IBN AL- HAITHAM J. FO R PURE & APPL. SC I. VO L.24 (1 ) 2011 Lithotripsy o f Urinary Tract Stones by Using Eggshell A. G. Sabar Departme nt of Community Health, College of Medical and Health Technology, Foundation of Technical Education Recei ved in ,28,June,2010 Accepted in , 19, O ct , 2010 Abstract This research aimed to use eggshell p owder as a lithtripsian for different ty p es of urinary st ones and determine the efficiency of these preparations against different t y p es of st one. The grounded and st erilized eggshell was dissolved in fresh lemon juice .The treatment was orally given for successive 7 days before breakfast . Eighty five p atients with different ty p es of urinary st one were particip ated in this research. All p atients were subjected to Ultrasonography and intravenous p y elography examinations to localize the p osition and detect diameter of the st one. The above examination and also biochemical tests for diagnosis of st ones ingredients were repeated after the administ ration of treatment and excretion of st one fragments in urine. The results cleared out 60 (100% ) of p atients with p ure uric acid st one undergoes comp letely lithotripsed of there st ones, while 10 out of 25 (40%) of p atients with mixed(uric acid/ ca-oxalate) st one were only undergoes lithotripsic events. T he results were so p romising esp ecially against p ure uric acid st one. Introduction The renal st ones are solid concretions or calculi (cryst al aggregations) formed in the kidney s from dissolved urinary minerals[1]. There are several ty p es of kidney st ones depended on the ty p e of cryst als of which they consist. The majority are calcium oxalate st ones, followed by calcium p hosp hate st ones[2] . M ore rarely , st ruvite st ones are p roduced by urea-sp litting bacteria in people with urinary tract infections . People with certain metabolic abnormalities may p roduce uric acid stones or cyst ine st ones[3] . Statist ical st udies showed that men with ages in the range of 20 to 40 have the highest risk. Peop le living in the arid areas (warm climates) have the highest incidence rates[4,5].T he common diet in these areas is usually vegetables and tea M uch less common is t he uric acid stone and the rare cyst ine st one. Uric acid st ones are truly unique in that they dissolve readily in a favorable urinary p H milieu, achievable with oral medical therap y [6,7] . Eggshell contains about 4% organic matter and a substantial amount of calcium and other minerals, including magnesium and zinc[8] .Dried eggshell p articles contain app roximately 94% calcium carbonate, with 39% of the compound being absorbable calcium[8] . Although US Patent No. 045 ،323 describes a method for p reparing comp ounds from eggshells, p articularly from the chicken eggshell, which could be utilized for medical p urp oses for treating certain diseases and for replacement of deficient materials in living tissues[9] . So far egg shells have already been used for curing certain diseases, their app lication has been based rather on intuition without p rovision of a comp ound having st able, st andardized p rop erties, and without determination of their sp ecific effectiveness and activity based on objective biological knowledge and p harmaceutical methods[10] . The p harmaceutical comp ositions according to the p resent invention proved particularly effective for geriatry where currently used medicaments have not IBN AL- HAITHAM J. FOR PURE & APPL. S CI. VOL.24 (1) 2011 been effective or exhibited unfavorable side effects, or have not been prop erly tolerated by the body [11]. Eggshe ll membrane of the hen also has been shown t o contain acid glucosaminoglycans including dermatan sulfate and chondroitin-4-sulfate[12]. Ot her comp onents dentified ineggshe ll membraneinclude ovot ransferrin ، desmosine and sodesmosineysy loxidase and ly sozy me ]13[ . Gel electrop horesis reveals a comp lex array of matrix p roteins can be classified as egg white proteins ) lysozyme ،ovalbumin ،ovotransferrin ، clust erin ( ، bone protein ) ost eopontin ( ]14 [ ، and ) ovocleidins-17 and –116; ovocalyxins-32 and – 36) [15]. Glucosamine and chondroitin sulfate have been purp orted to be effective in the treatment of osteoarthritis over the last 3 to 4 decades [16]. Since eggshell membrane contains both glucosamine and chondroitin sulfate, it is suggested that this natural composition might be effective in r elievin g joint and soft tissue p ain . However eggshell p owder is widely used in India and eastern Asia, in traditional medicine, also in Iraqi fo lk medicine . The dose normally recommended in traditional Ay urvedic ]17[ use is one teasp oonful of this p owder. Also the same dose was documented in Arabic antique manuscript ) Tathkarat Daood AL- Ant aky ]18 [ . Material and Method Cl ini cal Data The p articip ants in this st udy were 85 lithogenic patients who conducted from 2001-2009 , diagnosed by sp ecialist p hy sicians in p rivate clinics from different sites of Iraq (Baghdad,diy ala,mosoul,and anbar) . Method NO TE: Before started giving p reparation we obtained the writt en consent of the patients who included in this st udy . - Eggshell p owder was obtained by the patent described by M ickalek[19] which detailed by (A) emp ty ing eggs, p referably chicken eggs (B) removing residues of egg y olk and white,ballast constituents, contaminants and then membrane st icking to the interior eggshell surface , and p urifying the eggshell (C) dry ing the eggshell with hot air by using hair st y ler (D) crushing and grinding the eggshell to very fine p owder and (E) sterilizing the eggshell p owder at a temp erature of 120 C 0 in oven to devitalize p athogenic and conditionally p athogenic microorganism. - one teasp oonful of p owdered eggshell was added to cup of fresh lemon juice which is a source of citric acid, the p reparation was kept cool overnight to comp lete reaction and p roduce ca- citrate . - A single dose administ ration (before breakfast) . - This p rocedure was repeated for 7 day s. - Ultrasonography (U/S) , intravenous p y elography (IVP), were p erformed p re- and p ost - treatment to detect size and site of st one ,and then to be sure of emp ty ing urinary tract from any st one after treatment. - Urinary tract st ones were of different sizes ranging from 7mm to 1.7cm and they were seen in the kidney (renal stone) at up p er p ole calyx, mid renal p art and lower pole calyx, also they were seen in the ureter (uretral st one) , and finally they were seen inside urinary bladder (vesicle st one) - General urine examination (GUE) was done for all p atients ,urine routine which shows cryst als in urine , blood cells and pus cells. IBN AL- HAITHAM J. FO R PURE & APPL. SC I. VO L.24 (1 ) 2011 - Qualitative analysis of st one/fragments p assed after treatment , a p rocedure described by Hodgkinson[20] ,was employed to figure out t he structure of urinary st one. Re sults Data in table (1) showed that 60 p atient out of 85 p atients at age range (25-57) y ears had p ure uric acid st one , while the remainder 25 p atients at age range ( 30-50) had (ca-oxalate /uric acid )mixed st one. The results in table(2) cleared out all the p atients with p ure uric acid st one (60) undergoes comp letely lithotripsic events(100%) , while 10 p atients out of 25 with (ca- oxalate/uric acid) mixed st one undergoes lithotripsic events(40%). T he duration of p ure uric acid st one lithotripsy was (5-10) days , comp aring to (8-14) days in case of (ca-oxalate/uric acid) mixed st one (table3). Discussion Our results cleared out that t he local p reparation of eggshell was very p owerful to dissolved uric acid stones, since a hundred p ercent of this ty p e of stone had been lithotripsed, comp aring to (40%) for (ca-oxalate/uric acid) mixed st one. Since a home remedy about the wonder of eggshell dissolved by lemon juice being effective in breaking up kidney st one. The citric acid consists in lemon juice reacts with eggshell calcium to p roduce calcium citrate ,this reaction required several hours t o be completed. However ca-citrate decreased urinary saturation of ca-oxalate and undissociated uric acid. Also it will increase PH of urine, decreases urinary undissociated uric acid. Therefore ca-citrate may p rovide additional protection against formation of uric acid st one [21]. Although ,some researchers now suggest that citrate treatment may also be useful for those at risk for st ones, those citrate excretion is normal [22]. Tanner et al.[23] have recently cited from [24,25] that citrate salts imp rove renal function in rats with p olycyst ic kidney disease, mainly by its alkalinizing effects. Our results agreed of Toblli et al.,[26] who demonst rate a beneficial effects of ca-citrate sup p lementation in uric acid nephrop athy . By the other ,ca- citrate sup p lementation also attenuates tubulointerstitial damage in the rat model of obstructive nep hrop athy [27]. It could be argueds for that the effect of eggshell p reparation is depending totally on chemical structure of urinary st one , also it is clear from the results p resented in table(2) that uric acid whenever existed as one of the constituents of urinary tract st ones, it will p rovoke or st imulate the action of eggshell p reparation , in other word uric acid is a decisive comp onent of urinary tract st one that leads to lithotripsy whenever eggshell p reparation available. Finally it will be wise to conclude that eggshell p reparation is a reliable treatment in lithot ripsy , y et, we can not take this conclusion as a matt er of fact unless a further st udy on large scale on urinary tract st one conducted to confirm or deny this conclusion. Acknowle dgmeny The author is very grateful to Dr.Nabeel Fadhil , Dr.Qais Hassan ,and Dr.Nasseer Abed M ohd for their help in the diagnosis of t he patients. Thanks are also t o Prof. Dr. Z uhair Nouman for his scientific advices. IBN AL- HAITHAM J. FOR PURE & APPL. S CI. VOL.24 (1) 2011 Re ferences 1. Levy ,FL,Adams-huet,B. Pak, CY. (1995)."Ambulatory evaluation of nep hrolithiasis" : An up date of p rotocol. Am J. M ed;.98:50. 2. Oehlschlager,S,Hakenberg,ow,and Froehner M ,et al. (2003), "Evaluation of chemical comp osition of urinary calculi by conventional radiography ". J Endo urol;.17:841. 3. Silvia, F.R, and Rosa M .S. M ata ,et al.(2000), "Determination of urinary st one comp osition based on stone morp hology ". Jour Clin. Chem. 147,issue 5.561-564. 4. Curhan,GC. (2007),"Epidemiology of st one disease" .Urol Clin North Am;.34:287. 5. Curhan ,GC Willett ,wc,Sp eizer,FE,and Stamp fer,M J. (2001), "Twenty -four hour urine chemist ry and the risk of kidney st ones among women and men". Kidney Int; 59:2290. 6. E choo-Kang . (2008), "Chemical comp osition of urinary tract st one at the university hosp ital of the west indies". West Indian med. J. 57,n.5 ,mona nov.. 7. Curhan ,GC,and Taylor,EN. (2008), "24-h uric acid excretion and the risk of kidney st ones". Kidney Int; 73:489. 8. Arias, et al., (1991), "Ty p e I and X collagen ,Connective Tissue Research", 26-45,and (Wang et al.,. (1948), "Ty p e V collagen" , ,Dev.Biol., 104:28-36. 9. US-Patent No. 045,323. Preparing comp ounds from eggshell for medical p urp oses. 10. Kuroda, N.,and Kuno, M . (1999), "Sop histicated Ap p lication of Eggs".,J.Tech.on food &chem., 15;No.7: 67-71. 11. Yang,J. ,S. S. ,Chuang .W, et al., (2003) ."Egg membrane as a new biological dressing in sp lit-thickness skin graft donor site" ;Gung med J. 26: 153-159. 12. Cifonelli,JA. (1976),"The colorimetric estimation of uronic acid in : M ethodology of connective Tissue Research" , ED:DA Hall,Joy nson-Bruvvers Ltd. Oxford, ,chap .26 , 253- 256. 13. Y. Ny s,J. Gautron,M . et al. (2001), "Biochemical and functional of eggshell matrix p rotein in hens" ,world p oultry science journal ,Vol.57;401-413. 14. Arias. (2008), "Eggshell membrane as a biodegradable bone regeneration inhibitor".,Journal of Tissue engineering and Regenerative M edicine.2:4,228-235. 15. Joel, G.,and M axwell, T . et al., (2001), "Ovocaly xin-32, a novel chicken eggshell matrix p rotein".,DOI, 10.1074-J bc.M 10453200. 16. Deal ,C.L. and M oskowitz ,RW. (1999),"Galactosaminoglycan comp osition in chicken Eggshell in cure ost eoarthritis" ,J.Poultry Scie. 25:379-395. IBN AL- HAITHAM J. FOR PURE & APPL. S CI. VOL.24 (1) 2011 17. The Ay urvedic Pharmacopoeia of India (1999),Ap p endix.,Government of india.Part I,Volume II,First Edition:189-93. 18. Daood AL-Ant aky.(Tathkarat Daood),Arabic antique manuscript. 19. M ickalek, Dr. Karol. (1995),"Pharmaceutical comp osition of eggshell basis and their p reparation and use",European Patent; EP0347899;, Biomin,Akaciora' Sp olocnost '(Potocna' 1, cifer, 919 43, CS ). 20. Hodgkinson, A. (1971), "A combined qualitative and quantitative p rocedure for the chemical analysis of urinary tract calculi". J.clin.p ath.,. 24,147-151. 21. Khashar sakhaee,John R, et al.,(2004),"Stone forming risk of calcium citrate sup p lementation in healthy p ost menop oausal women" J.Urol., 172,issue 3; 958-961. 22. Ett inger B, Pak,CY, Citron JT, et al., (1997)"Potassium-magnisum citrate is an effective p rop hy laxis against recurrent ca-oxalate nephrolithiasis" J.Urol. 158:2069-2073. 23. Tanner, GA &Tanner JA.(2000),"Citrate therap y for p olycyst ic kidney disease in rats"Kidney Int ; 58: 1859-1869. 24. Tanner, GA.(1998) "Pot assium citrate⁄citric acid intake imp roves renal function in rats with p olycyst ic kidney disease" J Am Soc Nephrol ;9:1242-1248. 25. Tanner, GA &Tanner JA.(2003),"Dietary citrate treatment of p olycyst ic kidney disease in rats" J Nep hrol; 93:14-20. 26. Toblli JE, Derosa &Lago N et al., (2001)."Pot assium citrate administ ration ameliorates tubulointerstitial lesions in rats with uric acid nep hrop athy ". Clin Nep hrol ;55:59-68. 27. Godola et al., (2001)."Therap eutic effect of ca-citrate sup p lementation". Jam Soc.Nephrol 12:703A. Tab le(1) Chemical constituent of lithotripsed stones Ty p e of stone NO. of p atients % Patients age range (y ears) Pure uric acid 60 70.5 25-57 (ca-oxalate/uric acid) mixed st one 25 29.5 30-50 Total 85 100% IBN AL- HAITHAM J. FO R PURE & APPL. SC I. VO L.24 (1 ) 2011 Tab le(2) Comparison of lithotripsy events of both types of stone Ty p e of stone NO. of p atients NO. of lithotripsed st one % Pure uric acid 60 60 100 (ca-oxalate/uric acid) mixed st one 25 10 40 Total 85 Tabl e (3 ) Du rati on re qui re d to l i th otri pse d e ach type of sto n e Ty p e of stone Duration (day s) Pure uric acid 5-10 (ca-oxalate/uric acid) mixed st one 8-14 رفة والتطبیقیة المجلد 2011) 1( 24مجلة ابن الهیثم للعلوم الص تفتیت حصى المجاریة البولیة باستخدام قشور البیض احمد غازي صبار ھیئة التعلیم التقني،كلیة التقنیات الصحیة والطبیة ،قسم صحة المجتمع 2010،حزیران ،,28استلم البحث في 2010، ن االولتشر،19، قبل البحث في الخالصة �ب معلوماتن�ا ألول م�رة ف�ي ھ�ذا المج�ال اً مسحوق قشور البیض عالج عملنااست یھ�دف ھ�ذا . لتفتیت حصى المجاري البولی�ة حس �ث إل�ى اس�ت ُ قش�ور الب�یض عالج��عمال البح �ت حص� ا �ة األكب�ر تج�اه أي ن�وع م��ن لتفتی ى المج�اري البولی�ة بأنواعھ�ا وتحدی��د الفعالی وأعط�ي الخل�یط ع�ن طری�ق بإذابتھا في عصیر اللیمون الح�امض الط�ازج عملتإن قشور البیض المطحونة والمعقمة است.الحصى �رى الب�ولي اخض�عوا مریضا ممن یعانون من وجود ا لح 85شارك في الدراسة .أیام متتالیة قبل اإلفطار 7مدة الفم ص�ى ف�ي المج �ري ، واألشعة الملونة لتحدید موق�ع وحج�م الحص�ى ،) الموجات فوق الصوتیة(إلى فحوصات السونار �ثلث�م اج كاف�ة عین�ات البح الع�الج ك�ذلك أجری�ت الفحوص�ات البایوكیمیاوی�ة عل�ى الحص�یات عمالفحص اإلدرار العام و أعیدت ھذه الفحوصات بعد اس�ت عالی�ة تج�اه حص�اة ح�امض الیوری�ك النقی�ة یةتبین إن ھذا العالج فعال بكفا اذوالنازلة في اإلدرار لتشخیص مكوناتھا المتفتتة �ب الممت�زج % 40بینما لم تتفتت سوى ، )مریضا 60% (100ة ھي تكانت نسبة الحصوات المتفَ اذا، م�ن الحص�وات ذات التركی . 25مرضى من مجموع 10اي في