Abstract :

Background: Kidney stones (urolithiasis), particularly those composed of calcium oxalate (CaOx), remain a global health issue with a high recurrence rate. Non-pharmacological approaches using natural compounds are considered valuable alternatives to invasive treatments. Pineapple (Ananas comosus) contains citric acid and bromelain, which have potential inhibitory effects on CaOx crystallization, although scientific evidence is still limited.

Methods: A true experimental study with a post-test only control group design was conducted using four crystallization parameters (Tmax, SN, SA, and percentage of inhibition) across five groups: negative control, positive control (0.5% potassium citrate), and pineapple juice at concentrations of 25%, 50%, and 100%. Absorbance measurements were performed using a UV-Vis spectrophotometer at two-minute intervals for 60 minutes. Data were analyzed using Shapiro–Wilk, Levene’s Test, Kruskal–Wallis, and Dunn’s Post Hoc tests with a 95% confidence level.

Results: Pineapple juice exhibited strong inhibitory activity against CaOx crystal formation. All treatment concentrations reduced SN by more than 90% and achieved complete aggregation inhibition, along with increased Tmax compared to the negative control. The 25% concentration produced the most optimal inhibition effect, showing substantial SN reduction and a significant rise in Tmax. The Kruskal–Wallis test showed significant differences between groups for SN and Tmax, though pairwise comparison with Dunn’s Post Hoc indicated no significant differences after correction.

Conclusion: Pineapple juice effectively inhibited CaOx crystallization in vitro by delaying nucleation and preventing crystal aggregation, suggesting its potential role as a natural non-pharmacological preventive agent for kidney stone formation.

---

Keywords :

Ananas comosus, Calcium Oxalate, Crystallization Inhibition, in vitro, Kidney Stones.

---

References :

1. Peerapen P, Thongboonkerd V. Kidney stone prevention. Adv Nutr. 2023;14(3):555–69.
2. Dong C, Zhou J, Su X, He Z, Song Q, Song C, et al. Understanding formation processes of calcareous nephrolithiasis in renal interstitium and tubule lumen. J Nephrol. 2024.
3. Stamatelou K, Goldfarb DS. Epidemiology of kidney stones. Healthcare (Basel). 2023;11(3).
4. Liu Y, Chen Y, Liao B, Luo D, Wang K, Li H, et al. Epidemiology of urolithiasis in Asia. Asian J Urol. 2018;5(4):205–14.
5. Badan Penelitian dan Pengembangan Kesehatan. Riset Kesehatan Dasar (Riskesdas) 2013: Buku 1. Epidemiologi. Jakarta: Kemenkes RI; 2013.
6. Goller AAW, Telussa AS. Fresh graduate urologist in Eastern Indonesia: First year surgery experience. Indones J Urol. 2021;28(1):66–73.
7. Yong-Zyn Lo C, Khor QH, Abdullatif VA, Delgado C, Lu Y, Katz J, et al. Systematic review of pharmacological, complementary and alternative therapies for prevention of calcium oxalate stones. Asian J Urol. 2024.
8. Gopala SK, Joe J, Chandran J. Effects of lemon–tomato juice consumption on crystal formation in urine of patients with calcium oxalate stones: A randomized crossover clinical trial. Curr Urol. 2023;17(1):25–9.
9. Maharani ET, Susilo J, Sari SDK. Power to dissolve Ca oxalate by lemon juice (Citrus lemon) on variation of concentration and immersion times. Seminar Nasional Pendidikan, Sains dan Teknologi; 2017. p. 15–9.
10. Liu S, Li S, Ho CT. Dietary bioactives and essential oils of lemon and lime fruits. Food Sci Hum Wellness. 2022;11(4):753–64.
11. Huang CW, Lin IJ, Liu YM, Mau JL. Composition, enzyme and antioxidant activities of pineapple. Int J Food Prop. 2021;24(1):1244–51.
12. Ahmad S, Shad MA, Ansari TM. In vitro study on Nigella sativa as inhibitor of calcium oxalate crystallization. Indones J Urol. 2022;29(3).
13. Coe FL, Worcester EM, Evan AP. Idiopathic hypercalciuria and formation of calcium renal stones. Nat Rev Nephrol. 2016;12(9):519–33.
14. Kulkarni SJ. Production of citric acid: A review on research and studies. Int J Adv Res Found. 2015;2(11).
15. Varilla C, Marcone M, Paiva L, Baptista J. Bromelain, a group of pineapple proteolytic complex enzymes and their possible therapeutic and clinical effects. Foods. 2021;10(10).