DEFINITION:
The term Nephrolithiasis designates the presence of calculi, single or simpl or
multiple, in the kidneys or the urinary tract. A calculus may form in the renal pelvis or in
the bladder. It consists of a nucleus of organic material around which urinary salts are
deposited in organic matter. The salts, although crystalline in the form of amorphous
granules in the calculus.
AETIOPPATHOGENESIS:
The history of stone disease implies that many diverse factors might be involved in
its causation. An analysis of epidemiological evidence, however, diminishes the
importance of geographical location and ethnic origin and emphasis the part played by
environmental factors, like climate, dietary, life style, occupation, water available for
drinking, presence or absence of trace elements in foodstuff and drinking water.
Vesicle calculus has a high incidence in children (especially boys) in some parts of
England at beginning of last century but this is has gradually disappeared as diet of that
population changed for better, the stones were mostly ureteric and kidney in composition.
The incidence of renal calculus in economically highly developed Western
Countries has undergone opposite kind o change, in that there has been improved
methods of diagnosis developed last few decades. The stones are mainly calcium oxalate
(with & without apatic) in composition.
HOMOEOPATHIC CONCEPT OF ETIOLOGY OF STONES:
According to Boger, Diseases are logically divided into internal and external.
The former arise from the natural disposition, which is sometimes highly susceptible
(idiosyncrasy). The latter can excite disease principally by means of external impressions,
when there already a natural predisposition thereto.
The modified natural tendency depends, according to Hahnemann, upon the
uneradicated miasms of PSORA, SYPHILLIS, and SYCOSIS. When it does not
originate in these it is mostly composed of remnants and sequels of the acute affections
which so largely go to make up drug diseases and poisoning; but we not infrequently see
both factors combine to undermine the health, thus presenting a proportionately deeper
rooted disease just that much harder to combact. In such cases antipsoric remedies very
much excel all others in efficacy.
Whether or not we believe the psoric theory, the fact remains that the best selected
remedy is often ineffectual unless preceded by the proper antipsoric, antisycotic or
antisyphillitic, as the case may be, but because of their almost identical symptom lists it
is generally chosen with difficulty by differentiating and searching out the few true
characteristics.
Kent states that Hahnemann in $16 affirms that nothing, except in the form of a
simple substances, can so implant itself upon the economy as to run its course as a
disease either acute or chronic. No disease can implant itself upon the economy through
its ultimate forms; only in its invisible forms can it so act. All diseases known to man are in the form of simple substance, an invisible something that cannot be detected by the
chemist or the microscopist, and will never be detected in the natural world. Disease
cause is known, and known only, from its effects; it is not capable of investigation by the
natural senses and can only be investigated as to its results. Everything that can be seen,
felt or observed, or detected with the microscope, is but an ultimate, result. It is only by
the understanding, by reasoning from first to last and then back again, that we can
perceive that disease causes are invisible.
According to Hahnemann the cause of disease are of three types:
• Exciting cause
• Maintaining cause
• Fundamental cause
PATHOPHYSIOLOGY
Change takes place in stone bearing kidney which differ in extent and with time
chiefly according to whether there is or there is not a resulting obstruction or an
associated infection.
A calycle composed of calcium oxalate in non-infected kidney may grow very
slowly over many years with minimal structural change in kidney, though sometimes a
hydrocallycosis may develop when stone partially obstructs pelviuriteric outlet and give
rise to hydronephrosis, or if the gradual conversion of kidney under such circumstances
into a functionless hydronephrotic sac is occasionally seen.
An uninfected calculus which comes to rest in ureter may produce a considerable
degree of obstruction and there is some dilatation of ureter above stone. At site of arrest
the ureter is thick walled and there is periureteric edema. Complete obstruction to flow of
urine if prolonged leads initially to dilatation of renal pelvis, but if prolonged for several
months the kidney may undergo varying degree of atrophy until in end all excretory
tissue may be lost and there remains a mere fibrous shell covering a multiloculated
hydronephrotic sac representing the greatly dialated calyces, the ureter also being
considerably dilated above stone.
CLINICAL FEATURES
Stones may be completely asymptomatic, even when causing obstruction and
discovered during radiography for other reasons. While there may be symptoms referable
to underlying disease (e.g hyperparathyroidism or gout), symptoms due to stones may be
first manifestations of such illness.
1. Pain: In one of the major symptoms. The classic pain is renal colic with a sever
crescendo and decrescendo pattern beginning typically in costovertabral angle,
proceeding to flank and anteriorly into suprapubic region and radiating to external
genitalia. The pain may be excruciating and unbearable when it reaches its peak.
Colic is associated mostly with stone in ureter causing obstruction and increased
pressure behing stone. However pain may not of usual colicky variety, especially
when constant discomfort, sometimes only a sense of awareness and even if more
sever, the pain may not have spasmodic characteristic of colic. The distribution of
pain is at times misleading: it may be limited to the back of abdomen, suggesting
other illness.
Patients with severe pain are restless and generally try unsuccessfully to
obtain relief by changing position and by pacing the room. There is pallor, sweating
and often vomiting and patients may groan in agony.
2. Urinary tract infection: May be associated with stone. The presence of stone
predisposes to infection, especially when it is located so that partial obstruction to flow
of urine results. Sometimes infection is asymptomatic and sometimes it presents as
classic clinical picture of acute pyelonephrities with pain chills, fever and pyuria. (The
presence of urinary tract infection, whether associated with symptom of infection obstruction, or both constitutes an indication for an intravenous pyelogram in search
for structural lesion including stones). Obstruction and infection can result in chronic
parenchynmal renal disease with functional deterioration.
3. Gross haematuria: Even without pain may occur Microscopic haematuria without
other manifestations may be due to silent stones.
4. Frequency of urine: A stone in portion of ureter within the bladder wall causes
frequency urgency and dysuria that may be confused with urinary tract infecton
Other Symptoms
Staghorn Calculi :
Struvite, cystine and uric acid stones often grow too large to enter ureter. They
gradually fill renal pelvis and may extend outward through infundibula to calyces
themselves.
Nephrocalcinosis
Calcium stones grow on renal papillae. Most break loose and cause colic but
they may remain in place so that multiple papillary calcifcations are found by X-rays, a
condition termed nephrocalcinosis Papillary nephrocalcinosis is common in hereditary
renal tubular acidosis and in other types of sever hypercalciuria. In medullar sponge
kidney disease calcification may occur in dilated distal collecting ducts.
HOMOEOPATHIC MEDICINE FOR NEPHROLITHIASIS:-
1. Benzoic Acid:
Kent says that this remedy has a state and condition that is sometimes called the
gouty constitution, the uraemic or the lithium constitution and these cases are very
difficult to manage, as the state is so persistent. It is one of the manifestations of psora.
These pts suffer more or less from irregularity in the action of the kidneys. The urine is
copious and plenty of uric acid is being passed. Urine is full of deposits then the pt is at
his best. Urine is pungent and strong smelling like that of Hippuric acid, and so it is said
urine smells strong like that of a horse.
2. Berberis Vulgaris:-
N.M. Chaudhury states that it is predominatly a left sided remedy with stitching,
cutting pain in the left renal region that follows the course of the ureter into the bladder
and then into the urethral canal. This pain sometimes shoots all through the pelvis, into
the hips and down into the testicle of the affected side, which seems drawn up. Every
movement brings on the pain. There is bruised pain with stiffness, lameness and
numbness in the small of back which renders movement difficult.
Two symptoms are particularly characteristics of this remedy . One is wondering,
radiating pain. It rarely stops where it begins. Sticking pain radiating from the liver
under the border of false ribs on to the right said and into the abdomen, bubbling
sensations felt as if water were coming through the skin.
3. Calcarea Carb:
Farrington says that calc. osterarum is suited to cases in which there is defective
growth, hence it is very necessary remedy in childhood and in infancy. It affects chiefly
the vegetative system, altering materially the nutrition of the body. Under its influene
secretion and absorption progresses rapidly, so it becomes a favorite remedy in cases
where the “ CONSTITUTION ” has to be changed. There is tenesmus of the bladder, too
frequent emission of urine, even in the night. Urine is deep colored without sediment.
4. Cantharis:
Chaudary says that the symptoms of cantharis that should be written in flaming
characters on our memory are constant intolerable urging towards urination and a furious
burning, cutting pain in the urethra before, during and after maturation. Often times it is
so exaggerated and intensified that it becomes simply impossible for him to withstand the
desire. Urine does not come out with its natural flow. There is constant dribble and every
drop feels like molten lead. The urine itself is frequently bloody and the straining to expel
the few drops of the s bloody accumulation is intense. We find him passing urine every
two or three minutes. Fibrous casts, epithelial cells and little pieces of mucous membrane
from the lining of the bladder and the tubules of the kidney.
5. Dioscorea Villosa :
N. M. Chaudary says that it is a great anodyne. Here pains are neuralgic in
character. It is difficult to explain the why and where fore of this pain: It probably acts
upon the solar plexus and upon spinal nerves and there by causes pain over the body and
in the viscera. The statement of Burt is particularly illuminating and should be very
convincing. The grand sphere for the use of Dioscorea is among neurosis of the bowels
and stomach, where the celiac and umbilical plexus are in a state of great hyperesthesia,
the pain and spasm being umbilical plexus are in a state of great hyperesthesia, the pain
and spasm being unbearable which radiates all around the abdomen. The guts feel like
twisted most mercilessly. Another feature of this pain is the sudden shifting from the
original area of affection and reappearance of the pains in distant localities, such as the
fingers and toes. We must however feel that these pains are only confined to the intestine
alone. It is equally applicable in renal colic and other pains in urethra.
6. Equisetum :
Boericke says that principle action of this remdy is one the bladder. It is
predominantly right sided remedy and also for enuresis and dysuria. There is fullness
feeling in bladder not relieved by urinating. Urine flows only drop by drop. There is deep
pain along the region of right kidney, extending to lower abdomen, with urgent desire to
micturate.
7. Lycopodium :
Kent states that it is an anti-psoric, anti-syphilitic and also anti- sycotic. There is
predominance of symptoms on the right side of the body and they are likely to travel
from right to left or from above downwards. The kidneys furnish many symptoms andmay be the key to Lycopodium in many instances. There seems to be the same inactivity
in the bladder as in the rectum. Though he strains ever so much, he must wait a long time
for the urine to pass. It is slow to flow and flows in a feeble stream. The urine is often
muddy with brick dust, or red sand deposits.
8. Nux Vomica :
Farrington says that is is useful remedy in diseases of the genito-urinary organs. It
is indicated in renal colic, when one kidney, usually the right, is the seat of the disease.
The pain extends into the genital organs and down the leg. Nux also has haematuria and
also indicated in affections of the bladder. With this urging to urinate there is also urging
to stool. .
9. Ocimum Canum :
N.M. Chaudary states that it has specific action in diseases of the kidney, bladder
and urethra, The symptoms are excruciating crampy pains in the region of kidney with
violent vomiting every few minutes. The patient twists and turns in agony and wrings her
hands with intensity of the colic.
10. Pareria Brava :
Here N.M. Chaudary says that its most important symptom is a constant urging
for urination but then it is not evacuated easily. He must get down on all fours to urinate.
In his agony he cries most bitterly and can only emit only small quantities of urine by
going down on his knees and pressing his head firmly on the floor.
