol. 2015; 17(3): 117–128.4.)Alberto Trinchieri,Epidemiology of urolithiasis: an update,Clin Cases Miner Bone Metab. 2008 May-Aug; 5(2): 101–106.5.)Jia‑Le Song Xin Zhao Qiang Wang,Protective effects of Quercus salicina on alloxan‑induced oxidative stress in HIT‑T15 pancreatic β cells6.)Park SH, Kim HJ, Yoon JS, Lee HW, Park GC, Yi E, Yoon G, Schini-Kerth VB, Oak MH.,The Effect of Quercus salicina Leaf Extracts on Vascular Endothelial Function: Role of Nitric Oxide.,J Nanosci Nanotechnol. 2016 Feb;16(2):2069-71.7.)Michelle López,Bernd Hoppe,History, epidemiology and regional diversities of urolithiasis,Pediatr Nephrol. 2010 Jan; 25(1): 49–59.

<Kidney stone disease-2>[1] Lieske, JC; Segura, JW (2004). "Ch. 7: Evaluation and Medical Management of Kidney Stones". In Potts, JM. Essential Urology: A Guide to Clinical Practice (1st ed.). Totowa, New Jersey: Humana Press. pp. 117–52. ISBN 978-1-58829-109-7.[2] Reilly, RF, Jr, Ch. 13: "Nephrolithiasis". In Reilly Jr & Perazella 2005, pp. 192–207.[3] Lozano, R; Naghavi, Mohsen; Foreman, Kyle; Lim, Stephen; et al. (December 15, 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604. [4] Kidney Stones in Adults". February 2013. Retrieved 22 May 2015.[5] Moe, OW (2006). "Kidney stones: Pathophysiology and medical management" (PDF). The Lancet. 367 (9507): 333–44. doi:10.1016/S0140-6736(06)68071-9. PMID 16443041.

<Kidney stone disease-3>1.)Vamsi Sodimbaku, Latha Pujari,UROLITHIASIS–AN UPDATED REVIEW OVER GENETICS, PATHOPHYSIOLOGY AND ITS CLINICAL MANAGEMENT2.) Department of Pathology and Department of Urology, College of Medicine, University of Florida, Gainesville, Florida, USA.Transl Androl Urol. 2014 Sep3): 256–276.Reactive oxygen species, inflammation and calcium oxalate nephrolithiasis

Alternative Therapy

Clinical studies revealed that use of plants and

plant extracts acts by diuretic, antioxidant,

increasing urinary citrate, antimicrobial, and other

possible mechanisms.

Kidney stone treatment-1

Prevention Lifestyle Changes such as• Increase water intake(up to 2L/daily)• Maximizing the urinary output.• Limiting the use of drugs that induce Urolithiasis/Nephrolithiasis•Reduce animal protein intake.• Low intake of sodium.• Reduce the dietary intake of purine and oxalate rich food.• Limitation of dietary intake of calcium.• Monitoring the body weight gain

<References>1.)Vamsi Sodimbaku, Latha Pujari,UROLITHIASIS–AN UPDATED REVIEW OVER GENETICS, PATHOPHYSIOLOGY AND ITS CLINICAL MANAGEMENT2.) Department of Pathology and Department of Urology, College of Medicine, University of Florida, Gainesville, Florida, USA.Transl Androl Urol. 2014 Sep3): 256–276.Reactive oxygen species, inflammation and calcium oxalate nephrolithiasis

Shock Wave Lithotripsy (SWL)

Shock Wave Lithotripsy (SWL) is the most common treatment and shock waves from

outside the body are targeted at a kidney stone causing the stone to fragment. The

stones are broken into tiny pieces. It is sometimes called ESWL: Extracorporeal

Shock Wave Lithotripsy®

SWL works better with some stones than others. Very large stones cannot be treated

this way. The size and shape of stone, where it is lodged in your urinary tract, your

health, and your kidneys' health will be part of the decision to use it. Stones that are

smaller than 2 cm in diameter are the best size for SWL. The treatment might not be

effective in very large ones.

Kidney stone treatment-2

Shock waves break up stones

Kidney stone treatment-3

Transurethral Uretero-lithotripsy (TUL) 

TUL is a one of kidney stone treatment method by breaking of the calculus to a small size, and taking the stone out of

the body during surgery by inserting the camera (endoscope) from the urine outlet (urethra) to the site of the stone. The

cost is about 500 to 600 thousand yen without insurance. (In case of insurance, patients take 30% burden. It is also

subject to high-cost medical care and limit amount certification.)

Kidney stone treatment-4

Percutaneous Nephrolithotomy (PNL) 

PNL is a surgery to remove large stones directly from the kidney by making a small incision in patient’s back. Passes of a

tiny scope into the kidney to break up the kidney stone. Ultrasound lithotripsy is the most common technology utilized to

fragment the stones. The procedure is typically a three-day inpatient procedure. The ideal stone size for PNL is larger than

1.5 cm and located in either the kidney.

Quercus Salicina Blume

Quercus salicina, commonly called Japanese willow leaf oak or urajirogashi, its local name, a medium-sized evergreen oak with a round-spreading, low-branching form. It is native to temperate alpine forested areas of Japan, Korea and Taiwan where it typically matures to 30-60’ tall over time, but usually grows significantly shorter outside its native habitat.

Quercus Salicina” has been clinically used for the treatment for urolithiasis in Japan for 48years. It plays a big role in the prevention of stone formation and frequency in both clinical and dietary management of urolithiasis.[1]

[1] Moriyama MT1, Miyazawa K, Noda K, Oka M, Tanaka M, Suzuki K.,Urol Res. 2007 Dec;35(6):295-300. Epub 2007 Sep 20.,Reduction in oxalate-induced renal tubular epithelial cell injury by an extract from Quercus salicina Blume/Quercus stenophylla Makino.

What is Quercus Salicina?

Use of Quercus Salicina in Japan

What is the mechanism of Quercus Salicina in Kidney?

Studies shows that antioxidative activity of Quercus Salicina plays a big role in prevention of stone formation and recurrence.[2]

Increased urinary excretion of oxalate is a risk factor for the formation of calcium oxalate kidney stones in humans.

Researchers suggested that increased urinary excretion of oxalate increases free radical production in the kidney, leading to renal tubular cell damage.

[2]Moriyama MT1, Suga K, Miyazawa K, Tanaka T, Higashioka M, Noda K, Oka M, Tanaka M, Suzuki K. Int J Urol. 2009 Apr;16(4):397-401. Inhibitions of urinary oxidative stress and renal calcium level by an extract of Quercus salicina Blume/Quercus stenophylla Makino in a rat calcium oxalate urolithiasis model.

Quercus salicina extract has antioxidant activities that facilitates the spontaneous expulsion of ureteral stones.

Clinical studies show Quercus Salicina extract promotes stone discharge in a rat ureteral stone model, has a diuretic effect in urolithiasis patients, and dissolves calcium phosphate crystals and prevents crystal growth at a silk thread nucleus in the rat bladder.

Component

[1] KEGG DRUG Database http://www.kegg.jp/dbget-bin/www_bget?dr:D10763

Quercus Salicina contains following components and they are thought to be good for various stones;

Catechol tannins lithontriptic effect to dissolve stones

Flavonoid decomposition of blood cholesterol, for gallstone

Triterpene friedeline

antioxidant, anti-inflammatory, anti-allergic effect, for bladder stones. Antioxidant effect is thought to prevent the oxidation of cholesterol and effective for prevention of hardening of the arteries

componentQuercetin, Kaempferol, Quercetin 3-O-glucoside,Ellagic acid,3,3'-di-o-Methylellagic acid,1-O-Galloyl-beta-D-glucose,Catechol,Pyrogallol,Gallate,Succinate, Friedelin, epi-Friedelanol, Friedelanol,Taraxerol.

Other Health Benefits of Quercus Salicina

[3] Jia‑Le Song Xin Zhao Qiang Wang,Protective effects of Quercus salicina on alloxan‑induced oxidative stress in HIT‑T15 pancreatic β cells[4] Park SH, Kim HJ, Yoon JS, Lee HW, Park GC, Yi E, Yoon G, Schini-Kerth VB, Oak MH.,The Effect of Quercus salicina Leaf Extracts on Vascular Endothelial Function: Role of Nitric Oxide.,J Nanosci Nanotechnol. 2016 Feb;16(2):2069-71.

DiabetesQuercus Salicina water extract demonstrated protective activity against alloxan-induced cell death and prevent pancreatic beta cell death by increasing the activity of the intracellular antioxidant enzymes. Furthermore, Quercus Salicina promote insulin secretion in the alloxan-treated cells. [3]

Cardiovascular disease

Ethanolic extract of Quercus Salicina has been found to exhibit potent vasorelaxant activity Quercus Salicina ethanolic extract strongly and dose-dependently activate endothelial nitric oxide synthase in porcine coronary artery endothelial cell. Quercus Salicina extract could be a cardiovascular protective herbal medicine candidate associated with cardiovascular diseases and endothelial dysfunction.[4]

Made in Japan Halal Certified Quercus Salicina Supplement

Formulation

250mg per a tablet

Direction for use: 4 tablets a day

Ingredients Origin % Mg/TabletQuercus Salicina Extract Powder Quercus Salicina 40.00 100.00

Maltitol Cassava, Corn, Potato, Sweet potato 25.70 64.25Magnesium Oxide Magnesium Oxide 17.30 43.25

Microcrystalline Cellulose Wood Pulp 14.00 35.00Sucrose Fatty Acid Ester Sucrose(Sugar Cane, Sugar Beet) 3.00 7.50

Methyl Stearate (Palm)

Total 100.00 250.00

Name of Product: Quercus Salicina Extract Tablets

Shape: Disk-shaped tablet

Size: diameter 9.0mm