Does Chanca Piedra really work for breaking kidney stones?

If you’re passing a kidney stone, you’ve probably searched online for what you can take to help pass or dissolve it. It wouldn’t take long for you to find glowing testimonials for the natural herb “Chanca Piedra”. But does it really work? In this post we’ll review the available scientific research to try to get an answer.

What is it? The scientific name for Chanca Piedra is Phylllanthus niruri. It’s an herb which has been used in traditional medicine for over 2000 years. When used as a natural remedy for kidney stones it goes by the popular name of “stone breaker”.

It isn’t just for stones. It’s also purported to have anti-infection, anticancer, anti-inflammatory, anti-diabetic, and liver protective effects.

How is it taken? It’s widely available on the internet and from herbal stores as a capsule, tincture, dried leaf, root, or whole plant.

How might it work? Chemical compounds including lignans, alkaloids, and flavonoids in Chanca Piedra are thought to reduce the release of stone forming constituents in the urine and inhibit stone crystal formation. It may also cause smooth muscle relaxation in the ureter, easing stone passage.

What does the research show? While individual testimonials of how well a treatment works are important, they can’t always give us an accurate answer. Depending on the location and size of a kidney stone, 50-80% will pass spontaneously – with no treatment. Therefore, if you are passing a kidney stone you are inherently likely to have a successful stone passage regardless of what else you do. Anything you take may seem like an effective treatment even if it didn’t make an actual difference. To find out whether a treatment is truly effective, research needs to be performed to determine how a potential treatment works in the lab and in actual patients. We’ll next review what research has been done on Chanca Piedra.

Two laboratory studies of Chanca Piedra have been published. In one study, rats with implanted stones in their bladder who were fed a liquid extract of the herb appeared to have slower stone growth. A small minority of the treated rats (three of twenty-two) actually passed or dissolved their stone. No urinary differences in concentrations of typical stone forming substances (including calcium, oxalate, citrate, and uric acid) were seen. In Chanca Piedrastudy a liquid extract of Chanca Piedra was added to urine from rats and humans that had been seeded with calcium oxalate to induce stones. Stone crystals formation was not inhibited by the extract and in fact more crystals actually formed in the treated urine. However, the crystals that did form seemed to be smaller. Collectively these two small laboratory studies suggested that the herb may have a partial effect on how stone crystals form and it may do so in a way that does not change the typical measures of urinary chemistry that are seen in stone formers.

Three clinical studies of Chanca Piedra have been completed involving kidney stone patients. In two of the studies the herb was given as a capsule or infusion tea to stone formers. Urine and blood samples were tested before and after treatment for concentrations of expected stone affecting substances such as calcium, oxalate, citrate, or uric acid. In both studies, no overall differences were detected in blood or urine. Only when the researchers looked at a smaller subset of patients were they able to detect a benefit. These subsets were not consistent between the two studies making this a less convincing finding (patients with high urinary oxalate and uric acid in one study and patients with high urinary calcium in the other study). In the third clinical study, kidney stone patients who underwent extracorporeal shockwave lithotripsy treatment were given either Chanca Piedra in capsule form or no treatment (a control group). Stone clearance on x-ray and ultrasound was then compared. No overall differences were noted in stone clearance between those given or not given Chanca Piedra. Echoing the situation for the two studies above, only when the researchers looked at a smaller subset of patients (in this case those patients with stones in the lower part of the kidney) were they able to demonstrate a benefit. Taken together, these three studies aren’t enough to demonstrate that Chanca Piedra significantly changes urine in a way to dissolve or more easily pass stones. In all three studies the researchers had to resort to subgroup analysis to find a difference. When researchers have to “stretch” statistically like this, they are more likely to introduce random chance leading to erroneous results. You can read more details on each of the studies discussed at the bottom of this article.

The take away: Chanca Piedra is a commonly used natural remedy to encourage kidney stone passage and reduce future stone growth. Laboratory research suggests it may affect stone crystal formation, leading to reduced stone growth and facilitating stone passage. Clinical research in stone patients is limited and inconclusive on whether it is beneficial in stone prevention or in improving passage. Further study will be needed to demonstrate with more reliability the potential benefits of this treatment. Until more research is available, it’s not possible to conclude one way or the other whether Chanca Piedra is an effective stone treatment. It is however not likely to cause harm. Patients interested in this treatment should discuss this option with their treating medical provider but should also follow a traditional treatment plan.

Based generally on what we know about kidney stone treatment, it is unlikely that Chanca Piedra (or any treatment) will dissolve the majority of stones. Calcium based stones represent 80% of kidney stones and are dense, requiring direct treatment with laser or other energy to fragment. Patients with these types of stones may respond to treatments that facilitate passage of stones but likely will not have success with actually dissolving their stones. However, in patients with uric acid stones (only about 7% of kidney stones), treatments aimed at reducing urine acidity (including potassium citrate or orange/lemon juice and baking soda) can effectively dissolve stones. Chanca Piedra, if it is effective, is more likely to be able dissolve stones only in patients with uric acid stones. In the remaining majority of stone patients who have calcium based stones, it at best may facilitate stone passage or help to reduce future stone growth.

Details on research studies discussed: If you’re interested in looking at how the studies were performed and reviewing the details yourself, read on.

Laboratory research studies

“The effect of Phyllanthus niruri on urinary inhibitors of calcium oxalate crystallization and other factors associated with renal stone formation”. Freitas and colleagues. Published in 2002 in BJU International.

What was done: This study tested the effect of a liquid extract of phyllanthus niruri on rats. The rats were induced to form stones through the introduction of a calcium oxalate fragment placed into their bladders. Rats given the extract were compared to rats given water as a placebo.

Findings: There were no significant urinary or blood changes in concentrations of stone related substances (including calcium, oxalate, uric acid) between rats given water or the liquid extract. However, there was a significant inhibition of stone growth in the rats given the liquid extract. Additionally, three of twenty-two rats on the extract had their stones either pass or dissolve.

“Effects of an aqueous extract from Phyllanthus niruri on calcium oxalate crystallization in vitro”. Barros and colleagues. Published in 2003 in Urological Research.

What was done: This study tested the effect of an aqueous extract of Phyllanthus niruri on stone crystal formation in rat and human urine samples to which sodium oxalate was added to induce stone formation.

Findings: The Phyllanthus niruri extract did not inhibit initial stone crystal formation, with even more crystals noted in the treated urine. However, the crystals that did form were smaller. The authors suggested that the extract may interfere with stone aggregation (clumping of crystals together) and further growth.

Clinical research studies

“Phyllanthus niruri normalizes elevated urinary calcium levels in calcium stone forming patients”. Nishiura and colleagues. Published in 2004 in Urological Research.

What was done: 69 individuals with a history of calcium stones were randomized to either take Phyllanthus niruri (450mg capsules) or placebo capsules for 3 months. 24-hour urine collections and blood tests were compared before and after the intervention.

Findings: There were no significant overall differences in the blood or urine collections between those taking Phyllanthus niruri and those taking placebo. However, in a subset of 20 patients who had high urinary calcium levels in their pre-treatment urine collection, treatment with Phyllanthus niruri was associated with a reduction in urinary calcium levels. This suggests that Phyllanthus niruri treatment may be beneficial in this particular group of stone formers and it may do so by lowering urinary calcium levels. We should note though that performing subgroup analysis reduces the numbers of study participants and therefore increases the chances of a finding occurring randomly by chance (a type I error in statistics).

“Can Phyllanthus niruri affect the efficacy of extracorporeal shock wave lithotripsy for renal stones? A randomized, prospective, long-term study”. Micali and colleagues. Published in 2006 in The Journal of Urology.

What was done: 150 patients with kidney stones were treated with extracorporeal shockwave lithotripsy. Following their stone treatment they were randomly assigned with half given “Uriston” Phyllanthus niruri extract capsules for three months and half receiving no additional treatment. Stone free rates on x-ray and ultrasound were then compared between the two groups.

Findings: At the end of the study, there was no significant difference in stone free rates between the Phyllanthus niruri extract group and the no treatment group (93.5% versus 83.3% stone free). Only when the authors looked at the smaller subgroup of patients with stones only in the lower part of the kidney (56 patients), were they able to demonstrate a significant difference (93.7% versus 70.8% stone free) with the Phyllanthus niruri group showing improved stone clearance. This is a less convincing result as performing subgroup analyses generally increase the chances for erroneous random results and should therefore be confirmed with additional larger studies.

“Effect of Phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention”. Pucci and colleagues. Published in 2018 in the International Brazilian Journal of Urology.

What was done: 56 individuals with kidney stones 10mm or smaller in size were given Phyllanthus niruri tea infusion made from a dry extract for 12 weeks. 24-hour urine tests and serum tests were obtained prior to initiation of the tea, after the 12 weeks, and 12 weeks later (washout phase).

Findings: Overall, there were no changes in the main urinary risk factors for stones including urinary calcium, oxalate, citrate, or uric acid. There was an increase in the less important for stone formation levels of urinary potassium and urinary magnesium. On subgroup analysis, five patients with high urinary oxalate had a reduction in urinary oxalate and six patients with high urinary uric acid had a reduction in the urinary uric acid. The same caveats regarding random chance discussed for the above studies apply here given these very small numbers in subgroups. Unlike in the Nishiura study above, no difference was seen in patients with high urinary calcium levels. This study also reported that the average number of kidney stones decreased from 3.2 to 2.0 per patient. This last finding does not necessarily indicate benefits from the Phyllanthus niruri treatment given we know that most stones will pass spontaneously whether they are treated or not.