A case of urolithiasis treated with homoeopathy

Dr G Swati

ABSTRACT: 
Urolithiasis is one of the most common disorders of the urinary tract. Dietary factors and addictions such as smoking and alcohol consumption have been implied as risk factors in Urolithiasis. A case of a 34 year old male suffering from recurrent Urolithiasis was treated successfully with homoeopathy with Ultra sonogram reports confirming the same.

INTRODUCTION:
Urolithiasis is the process of formation of stones in the urinary tract, principally in the kidneys or ureter and there may be either stone formation or migration to lower urinary tract (bladder and urethra).¹ 

Global prevalence ranges from 5-12 % approximately. The disease affects males approximately 1.5 – 2.5 times more than it affects females. In the Indian scenario, the prevalence of renal calculi is 15%. Risk factors include past history of stone formation, family history of Urolithiasis, dietary factors like high intake of oxalate, animal protein, sodium and calcium and inadequate fluid intake, and certain kinds of medications. The peak age of incidence is between 40 to 60 years.² 

Clinical features include acute renal colic with severe loin pain which may radiate to the groin and genitals, nausea, vomiting, frequent urination, dysuria, oliguria, hematuria and pyuria. Up to 98 % of urinary tract stones with size less than 5 mm in diameter can pass spontaneously. Stones of 5-7 mm size have 50 % chance of passage whereas those greater than 7 mm size require surgical intervention in most cases.³ 

Diagnosis is based on clinical presentation with USG-KUB confirming the presence of urinary calculi. Following is a case of Urolithiasis treated by homoeopathic medicines.

CASE: A 34 year old male patient reported to the Outpatient department of Government Homoeopathic medical College, Bengaluru on 22nd June 2019 with severe pain in the left loin region since 3 days. It was associated with shifting pain in abdomen with sensation as if abdomen was blocked, decreased appetite and bitter taste in mouth. He also complained of weakness and difficulty in passing stools. There was no history of nausea, vomiting, dysuria, oliguria, hematuria. A thorough physical examination of the patient was done and no abnormal findings were revealed. Treatment history: The patient had already sought conventional treatment and found no major relief in pain. 

INVESTIGATIONS: SPIRAL CT SCAN – KUB (Figure 1) revealed mild Left hydroureteronephrosis due to a calculus in the distal ureter 10 mm proximal to the vesico-ureteric junction measuring 6 X 4.5 X 9 mm with a mean attenuation value of 1160 Hu and a 2 mm calculus in the mid calyx of the left kidney. 

FIGURE 1:

Patient was visibly in severe pain and wasn’t in a state to talk or give history. He was highly restless and his wife reported that he was tossing and turning throughout and kept expressing a feeling of hopelessness due to the pain. Hence, an acute totality was made based on the presenting state as described below under repertorisation. 

RUBRICS AND REPERTORISATION:

1. MIND – DESPAIR – pains, with the

2. MIND – ANGUISH – pain; from – Abdomen; in

3. KIDNEYS – STONES

4. GENERALS – SIDE – left

 

BASIS OF PRESCRIPTION: Lachesis was chosen based on the results of repertorial totality owing to the intense, agonizing pains, sensitivity of the abdomen and Left sided affection. 

FIRST PRESCRIPTION ON 22/06/2019: Lachesis 200 1 dose followed by Placebo for 3 days. 

FOLLOW UP:  is as in the table given below.

FOLLOW UP DATE	SYMPTOMS	MEDICINE
23/06/2019 (via phone call)	Pain in the loin and abdomen is much better.  Patient was able to sleep. Restlessness and tossing about was much better. Appetite improved. Was able to pass stool. Weakness better	Placebo TID/ 3 days
26/06/2019	Complete relief in pain. Generals are good.	Placebo TID/ 1 week
1/07/2019	Mild pain and heaviness in left loin region while passing urine, lasted for a few seconds and patient felt that he heard a clicking sound and felt that the stone had passed off with the urine. Otherwise better. All generals good.	Placebo TID/ 15 days
13/07/2019	No pain/ discomfort in loin or abdomen. No new complaints. All generals good.	Placebo TID/ 15 days Patient was advised to repeat USG-KUB.

The patient had revealed in his last follow up that he had a history of annual recurrence of Urolithiasis since 2016. He was advised that he would require a constitutional treatment to prevent the recurrence and that Lachesis was just a state prescription. However, he didn’t turn up for quite some time.

On 14/11/2019, the patient presented with severe pain in Right lumbar region radiating to Right hypochondriac region since 2 days. There were no associated symptoms. The patient was advised USG-KUB [Figure 3] which revealed Right sided hydroureteronephrosis secondary to a distal ureteric calculus measuring around 7mm in size and lying around 9 mm from the U.V junction. 

FIGURE 3:

This time since the pain wasn’t as severe as previous time, a detailed history was taken and constitutional medicine was prescribed.

PAST HISTORY: History of recurring urolithiasis since 2016 for which he had undergone lithotripsy.

FAMILY HISTORY: Family history revealed cholelithiasis and Bronchial asthma in mother. Others were apparently healthy.

PHYSICAL GENERALS:

• Appetite – Good, Prefers WARM and fresh food.
• Desires – Rice, eggs
• Thirst – 2-3 Litres/ day 
• Bowels – Once daily, no difficulties
• Bladder habits – 3-4 times/day, no difficulties
• Perspiration – Profuse on neck
• Sleep – Alert sleep, disturbed by slightest noise
• Thermals – HOT

MENTAL GENERALS:

• Boaster
• Wants to be respected, egoistic, wants appreciation. Feels bad when not valued.
• Image conscious
• Talkative
• Angered easily
• Lazy – aversion to physical work

RUBRICS AND REPERTORISATION:

1. MIND – LAMENTING, appreciated, because he is not

Figure 4

BASIS OF PRESCRIPTION:

Keeping in mind- the loquacity, boasting, aversion to physical work and egotism along with desire for eggs, Calcarea sulph was chosen as per repertorisation. The rubric “KIDNEYS- STONES” is also covered by Calcarea.

PRESCRIPTION on 16/11/2019:

Calcarea sulph 200 1dose, followed by Placebo TID for 2 weeks was given.

FOLLOW UP of the case is as given in the table below:

DATE OF FOLLOW UP	SYMPTOMS	MEDICINE
30/11/2019	No episode of pain or heaviness in the right lumbar region in the last 2 weeks. No fresh complaints. All generals good.	Rx Placebo TID/ 2 weeks
17/12/2019	Patient feeling better. No fresh complaints. All generals good.	Rx Placebo TID/ 2 weeks
11/01/2020	Patient is better. All generals good. USG-abd revealed normal study.	–
25/02/2020	Patient is better. All generals good.	–

AFTER TREATMENT as on 11^th Jan 2020: USG abdomen and pelvis revealed no abnormalities in kidneys and bladder. [Figure 5]

FIGURE 5:

CONCLUSION: Cases of Urolithiasis even of sizes > 7 mm can be treated successfully with holistic homoeopathic intervention. 

CONSENT: Patient’s consent was taken for the images and clinical images to be reported for this article.

REFERENCES:

1. Colella J, Kochis E, Galli B, Munver R. Urolithiasis/nephrolithiasis: what’s it all about. Urol Nurs. 2005 Dec;25(6):427 Available from.https://www.suna.org/download/education/2007/article12427449.pdf

2. Awasthi M, Malhotra SR. Renal Calculi-Prevalence, Risk Factors and Dietary Management: A Review. Indian Journal of Nutrition and Dietetics. 2016 Apr;53(2):229.  Available from: https://scholar.googleusercontent.com/scholar?q=cache:0rI8ssYCmIJ:scholar.google.com/+Renal+calculiprevalence,Riskfactors+and+dietary+management+:+A+review&hl=en&as_sdt=0,5

3. Sumithran PP. A case of multiple urinary calculi. Indian Journal of Research.2016;10
4. Radar software: Frederik Schroyens Synthesis Repertory, Version 9.1

Dr. G. Swati
PG scholar, Department of Materia medica,
Government Homoepathic Medical College & Hospital, Bengaluru