Targeting Kidney Stone Recurrence with Multi-Mechanistic Phytotherapeutics: Translational Promise of Tribulus terrestris, Bryophyllum pinnatum and Citrate-Rich Botanicals

Urolithiasis is a common and highly recurrent urinary tract disorder characterized by the formation of crystalline calculi within the renal system. Although contemporary interventions such as surgical stone removal and pharmacological prophylaxis are effective in acute management, recurrence rates remain high due to the multifactorial pathogenesis of the disease and limitations of long-term preventive therapies. Consequently, increasing attention has been directed toward phytotherapeutic agents possessing multi-target pharmacological actions. This review critically examines the mechanistic rationale, preclinical evidence, and translational potential of Tribulus terrestris, Bryophyllum pinnatum, and citrate-rich botanicals as preventive or adjunctive strategies for recurrent urolithiasis. Relevant literature published between 2000 and 2026 was evaluated from major scientific databases including PubMed, Scopus, and Web of Science. Current evidence indicates that recurrent stone disease is driven by urinary supersaturation, crystal nucleation, oxidative epithelial injury, inflammation, and impaired endogenous inhibitory mechanisms. Tribulus terrestris demonstrates diuretic, crystal-growth inhibitory, and urinary biochemical modulating effects, primarily attributed to steroidal saponins and flavonoids. Bryophyllum pinnatum exhibits antioxidant, nephroprotective, and anti-adhesion activities that may reduce tubular injury and crystal retention. Citrate-rich botanicals, particularly Citrus sinensis derivatives, enhance urinary citrate, chelate calcium ions, and promote urinary alkalinization, thereby limiting calcium stone formation. Collectively, these agents target complementary stages of lithogenesis and may offer value in recurrence prevention. However, rigorous randomized clinical trials, pharmacokinetic characterization, and standardized formulations remain necessary before routine clinical application.