A case report on renal calculi treated with homoeopathy

Abstract

The following case report is of a male diagnosed with renal calculi in left kidney. Renal calculi is a condition having hard deposits of mineral and acid salts that stick together in concentrated urine. When patient came for consultation, he was presented with pain in abdomen in the right hypochondrium, right lumbar and right iliac region. After thorough case taking, symptoms were aggregated to make the totality and the case was repertorised using Synthesis Repertory in which a few homoeopathic medicines including Aloes socotrina, Natrum muriaticum, Arsenicum album, Sulphur, Sepia, etc. came up. The final selection of remedy was done on the basis of presenting complaints, mental generals, and physical generals.

Keywords

renal calculi, risk factors, Aloes socotrina, homoeopathy

Abbreviations

e.g. – example, Rt. – right, yr – year

Introduction

Nephrolithiasis is a condition in which organic and inorganic masses form within the urinary tract. Stone formation may occur when the urinary concentration of crystals (e.g., calcium, oxalate and uric acid) is high and when the concentration of substances that inhibit stone formation (e.g., citrate) is low.¹

Classification and pathophysiology

Kidney stones are broadly categorised into calcareous (calcium containing) stones, which are radio-opaque

and non-calcareous stones. On the basis of their com-position, stones are classified as shown in the table. The figure shows multiple calcium oxalate stones.

Recent evidence indicates that formation of kidney stones is a result of a nanobacterial disease akin to Helicobacter pylori infection and peptic ulcer disease.² Nanobacteria are small intracellular bacteria that form a calcium phosphate shell (an apatite nucleus) and are present in the central nidus of most (97%) kidney stones and in mineral plaques (Randall’s plaques) in the renal papilla. Further crystallisation and growth of stone are influenced by endogenous and dietary factors. Urine volume, solute concentration, and the ratio of stone inhibitors (citrate, pyrophosphate, and urinary glycoproteins) to promoters are the important factors that influence crystal formation. Crystallisation occurs when the concentration of two ions exceeds their saturation point in the solution.

Classification of kidney stones3
Composition	Causative factors	Frequency (%)
Calcium oxalate, Phosphate or both	Underlying metabolic abnormality, idiopathic (25%)	60-80
Struviate (triple phosphate)	Infection	10-15
Uric acid*	Hyperuricaemia and Hyperuricosuria Idiopathic (50%)	5-10
Cystine	Renal tubular defect	1
Other (xanthine, indigo, triamterene, indinavir*, etc)		1
*Pure uric acid and indinavir stones are radiolucent. Cystine stones are radio-opaque because of the sulphur content

Risk factors for kidney stones

A precise causative factor is not identified in most cases. A family history of kidney stones (increases risk by three times), insulin resistant states, a history of hypertension, primary hyperparathyroidism, a history of gout, chronic metabolic acidosis, and surgical menopause are all associated with increased risk of kidney stones.^4-10 In post-menopausal women, the occurrence of kidney stones is associated with a history of hypertension and a low dietary intake of magnesium and calcium.¹¹ Incidence of stones is higher in patients with an anatomical abnormality of the urinary tract that may result in urinary stasis (box 1). Most patients (up to 80%) with calcium stones have one or more of the metabolic risk factors shown in box 2, and about 25% of stones are idiopathic in origin.

Case study

Introduction

A 36 year old male presented with the chief complaints of pain in right side of abdomen since 1 year associated with rumbling in abdomen, after eating, with stool passing during discharge of flatus. He had a history of renal calculi 2 years back which was treated with homoeopathically. He was having addiction of tobacco and alcohol 5years back.

Presenting complaints

• Pain in right sided abdomen (Rt hypochondrium, Rt iliac region, umbilicus) since 1 yr.

Pain with rumbling after eating something

Modalities: Aggravation – after eating,

                   Amelioration – passing flatus

• Stool during passing flatus

Physical Generals

• Appetite: Adequate
• Thirst: Regular, normal water
• Desire: Salty things
• Aversion: Nothing significant
• Intolerance: Nothing significant
• Stool: Regular, satisfactory
• Urine: Clear, non-offensive
• Sleep: 8 hours/day, refreshing

Mental generals

• Expressed his anger
• Did not want to talk when angry
• Did not want consolation during anger
• Desire for company

Analysis and evaluation of the case:

Physical generalsIntensity	Desires salty things++
Mental generalsIntensity	Consolation aggravation++	Doesn’t like to talk when angry+
ParticularsIntensity	Pain in right hypochondrium++	Pain in umbilicus++	Rumbling in abdomen after eating++	Pain aggravates after eating anything++	Pain ameliorates on passing flatus++	Passage of stool on passing flatus++

Provisional diagnosis

Renal calculus¹²

Totality of symptoms

• Pain in right hypochondrium
• Pain in umbilicus
• Rumbling in abdomen after eating
• Pain aggravated after eating anything
• Pain ameliorated after passing flatus
• During passing flatus, there is passage of stool
• Desire for salty things
• Consolation aggravation

Reportorial analysis

The case was repertorised with the help of Radar Software 10 using Synthesis repertory 2009.¹³ After the analysis and evaluation of the case, the totality of the case was constructed on the basis of the characteristic symptoms. “Pain in right hypochondrium with rumbling in abdomen amelioration after passing flatus, passage of stool during passing flatus, stool after eating anything, desires salty things were some important symptoms of the case. On the basis of reportorial analysis and consultation of the Boericke materia medica¹⁴, Aloes socotrina was found to be the simillimum to the case having the highest score, i.e. 15/8 covering all the rubrics.

Reportorial result¹³

• Mind- Consolation- Agg
• Abdomen- Flatus – Discharge of – after- amel
• Abdomen- Pain – Hypochondria- right
• Abdomen- Pain – Umbilicus
• Abdomen- Rumbling- Eating, after
• Stool- Eating- after
• Stool- Flatus passing, when
• Generals- Food and Drinks – salt – desire

Prescription

Aloes socotrina 30 / 4 dose

Basis of prescription

After analysing the reportorial result and consultation with The Guiding Symptoms of Our Materia Medica¹⁵ and The Dictionary of Practical Materia Medica¹⁶, Aloes socotrina 30/ 4 doses were prescribed (including symptoms such as consolation aggravation, pain in right hypochondrium, rumbling after eating and passing stool during flatulence, etc.). Although consolation aggravation and other characteristic symptoms of the case was also present in Natrum muriaticum, Arsenicum album and other remedies in the repertorial result. Aloes socotrina was selected as per the persisting abdominal symptoms. Aloes socotrina was given in 4 doses after which the patient showed improvement in his complaints followed by placebo for 1 month.

Potency– Sixth potency and higher. In rectal conditions, a few doses of the third, then wait.¹⁴

Follow Up

Date	Symptoms	Prescription
15-10-2021	1st visit of patient	Aloes socotrina 30 / 4 dose (“The dose of medicine (of the first prescription) that acts without producing new troublesome symptoms in to be continued while gradually ascending, so long as the patient with general improvement, begins to feel in the mild degree the return to of one or several old original complaints”.) (Aph 248,280)17
25-10-2021	Slight relief in pain in abdomen	Placebo
05-11-2021	Pain in abdomen is better than earlier	Placebo

BEFORE

AFTER

Discussion and conclusion

This case of renal calculi is treated according to the cardinal principles of homoeopathy and the medicine selected on the basis of characteristic symptoms, i.e. stool passing with flatus, rumbling sensation in abdomen, etc., mental generals of the patient has proved to be very effective in this case of renal calculi. The potency was selected on the basis of susceptibility of the patient as the patient has a history of addiction of alcohol and tobacco and the pathological condition so the susceptibility of the patient is low this suggested the selection of low potency. The selected medicine, Aloes socotrina, has been given in 4 doses and then the follow up was done in every 10 days with no repetition only placebo was continued for further follow ups. The medicine shown its results in very few doses in a very short period of time this established the fast and gentle recovery according to the homoeopathic principles and philosophy.

The potency selection was done on the basis of susceptibility as stated by¹⁸:

Constantine Hering, “if the symptoms of the case generally have more resemblance to the primary symptoms of the drug, then lower potencies, on the contrary more resemblance with the later effects (secondary action) thence advocate higher potencies.”

Dr Close:

1. The greater the characteristic symptoms of the drug in the case, the greater the susceptibility to the remedy and the higher the potency required.
2. Age: medium and higher potencies for children
3. Higher potencies for sensitive, intelligent persons.
4. Higher potencies for persons of intellectual or sedentary occupation and those exposed to excitement or to the continual influence of drugs.
5. In terminal conditions even the crude drugs may be required
He also writes, “different potencies act differently in different cases and individuals at different times under different conditions. All may be needed. No one potency, high or low, will meet the requirement of all cases at all times.”

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About Author:

Dr Ajay Vishwakarma Principal I/C, (Associate Professor/ HOD,

Department of Anatomy, Chandola Homoeopathic Medical
College and Hospital, Rudrapur, U S Nagar, Uttarakhand)