Abstract: Polycystic kidney disease is the 4th most common cause of chronic renal insufficiency or end stage kidney disease. It is characterized by the presence of fluid -filled cysts in the kidney. It is an inherited disorder with two main types such as Autosomal dominant polycystic kidney disease and Autosomal recessive polycystic kidney disease. Autosomal dominant polycystic kidney disease (ADPKD) is more common and most frequently found in adults whereas Autosomal recessive polycystic kidney disease (ARPKD) is a rare form of disease mainly seen perinatally or in early childhood. In ADPKD patients usually present with chronic flank pain, hypertension, haematuria and with more advanced disease there is progressive decline in renal function. ARPKD is a more severe form of disease where there are genetic mutations in the PKHD1 gene. Some serious manifestations are present at birth and result in death from renal failure in early childhood. Conventional management focuses on controlling symptoms, managing complications and slowing disease progression. Treatment includes blood pressure control, pain management and in advanced cases dialysis or kidney transplantation. Homoeopathy is a system of alternative medicine based on the principle of “like cures like”. Homoeopathic medicine can be used to manage symptoms and improve quality of life. Homoeopathy should be integrated with conventional medical approaches to ensure comprehensive care.
Key words:
Polycystic kidney disease, ADPKD, ARPKD, Homoeopathy
Introduction:
Polycystic kidney disease is an inherited disorder in which a cluster of cyst develops in the kidney. It is common to encounter patients with single cyst or even multiple cysts as an incidental finding especially in those aged 50 years and over. Usually, these cysts are of no clinical consequences and are asymptomatic but occasionally they can cause pain or haematuria. It is inherited mainly in two forms such as Autosomal dominant polycystic kidney disease and Autosomal recessive polycystic kidney disease. ADPKD is more prevalent affecting 1 in 400 to 1,000 people, while ARPKD occurs less frequently with an estimated prevalence of 1 in 20,000 to 40,000 individuals.
Autosomal Dominant Polycystic Kidney Disease:
Also known as adult polycystic kidney disease. It is relatively common and is the cause of end stage renal failure in approximately 10% of haemodialysis patients. It accounts for 90% of cases with PKD. Family history of renal disease may be present. There is mutation in the PKD1 gene located on chromosome 16 and the PKD2 gene located on chromosome 4 which encodes proteins called polycystin-1 and polycystin-2 respectively. Though the kidneys are abnormal at birth, the renal function is retained, and symptoms appear in adult life, mostly between the age 30 and 50 years.
Clinical features:
- Vague discomfort in loin or abdomen due to increasing mass of renal tissue.
- Acute loin pain or renal colic due to cyst rupture, hemorrhage into cyst or ureteric stones.
- Hypertension.
- Haematuria – often visible but with little or no proteinuria.
- Urinary tract infection or cyst infections.
- Progressive decline in renal function (50%) of patients and after the age of 60 years they develop end stage renal disease.
This form of PKD usually presents with extra renal anomalies such as:
- Extra renal cyst – Most commonly seen in the liver followed by pancreas, spleen.
- Berry aneurysm (5-10%)
- Colonic diverticulosis
- Mitral valve prolapse
- Arterial dolichoectasia (Malformations of vasculature of brain)
Most common cause of death in patients with ADPKD is left ventricle hypertrophy due to hypertension.
Autosomal recessive polycystic kidney disease:
Also known as infantile polycystic kidney disease. It is rare and family history of similar disease is usually not present. There is mutation in the PKHD1 gene located on chromosome 6 which encodes a protein called fibrocystin. It is invariably bilateral. The age at presentation may be perinatal, neonatal, infantile or juvenile but frequently serious manifestations are present at birth and results in death from renal failure in early childhood.
Clinical Features:
- The clinical manifestations depend on the age of the child.
- In severe form, the gross bilateral cystic enlargement of the kidney may interfere with delivery.
- In infancy, renal failure may manifest early.
- Almost all the cases of infantile polycystic kidney disease have associated multiple epithelium-lined cyst in the liver or proliferation of portal bile ductules.
- In older children, associated hepatic changes develop in the form of congenital hepatic fibrosis.
Investigation:
- CT scan, MRI
- USG Abdomen – Shows number of cyst.
- Kidney function test
- Genetic testing
Diagnostic criteria:
- 15-39 years of age: at least three unilateral or bilateral kidney cysts.
- 40-59 years of age: at least two cysts in each kidney.
- 60 years or older: at least four cysts in each kidney
Homeopathic approach:
The holistic and patient centered nature of homeopathy helps those seeking additional support alongside conventional medical care. Homeopathic remedies are often used to manage symptoms associated with PKD such as pain, hypertension, urinary tract infection, haematuria, heart trouble.
Indications of remedies:
- Apis:
Apis is indicated in PKD when a patient presents with burning soreness while urinating. Pain in the region of the kidney with frequent desires to pass urine and scanty urine. Patients are usually thirst less. Great irritation at the neck of the bladder, urine scanty, high coloured, hot and bloody.
- Cantharis:
Cantharis is indicated when PKD is associated with cystitis. Patients usually present with violent tenesmus and burning in bladder, violent, but ineffectual urging to urinate, also there is drop discharge of saturated dark urine. Stinging and burning pain in the region of the bladder, before and after urination or cutting pain from kidney to bladder. Abdomen is distended and painful to contact especially in the region of the bladder. Great thirst but drinking and even a site of water increases the pain.
- Colocynth:
Colocynth is indicated when there is severe pain in the abdomen along with PKD. There is pain on urinating over the whole abdomen with a viscid fetid small quantity of urine and frequent urging. There is agonizing cutting pain in the abdomen causing the patient to bend double and pressing on abdomen. Each paroxysm is attended with general agitation and a chill over the cheeks ascending from the hypogastrium.
- Berberis vulgaris:
Berberis vulgaris is indicated when a patient presents with PKD along with a complaint of renal stone. There is burning pain with sensation as if some urine remained after urinating. Urine with thick dark mucus and bright red sediments. There is pain in thighs and loins when urinating. Also there is frequent urination and burning in urethra when not urinating.
- Digitalis:
Digitalis is indicated when PKD is associated with heart trouble. There is continued urging, in drops, urine is dark, hot, burning with sharp cutting or throbbing pain at the neck of the bladder. Full feeling after urination. There is violent palpitations at least movement. Pulse is very slow, intermittent and weak. Dilated heart, tired, irregular with slow and feeble pulse. Hypertrophy with dilatation.
- Convallaria Majalis:
It is indicated when a patient of PKD presents with cardiac complications. There is aching in the bladder, it feels distended. Frequent urination with offensive scanty urine. This remedy increases the energy of the heart’s action and renders it more regular. Ventricles are over distended and dilatation begins. There is absence of compensatory hypertrophy. Extremely rapid and irregular pulse.
- Rauwolfia serpentina:
It is indicated in patients of PKD with hypertension. There is high blood pressure without marked atheromatous changes in the vessels. Also there is high blood pressure with irritative conditions of the central nervous system. It also acts as a sedative. It produces sleep and by this way it lowers the blood pressure.
- Serum anguillar:
It is indicated in cases of kidney disease along with heart affection. The presence of albumin and renal elements in the urine. The haemoglobinuria, the prolonged anuria, plainly demonstrates its elective action on the kidney. Secondarily the liver and the heart are affected. The serum of the eel seems better adapted to cases of hypertension and oliguria without oedema. The serum of the eel has put an end to the renal obstruction and produced an abundant diuresis. Mitral insufficiency asystolia with or without oedema, dyspnoea and difficult urinary secretion. Also there is a high creatinine level in the blood.
- Terebinthina: It is of great use in case of kidney disease with haematuria. Urine scanty, suppressed with odor of violets. Urethritis, constant tenesmus. Inflammation of kidney with haemorrhage – dark, passive, fetid. Much blood with very little urine and constant painful dysuria. Burning sensation, incisive pain and spasmodic tenesmus of the bladder. Pressure in the kidney when sitting, going off during motion. Sensation of heaviness and pain in region of kidney.
Conclusion:
Homoeopathic remedies can be used in cases of PKD as a complement along with conventional medicine for better management of cases. More research is needed in this area to better understand the efficacy of homeopathic medicine in cases of polycystic kidney disease.
Reference:
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- Davidson, Principles and practice of medicine; edition by Ian D Penman, Stuart H Ralston, Mark WJ Strachan, Richard Hobson: 24th edition 2022.
- Lilienthal Samuel, Homoeopathic Therapeutic; 24th impression 2016: India; B. Jain Publishers Pvt. Ltd.
- M. Harsh, Textbook of pathology, 3rd edition 1998: India; Jaypee Brothers Medical Publishers Pvt. Ltd.
- https://www.ncbi.nlm.nih.gov/books/NBK532934/#:~:text=Epidemiology.%20ADPKD%20is%20a%20worldwide%20condition%20affecting,to%2010%%20of%20all%20patients%20with%20ESKD.[5][6][7]&text=Corresponding%20data%20for%20the%20same%20time%20frame,5.6%20and%204.0%20per%20million%20in%20Japan.