The

ole of Rhaphidophora pinnata (L.f) Schott Water Extract on

Dissolution of Calcium Containing Renal Stones

Masfria

1,2

, Marianne

1,2

, and Y. M. Permata

Faculty of Pharmacy, Universitas Sumatera Utara, Medan 20155, Indonesia

Nanomedicine Centre of Inovation, Universitas Sumatera Utara,

Medan 20155, Indonesia

Keywords: Kidney srones, invitro, antinephrolithiasis, Rhaphidophora pinnata,

Abstract: Kidney stone disease is a common chronic disorder in humans and the most common type of renal stone is

made of calcium oxalate. Calcium oxalate stones are made of calcium oxalate monohydrate and dihydrate,

often combined with calcium phosphate which is the original cause of stone formation. Growth and

aggregation of calcium stone inhibits by coating the surface of growing calcium crystals or by complexing

with calcium and oxalate, such as potassium ion and magnesium ion. Rhaphidophora pinnata (L.f) Schott

leaves contain high potassium mineral that is 847.9 mg / 100g and calcium 474.7 mg / 100g. This study was

to investigate the effect of water extracts of Rhaphidophora pinnata (L.f) Schott leaves toward solubility of

kidney stone. The water extract of Rhaphidophora pinnata (L.f) Schott leaves, simplicia, and nano-simplicia

was made in three different concentration, 5%, 10%, and 20%. Dissolution of calcium-containing renal

stone was performed by incubating each water extract with 0.1% calcium containing renal stone for 4 hours.

Nano-simplicia water extract was shown the highest dissolution ability, 80.55% calcium of kidney stones

decomposed within 4 hours of incubation.

1 INTRODUCTION

The search for the source of medicinal plants

continues to produce chemical compounds used in

various diseases, including from plants that have the

potential in the treatment of kidney stone disease

(Vina, 2010). Kidney stone disease is one of

common chronic disorder in humans. Renal stone

(calculi) is made of calcium oxalate, and also

contain other crystals and organic component that

formed in the renal pelvis or calyces. This process

called urolitiasis (litiasis renalis, nefrolitiasis)

(Pratomo, 2008), (Basavaraj, 2007), (Worcester and

Coe, 2008), (Cunningham, 2016).

Treatment of kidney stones is carried out

depending on the size of the stone. If kidney stones

are still relatively small or medium, and still can

pass through the urinary tract without surgery,

doctors usually recommend drinking lots of water

(Nouvenne, 2013). Handling of kidney stones with

special procedures (eg laser energy, ultrasound, or

surgery) is usually applied only if the stone is larger

enough to clog the patient's urinary tract.

Calcium oxalate stones are made of calcium

oxalate monohydrate and dihydrate, often combined

with calcium phosphate which is the original cause

of stone formation. Calcium oxalate monohydrate is

thermodynamically most stable form and observed

more frequently in clinical stones than calcium

oxalate dihydrate, at a ratio of >2:1. The stone will

be more quickly formed when the urine is very

concentrated and cause the supersaturating of

calcium oxalate. These condition will gradually form

a solid mass and hard resemble a stone (Pramono,

1988), (Brown, 1989), (Basavaraj, 2007),

(Worcester and Coe, 2008).

Growth and aggregation of calcium stone inhibits

by coating the surface of growing calcium crystals

or by complexing with calcium and oxalate, such as

potassium ion, magnesium ion. citrate,

pyrophosphates, inter-alpha-trypsin inhibitor family

of proteins, Tamm-Horsfall protein (THP),

glycosaminnoglycans, and renal lithostathine.

Potassium and magnesium ions can inhibit the

formation of stones by binding with oxalate, it will

form a water-soluble oxalate salt. Similarly, citrate

binding with calcium ions to form calcium citrate

472

Masfria, ., Marianne, . and Permata, Y.

The Role of Rhaphidophora pinnata (L.f) Schott Water Extract on Dissolution of Calcium Containing Renal Stones.

DOI: 10.5220/0010074004720475

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

472-475

ISBN: 978-989-758-449-7

which is water-soluble, and these condition lead to

decreasing of calcium oxalate supersaturation

(Basavaraj, 2007), (Putra and Fauzi, 2016),

(Maharani, 2012). Besides phytochemicals as

antioxidant, dietary phyto-phenols were found to be

effective for the prevention the growth of renal stone

by inhibits the stone formation process in the urinary

tract (Nirumand, 2018).

Supersaturation of urinary salts and crystal

retention in the urinary tract initiated the formation

of renal stones. Deficiency or abundance of

inhibitors are almost certain to predispose to stone

disease. Some herbal plants have been detected as a

deterrent of kidney stones allegedly contain high

potassium mineral such as tempuyung leaves, nasty

shard, kapok, corn hair and lettuce (Alvin, 2015),

(Girsang, 2016), (Muhgni, 2013), (Nessa, 2013),

(Permata, 2017). R. pinnata leaves contain high

potassium mineral that is 847.9 mg / 100g and

calcium 474.7 mg / 100g. According to these results,

allegedly the potassium ion can act as an agent to

bind oxalate (water-soluble), so as not to form stones

in the kidney. The kidneys will pass trough

potassium oxalate and remove it through the urine.

Based on the description above, since the human

nephron is a dynamic system, in vitro crystal

behaviour is too simplistic a concept to entirely

explain renal calculus formation. This study was to

see how the water extracts of simplicia leaves of R.

pinnata predispose to kidney stone

2 MATERIALS AND METHODS

2.1 Materials

The materials used in this research were R. pinnata,

calcium-containing renal stone, nitric acid, distillate

water, calcium standard solution. Those chemicals

and solvents used were analytical grade and are

commercially available from Merck. R. pinnata leaf

plants were cleansed and dried, then crushed to

obtain simplicia powder and nano simplisia powder.

The nano simplicia powder was analyzed by LIPI

(Lembaga Ilmu Pengetahuan Indonesia) using

particle size analyzer nano.

2.2 Methods

2.2.1 Water Extract Preparation

The water extract of R. pinnata leaves, simplicia R.

pinnata, and simplicia nano R. pinnata was made in

three different concentration-5%, 10%, and 20%- in

water, using infused technique according to

Farmakope Indonesia 4

Edition.

2.2.2 Dissolution of Calcium-containing

Renal Stone

Dissolution of calcium-containing renal stone was

performed by incubating each water extract with

0.1% calcium-containing renal stone for 4 hours.

The levels of calcium free ions present in the water

extract before and after incubation were measured

using atomic absorption spectrophotometry methods.

The dissolution percentage of calcium was

calculated by the formula below:

DCa (%) =

(1)

Where DCa is the dissolution percentage of calcium;

CAD is the calcium content after dissolution; CBD

is the calcium content in water extract; and CaRS is

the calcium contain in renal stone (1 gram of renal

stone contain 10.29 mg calcium).

3 RESULT AND DISCUSSION

The following Table 1 was the result of calcium

analysis in water extract of R. pinnata leaves,

simplicia of R. pinnata and nano-simplicia of R.

pinnata..

Table 1: The effect of treatments on calcium content in

water extract before and after dissolution.

No Treatments

Water

extract

(%)

Calcium level

(μg/ml)

in water

extract

Calcium

(μg/ml)

after

dissolution

1 R. pinnata

water

extract

5 2.22 2.77

10 3.79 4.18

20 5.11 5.70

2 Simpicia R.

pinnata

water

extract

5 6.21 7.84

10 17.57 19.78

20 26.56 40.09

3 Nano-

simplicia

R. pinnata

water

extract

5 61.91 105.62

10 112.20 169.28

20 206.53 436.05

The Role of Rhaphidophora pinnata (L.f) Schott Water Extract on Dissolution of Calcium Containing Renal Stones

473

The effect of water extract on dissolution

percentage of calcium-containing renal stone result

is presented in the Figure 1.

Figure 1: The effect of water extract on dissolution

percentage of calcium-containing renal stone in the R.

pinnata. RPWE = R. pinnata water extract; SRPWE =

Simplicia of R. pinnata water extract; NSRPWE = Nano-

simplicia R. pinnata water extract.

From the data Table 1 and Figure 1 can, be seen

there are differences in calcium levels in R. pinnata

water extract incubated with kidney stones. After

incubation the levels of calcium in the water extract

as a whole increased. The highest dissolution was

shown by a 20% nano-simplicia water extract,

80.55% calcium of kidney stones decomposed

within 4 hours of incubation. The lowest dissolution

was shown by fresh water extract of R. pinnata

where for the three concentrations of water extract

did not show a significant difference that is below

1%.

Based on research conducted by (Alvin, 2015)

and (Girsang, 2016), reports that plants with high

potassium content, such as tempuyung and keji

beling has good solubility to calcium oxalate. In

terms of reactivity of alkaline ions, the position of

potassium in the voltaic series is more left than

calcium so that potassium is more reactive (the more

easily the electrons are released) then the potassium

gets rid of calcium to join the carbonate compound,

oxalate or urate from the calcium compound to

dissolve. In a supersaturated calcium oxalate

solution 2 mmol/L magnesium reduced particle

number by 50%. It was found that magnesium exert

a fine kinetic control on the precipitation and growth

of calcium oxalate monohydrate (Girsang, 2016),

(Permata, 2017), (Desmars and Tawashi, 1973),

(Basavaraj, 2007). Magnesium can form complexes

with oxalate and decreases supersaturation. Oral

intake of magnesium will decline the oxalate

absorption and urinary excretion, in a manner

similar to calcium by binding to oxalate in the

intestines (Liebman and Costa, 2000).

The figure 2 illustrated the extrapolation of the

dissolution effect of nano-simplicia of R. pinnata

water extract, since this extract shown the highest

ability to dissolve calcium contain renal stone. A

hundred percent of calcium contain renal stone (1

gram of renal stone contain 10.29 mg calcium)

should be dissolve in 27% nano-simplicia of water

extract approximately. By this concentration, the

future research of animal study of anti-

nephrolithiasis of R. pinnata should be done.

Figure 2: The Dissolution Percentage of Calcium Nano-

simplicia R. pinnata water extract extrapolation

Calcium oxalate is the constituent component of

the process of formation of kidney stones in the

human body. Calcium oxalate stones are difficult to

dissolve in water and clog up the urinary system. By

the content of potassium ions and also high

magnesium, calcium oxalate can be broken down

and form new compounds that easily dissolve in

water (Girsang, 2016), (Permata, 2017). After

incubation with water extract of each treatments, the

levels of calcium in the water extract as a whole

increased. The highest dissolution was shown by a

20% nano-simplicia water extract, 80.55% calcium

of kidney stones decomposed within 4 hours of

incubation. But the fresh water extract of R. pinnata

leaves and water extract of R. Pinnata simplicia did

not show a significant difference that is below 5%.

However, there is little evidence to recommend

magnesium therapy in patients with renal stones.

4 CONCLUSIONS

R. pinnata water extract has the ability to dissolve

calcium containing renal stone allegedly due to their

potassium and magnesium contained in the water

extract. Nano-simplicia shown the highest

dissolution percentage, 80,55%. However, the future

research of animal study of anti-nephrolithiasis of R.

pinnata should be done.

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

474

ACKNOWLEDGEMENTS

We are gratefully to Ministry of Higher Education

for financial support in order to carried out this

research.

REFERENCES

Alvin, Y. (2015). Analisis Kelarutan Kalsium Oksalat dan

Kalsium Karbonat Pada Infusa Daun Tempuyung

Segar (Sobchus arvesis L.) dan Sediaan Kapsul

Ekstrak Daun Tempuyung Secara Spektrofotometri

Serapan Atom. Skripsi. Medan: Fakultas Farmasi

Universitas Sumatera Utara. hal. 2.

Basavaraj, D.R., Biyani, C.S., Brawning, A.J., and

Cartledge, J.J. (2007). The Role of Urinary Kidney

Stone Inhibitors and Promoters in the Pathogenesis of

Calcium Containing Renal Stones. Eau-Ebu. 5: 126-

136.

Brown, S. B (1989). Manual Penyakit Ginjal.

Diterjemahkan oleh Moch. Sadikin dan Winarsi

Rudihorso. Jakarta: Gramedia Pustaka Utama. Hal.

228-231, 233-235, 324-325. Binarupa Aksara

Cunningham, P., Noble, H., Al-Modhefer, A-K., and

Walsh, I. (2016). Kidney stones: pathophysiology,

diagnosis and management. British Journal of

Nursing, 25(20), 1112-1116.

Depkes RI. (1995). Farmakope Indonesia. Edisi IV.

Jakarta: Depertemen Kesehatan RI. hal. 1126, 1213.

Desmars JF, and Tawashi R. (1973). Dissolution and

growth of calcium oxalate monohydrate. I. Effect of

magnesium and pH. Biochim Biophys Acta;313:256–

67.

Girsang, C.A. (2016). Pengaruh Infusa Keji Beling

(Sericocalyx cripus (l.) Bremeck) terhadap Kelarutan

Kalsium pada Batu Ginjal Secara In Vitro. Skripsi.

Medan: Fakultas Farmasi Universitas Sumatera Utara.

hal. 1-11.

Liebman M, and Costa G. (2000). Effects of calcium and

magnesium on urinary oxalate excretion after oxalate

loads. J Urol;163:1565–9.

Maharani, E.T., Mukaromah, A.H., and Susilo, J. (2012).

Analisis Kalium dan Prosentase Daya Larut Calsium

Oksalat oleh Kalium dalam Ait The Daun Sukun

(Artocarpus altilis). LPPM Unimus. ISBN: 978-6020-

18809-0-6: 196-202.

Muhgni, A.I. (2013). Uji Aktivitas Ekstrak Etanol 70%

Kulit Batang Kapuk Randu (Ceiba petandra (L.)

Gaertn) Sebagai Penghambat Batu Ginjal pada Tikus

Putih Jantan. Skripsi. Jakarta: UIN Syarif

Hidayatullah. hal.1-26.

Nessa, Helmi, A., and Husni, M. (2013). Efek Diuretik

dan Daya Larut Batu Ginjal Dari Ekstrak Etanol

Rambut Jagung (Zea mays L.). Prosiding Seminar

Nasional Perkembangan Terkini Sains Farmasi dan

Klinik III. ISSN: 2339-2592. hal.1-14.

Nirumand, M.C., Hajialyani, M., Rahimi, R., Farzael,

M.H., Zingue, S., Nabavi, S.M., and Bishayee, A.

(2018). Dietary Plants for the Prevention and

Management of Kidney Stones: Preclinical and

Clinical Evidence and Molecular Mechanisms.

International Journalof Molecular Sciences. 19: 765.

Nouvenne, A., Ticinesi, A., and Meschi, T. (2013).

Nephrolithiasis and Gastrointestinal Tract Diseases:

Can Diet Intervention Help? Practical

Gastroenterology. 116: 27-35.

Permata, Y.M., Angkat, L and Wahyuni, H.S. (2017).

Analisis Kadar Kalium dan Daya Larut Kalsium

Oksalat oleh Infusa Selada (Lactuca sativa L.) secara

Spektrofotometri Serapan Atom. Jurnal Farmasi

Galenika, 4(2):38-44.

Pramono, S. (1988). Buku Temu Risalah Temu

Ilmiah.

Yogyakarta: Pustaka Baru. Hal. 10-13, 21-29,

68-72.

Putra, M.M.A. and Fauzi, A. (2016). Nefrolitiasis.

Majority. 5(2): 69-73.

Vina, J.A., Siti, A., and Iqbal, M. (2010). Isolasi dan

karakterisasi senyawa turunan terpenoid dari fraksi n-

heksana Momordica charantia L. Jurnal Sains dan

Teknologi Kimia:l1(1): 88-93.

Worcester, E.M. and Coe, L.F. (2008). Nephrolithiasis.

PrimCare. 35(2): 369.

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