Renal calculus and homoeopathic management

Dr Dinesh Kumar

ABSTRACT: Now days homeopathy is a second most rapidly growing system of amongs all pathies and its very popular practice in all over the world. Homoeopathy treatment is found to be more advisable because having no side effect with very safe for all ages patients Kidney stones are a major health problem today. Disordered life style, fast food habits are major reasons for health. More over medicine will prevent the future recurrence of stones. Study shows that 4% of the total population has stones in urinary tract.

KEYWORDS: Homoeopathic, Kidney stone, Renal Calculi, Renal Stone.

INTRODUCTIONS: Kidney Stones or Renal calculi are solid masses made-up of crystals, usually originate is in the kidney, but can develops along with urinary tract. Stone formation occurs when urinary chemistry results in concentrations of stone salts that exceeds the limit of metastability for that salt in solution. This most often reflects excessive excretion of one or more stone constituents, deficient inhibitory activity in urine, or simply a low urine volume resulting in excessively concentrated urine.

ETIOLOGICAL FACTORS: Kidney stone often has no definite, single cause, although several factors may increase your risk. There are different type of renal calculi and the causes for each is given below.

SYMPTOMS/ SIGNS:

1. Occult passage of small, asymptomatic stones may occur. More frequent, however, asymptomatic renal stones are identified radiographically during evaluation for other, unrelated conditions.
2. Hematuria regularly accompanies stone movement within the urinary tract and may be microscopic or gross. It may occur with or without pain.
3. Frequency and dysuria are common complaints of patients with stones lodged in the intravesical segment of the distal ureter and may be mistaken as the symptoms of cystitis. Dysuria also occurs during the passage of grumous or pulaceous sludge.
4. Abdominal pain, tenesmus, and rectal pain may occur with a stone in the renal pelvis and often are accompanied by nausea and vomiting.
5. Renal colic with flank pain radiating to the inguinal ligament, urethra, labia, testis or penis is typical of a stone in the mid-ureter.
6. Acute obstruction by a stone may occur, generating renal colic.
7. Infection often complications stone diseases and usually produces flank or back pain, fever and chills particularly with urinary obstructions.

TYPES OF RENAL CALCULI:

1. Calcium oxalate stones (more than 70%). Often calcium oxalate is mixed with calcium phosphate or uric acid.
2. Calcium phosphate usually occurs as apatite or brushite. Calcium phosphate crystals are readily soluble in acidic urine. Thus, presence of pure calcium phosphate stone is evidence of persistently alkaline urine, as occurs in distal renal tubular acidosis.
3. Cystine stones occur only in patients with cystinuria.
4. Magnesium ammonium phosphate stones (also known as ‘triple phosphate’ or struvite) occur in UTI with an urease-producing organism. They can be very difficult to eradicate because the organisms can infect the stone matrix, where they may be sheltered from exposure to antibiotics. Cystine stones can be resistant to lithotripsy.
5. Both cystine and struvite stones can grow to fill the entire renal pelvis, forming a staghorn calculus. Staghorns are uncommon with calcium and uric acid stones.
6. Rarely drugs, such as triamterene, 5-fluorocytosine and indinavir can crystallise in the urine to form stones.
7. Uric acid stones are radiolucent by simple abdominal radiography or IVP, but radio dense on helical CT and echogenic on ultrasonography.
8. Other rare type of stones includes xanthine, 2,8-dihydroxy-adenine, gypsum and silicate.

PREDISPOSING FACTORS:

1. Hypercalciuria, the most common risk factor for formation of calcium oxalate stones, is idiopathic hypercalciuria. This is a complex condition that reflects excessive intestinal absorption of dietary calcium, excessive resorption of bone and (rarely) a renal calcium leak. Excessive intake of animal protein can increase calcium excretion through several mechanisms, including resorption of bone to buffer the acid component of animal protein. Idiopathic hypercalciuria is often hereditary. Hypercalciuria can also occur as a secondary consequence of primary hyperthyroidism, granulomatous disease (sarcoidosis, tuberculosis) and excessive intake of vitamin D or A.
2. Hyperoxaluria, Extreme hyperoxaluria occurs in the rare hereditary condition, primary hyperoxaluria. Less severe hyperoxaluria is seen in intestinal malabsorption. This is because steatorrhoea allows calcium to bind to fat rather than to intestinal oxalate, allowing ingested oxalate to remain free in solution and thus more available for absorption. Mild hyperoxaluria is more common in stone patients and reflects excessive dietary intake of oxalate (nuts, beans, beets, spinach, rhubarb, strawberries). Inadequate dietary calcium intake can allow increased intestinal absorption of dietary oxalate.
3. Citrate forms soluble complexes with calcium and is an important inhibitor of calcium stone formation. Foods that are high in citrate are usually also high in oxalate.
4. Hyperuricosuria is generally metabolic in origin, though a diet high in red meat can increase urate excretion, thus promoting precipitation of uric acid.
5. Urinary pH is important in case of uric acid, cystine or calcium phosphate stones. Acid urine favours formation of uric acid and cystine stones. In renal tubular acidosis, urine pH never falls below 5.5, and this allows crystals of calcium phosphate to form and grow.
6. Low urine volume. About 10% of stone-forming patients have no identifiable risk factor other than concentrated urine due to low urine volume.

EVALUATION OF STONE RISK: In all first-time stone formers appropriate diagnostic investigations should include analysis of the composition of the retrieved stone, urine culture, and measurement of serum calcium (for primary hyperparathyroidism), bicaronate (to screen for renal tubular acidosis) and creatinine, and urinalysis and measurement of pH. Examination of urine sediment is often useful in revealing crystals that can indicate the likely nature of the stone.

Patients with recurrent or bilateral stones should undergo more complete metabolic evaluation, including measurement of calcium, oxalate, citrate, uric acid, sodium and creatinine in 24–hour urine specimens. Daily excretion of creatinine is the only practical measure of whether the 24–hour collection was complete, it should be invariable in patients in a steady state, regardless of renal function, and should be about 15–20 mg/kg in women and 20–25 mg/kg in men.

INVESTIGATIONS:

1. History–Occupation, Vit-D consumption, Gouty arthritis
2. Mid stream urine exam- Culture, Crystal, RBCs, Urinary pH, Pus cells.
3. Blood -Blood urea, Serum creatinine, Serum electroytes, including calcium
4. X-ray plain KUB- IVP and cystoscopy
5. Ultrasonography
6. CT scan

ROLE OF HOMOEOPATHY

According to Dr. Samuel Hahnemann

Definition: One-sided diseases are chronic diseases with one or two principle symptoms which obscure almost all the symptoms. Hence, they are less amendable to cure. Chronic diseases which are having too few symptoms are called one sided diseases. The availability of symptoms are less in number in such diseases, as a result construction of totality becomes very difficult. Hence they are difficult to cure (§172 & 173).

Local maladies because of internal cause (§187 & 188) This is the second group of local maladies where the physician cannot notice ant type of external cause like injury or accident. Here, the cause is purely internal and dynamic. Example: eruptions on the lip and whitlow, etc (§ 189). Such local diseases where external cause could not be traced out, must be treated with internal remedies to achieve a judicious, sure, efficient and radical cure (§190).

1. A suitable homeopathic medicine in such cases, will not only cure the local maladies but also improve the general health of the patient (§191).
2. For the selection of such remedy, enquiry of exact character of the local affection and through investigation of patient’s disposition must be enquired, like in any other dynamic chronic disease (§192).

iii. Based on the totality of symptoms when the selected dynamic medicine is administered, it will radically cure the local malady as well as improve the general condition of the patient (§193).

1. In local maladies of the second variety, it is not at all advisable to use any kind of external applications. Even the internally administered similimum remedy cannot be applied externally. Only the internal use of dynamic homeopathic remedy alone is sufficient to bring about the cure. If such cure is not brought out, then psora has to be considered as the cause (§194).
2. In local maladies of psoric origin, the anti-psoric treatment is the only solution (§195). Administration of such anti-psoric medicines have to be done in succession i.e. each medicine has to be administered after one has completed its action.
3. The external applications are not allowed not only in psoric cases but also in syphilitic as well as sycotic types. This is because if local application is given the chief presenting complaint will disappear, leaving the internally present miasmatic disease uncured. So judicious and ideal cure is not possible (§196-198).

MIASMATIC BACKGROUND

S. N.	PSORA	SYCOSIS	SYPHILIS	TUBERCULAR
Kidneys, Micturition’s And Urine	Fibrous changes in kidney. Pain in kidney area, with inflammation of functional origin, nephritis, pyelitis, cystitis and urethritis. Stress incontinence Passes involuntarily and often frequent, when sneezing coughing, laughing. Dark but can also be yellowish or brownish.	Renal calculi with stitching and wandering pains. Tumors of the kidneys or bladder are encapsulated and malignant. Painful micturition, contraction of urethra. Frequent desire to urinate. Painful spasmodic urinary cramp affects the urethra & bladder. Yellow colors urine. Fish brine odors.	Fibrous change Diminish flow Burning and irritation during flow of urine. Acridity of urine. Red coloured urine with streaks of pus is character-ristics.	Recurrent, intermittent and periodic renal spasm with bleeding, Colorless, profuse urination. Involuntary urination. Albuminuria, urine loaded with phosphate, sugar or proteins.

TREATMENTS AND MANAGEMENTS:

1. Recommendation for more drink of waters, there should be high fluid intake at all times.
2. Uric acid and urate calculi-red meat, fish which are rich in purine are to be avoided.
3. Calcium oxalate calculi: Strawberries, plums, spinach, and asparagus which are rich in oxalate should only be taken if they are accompanied by cream or milk as these oxalates are precipitated as unusable calcium salt in intestine and are not absorbed.
4. Phosphate calculi: Excessive alkalinity of urine should be treated by giving ammonium chloride, phosphates should be restricted.
5. Cystine calculi: Sulphur containing proteins such as eggs, meat and fish are restricted and proteins with low sulphur substituted.
6. Milk, cheese and other items of diet containing a great deal of calcium is to be avoided.
7. Surgical ureteroscopic stone extraction percutaneous nephrolithotomy (gravel stones).
8. ESWL (Extra Corporeal Shock Wave Lithotripsy).

RUBRICS RELATED TO RENAL CALCULUS FROM COMPLETE REPERTORY

[COMPLETE] [BLADDER] CALCULI: (287) 1 Absin, 1 Acon, 1 Act-sp, 1 Agar, 1 Age-a, 2 Agri, 1 All-c, 2 Aln, 2 Alth, 1 Alum, 4 AM-C, 1 Am-caust, 1 Am-m, 3 Ambr, 2 Ammi-v, 1 Ang, 4 ANT-C, 1 Ant-t, 2 Ap-g, 1 Apis, 1 Apoc-a, 1 Aren-r, 3 Arg-n, 3 Arn, 4 ARS, 1 Ars-met, 4 ARUND, 3 Aspar, 2 Asper, 1 Astac, 1 Aur, 1 Aur-ar, 1 Aur-m, 1 Aur-s, 1 Bac, 1 Bapt, 3 Bar-m, 1 Baros, 3 Bell, 1 Benz, 4 BENZ-AC, 4 BERB, 1 Berb-a, 1 Beryl, 2 Betul, 3 Bor, 3 Bruc, 1 Bry,

[COMPLETE] [KIDNEYS] CALCULI, STONES: (132) 1 Absin, 1 Act-sp, 2 Agri, 2 Alth, 1 Alum, 1 Am-c, 1 Ambr, 2 Ammi-v, 1 Ang, 3 Ant-c, 2 Ap-g, 1 Apoc-a, 1 Arg-n, 1 Arn, 1 Ars, 2 Aspar, 1 Astac, 1 Baros, 3 Bell, 4 BENZ-AC, 3 Berb, 1 Berb-a, 1 Beryl, 2 Betul, 3 Bruc, 1 Cadm, 1 Cadm-o, 4 CALC, 1 Calcul-r, 3 Callun, 3 Cann-s, 3 Canth, 2 Cent-u, 1 Cham, 1 Chel, 3 Chim, 2 Chin, 1 Chin-s, 1 Chlol, 1 Coc-c, 1 Colch, 1 Coloc, 3 Dios, 1 Elem, 3 Epig, 1 Equis, 1

[COMPLETE] [URINE] SEDIMENT: SAND: GRAVEL, SMALL CALCULI: (102)
1 Age-a, 2 Agri, 1 Aln, 1 Alum, 2 Am-c, 1 Am-m, 3 Ambr, 4 ANT-C, 2 Ap-g, 1 Apoc-a, 1 Arg-n, 3 Arn, 1 Aspar, 2 Asper, 3 Bar-m, 1 Baros, 3 Benz-ac, 3 Berb, 4 CALC, 1 Calcul-r, 3 Callun, 3 Cann-s, 3 Canth, 1 Carb-v, 3 Chim, 3 Chin, 1 Chin-s, 1 Cimic, 1 Coc-c, 1 Cocci-s, 3 Coch, 1 Coll, 1 Coloc, 1 Con, 3 Epig, 1 Equis, 3 Equis-a, 1 Eup-pur, 1 Fab, 1 Gali, 2 Glech, 4 GRAPH, 1 Hier-p, 3 Hydrang, 3 Ipom, 1 Kali-bi, 1 Kali-c, 1 Kali-i, 1 Kiss, 1 Lach, 1 Lappa, 3 Lith-c, 4 LYC, 3 Meny, 1 Merc, 3 Merc-c, 2 Nast-a, 1 Nat-hchls, 3 Nat-m, 3 Nit-ac, 4 NIT-M-AC, 3

[COMPLETE] [BOGER’S GENERAL ANALYSIS 7] CALCULI, ATHEROMATA ETC.: (19) 3 Bell, 2 Benz-ac, 3 Berb, 2 Bry, 3 Calc, 3 Chin, 3 Coloc, 2 Dios, 2 Hydr, 2 Lach, 4 LYC, 2 Merc, 3 Nux-v, 2 Oci-c, 2 Pareir, 2 Podo, 2 Polyg, 2 Sars, 2 Sep,

[COMPLETE] [BLADDER] CALCULI: URINE, WITH BLOODY: (17) 1 Acon, 1 Arg-n, 1 Berb, 1 Calc, 1 Canth, 1 Cham, 1 Coloc, 1 Dios, 1 Erig, 1 Lyc, 1 Mag-p, 1 Oci, 1 Oci-s, 1 Sars, 1 Tab, 1 Thlaspi, 1 Urt-u,

[COMPLETE] [KIDNEYS] PAIN: CALCULI, FROM: (15)
3 Arg-n, 1 Arn, 1 Berb, 1 Bruc, 3 Canth, 1 Cere-b, 3 Chlf, 2 Ery-a, 1 Hydrang, 1 Lyc, 1 Nat-hchls, 4 SARS, 1 Sil, 1 Tarent, 1 Thlaspi

COMPLETE] [BLADDER] CALCULI: OPERATIONS FOR, AFTER: (13)
3 Arn, 1 Bell, 3 Calen, 1 Cham, 1 Chin, 1 Cupr, 1 Dig, 1 Laur, 3 Mill, 1 Nux-m, 1 Nux-v, 4 STAPH, 1 Verat,

[COMPLETE] [URINE] SEDIMENT: SAND: GRAVEL, SMALL CALCULI: PAIN IN BACK, WITH: (6) 3 Berb, 3 Canth, 1 Hydrang, 3 Ipom, 1 Lyc, 1 Pareir,

[COMPLETE] [URINE] SEDIMENT: SAND: GRAVEL, SMALL CALCULI: INFLAMMATION OF BLADDER, IN: (2) 3 Chim, 2 Orthos,

[COMPLETE] [BLADDER] CALCULI: RIGHT KIDNEY, FROM: (1) 1 Sars,

[COMPLETE] [BLADDER] URINATION: IMPOSSIBLE: CALCULI, SEDIMENT, FROM: (1) 3 Uva,

[COMPLETE] [BLADDER] URINATION: INTERRUPTED, INTERMITTENT STREAM: CALCULI, SEDIMENT, FROM: (1) 3 Uva,

[COMPLETE] [KIDNEYS] CALCULI, STONES: ANGER, VEXATION, FROM SUPPRESSED: (1) 1 Lach,

[COMPLETE] [URINE] BLOODY: CALCULI, WITH RENAL: (1) 3 Sars,

HOMOEOPATHIC MEDICINES:

1. Baros: Marked specific effects on genito-urinary system; muco-purulent discharges. Irritable bladder, with vesical catarrh; prostatic disorders. Gravel. Leucorrhœa.
2. Benz-ac: Repulsive odor; changeable color; brown, acid. Enuresis; dribbling, offensive urine of old men. Excess of uric acid. Vesical catarrh from suppressed gonorrhœa. Cystitis.
3. Bell: Retention. Acute urinary infections. Sensation of motion in bladder as of a worm. Urine scanty, with tenesmus; dark and turbid, loaded with phosphates. Vesical region sensitive. Incontinence, continuous dropping. Frequent and profuse. Hæmaturia where no pathological condition can be found. Prostatic hypertrophy.
4. Berb: Urine, Burning pains. Sensation as if some urine remained after urinating. Urine with thick mucus and bright-red, mealy sediment. Bubbling, sore sensation in kidneys. Pain in bladder region. Pain in the thighs and loins on urinating. Frequent urination; urethra burns when not urinating.
5. Calc: Urine, Dark, brown, sour, fetid, abundant, with white sediment, bloody. Irritable bladder. Enuresis (Use 30th, also Tuberculin. 1 m.).
6. Canth: Urine, Intolerable urging and tenesmus. Nephritis with bloody urine. Violent paroxysms of cutting and burning in whole renal region, with painful urging to urinate; bloody urine, by drops. Intolerable tenesmus; cutting before, during, and after urine. Urine scalds him, and is passed drop by drop. Constant desire to urinate. Membranous scales looking like bran in water. Urine jelly-like, shreddy.
7. Chel: Urine, Profuse, foaming, yellow urine, like beer (Chenop) dark, turbid.
8. Epig: Chronic cystitis, with dysuria; tenesmus after micturition; muco-pus and uric-acid deposit, gravel, renal calculi. Fine sand in urine of a brown color. Burning in neck of bladder whilst urinating and tenesmus afterward. Pyelitis, incontinence of urine. Croaking noise and rumbling in bowels.
9. Eup-pur: Urinary, Deep, dull pain in kidneys. Burning in bladder and urethra on urinating. Insufficient flow; milky. Strangury. Hæmaturia. Constant desire; bladder feels dull. Dysuria. Vesical irritability in women. Diabetes insipidus. Back pain, Weight and heaviness in loins and back.
10. Hep: Urine, Voided slowly, without force-drops vertically, bladder weak. Seems as if some always remained. Greasy pellicle on urine. Bladder difficulties of old men (Phos; Sulph; Copaiva).
11. Hydrang: Urine, Burning in urethra and frequent desire. Urine hard to start. Heavy deposit of mucus. Sharp pain in loins, especially left. Great thirst, with abdominal symptoms and enlarged prostate (Ferr pic; Sabal). Gravelly deposits. Spasmodic stricture. Profuse deposit of white amorphous salts.
12. Lyc: Urine, Pain in back before urinating; ceases after flow; slow in coming, must strain. Retention. Polyuria during the night. Heavy red sediment. Child cries before urinating (Bor).
13. Med: Urine, Painful tenesmus when urinating. Nocturnal enuresis. Renal colic (Berb; Ocim; Pareir). Urine flows very slowly.
14. Nux-v: Urine, Irritable bladder; from spasmodic sphincter. Frequent calls; little and often. Hæmaturia (Ipec; Tereb). Ineffectual urging, spasmodic and strangury. Renal colic extending to genitals, with dribbling urine. While urinating, itching in urethra and pain in neck of bladder.
15. Oci: Urine, High acidity, formation of spike crystals of uric acid. Turbid, thick, purulent, bloody; brick-dust red or yellow sediment. Odor of musk. Pain in ureters. Cramps in kidneys.
16. Pareir: Urine, Black, bloody, thick mucous urine. Constant urging; great straining; pain down thighs during efforts to urinate. Can emit urine only when he goes on his knees, pressing head firmly against the floor. Feeling of the bladder being distended and neuralgic pain in the anterior crural region. (Staph.) Dribbling after micturition. (Selen.) Violent pain in glans penis. Itching along urethra; urethritis, with prostatic trouble. Inflammation of urethra; becomes almost cartilaginous.
17. Pipe: Urine, Increased. Burning during micturition, gonorrhœa, and gleet. Cystitis. Chordee.
18. Urine, Burning in bladder and urethra. Difficult micturition. Bladder feels full, swollen; frequent inclination without success. Priapism.
19. Sep: Urine, Red, adhesive, sand in urine. Involuntary urination, during first sleep. Chronic cystitis, slow micturition, with bearing-down sensation above pubis.
20. Sars: Urine scanty, slimy, flaky, sandy, bloody. Gravel. Renal colic. Severe pain at conclusion of urination. Urine dribbles while sitting. Bladder distended and tender. Child screams before and while passing urine. Sand on diaper. Renal colic and dysuria in infants. Pain from right kidney downward. Tenesmus of bladder; urine passes in thin, feeble stream. Pain at meatus.
21. Tab: Urine, Renal colic; violent pain along ureter, left side.
22. Urt-u: A remedy for agalactia and lithiasis. Profuse discharge from mucous surfaces. Enuresis and urticaria. Spleen affections. Antidotes ill-effects of eating shellfish. Symptoms return at the same time every year. Gout and uric acid diathesis. Favors elimination.
23. Uva: Urine, Frequent urging, with severe spasms of bladder; burning and tearing pain. Urine contains blood, pus, and much tenacious mucus, with clots in large masses. Involuntary; green urine. Painful dysuria.

SOME OTHER MEDICINES: Chin-s, Solid, Cere-b, Tarent, Sil, Arg-n, Coc-c, Dios, Fab, Nit-ac, Stigm, Arn, Calcul-r, Cham, Coll, Erig, Ery-a, Gali, Gast, Hedeo, Junc, Methyl, Onis, Op, Oxyd, Pariet, Polyg, Thlaspi, Vesi, Helo.

CONCLUSIONS: Homoeopathic can be prove as beneficial to patients whom surgery is a risky afire like diabetes, hypertension etc or those search for an alternate to surgery and safe for health and for both economic or psychological reasons. No matter what disorders are found, very patient should be counseled to avoid dehydration and drink copious amounts of water. The efficacy of huge fluid intake more during night.

REFERENCES:

1. API Practice of Medicine
2. Babu Nagendra, Organon of the medicines
3. Borickes W. Borickes G Materia medica and Repertory.
4. Shah J. Hompath Repertory Software- Zomeo Ultimate Pro version.
5. Increasing International Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com

Dr. Dinesh Kumar BHMS, MD (Hom.) Scholar
Dept. of Case Taking and Repertory, Bakson Homoeopathic Medical College and Hospital Greater Noida, Gautam Budha Nagar, Uttar Pradesh.