Homoeopathy in chronic renal failure

Dr Prathibha K

ABSTRACT:
Chronic renal failure (CRF) is a progressive disease which is characterized by an increasing inability of the kidneys to maintain normal low levels of the products of protein metabolism (such as urea), normal blood pressure, haematocrit, sodium, water, potassium and acid-base balance.¹

INTRODUCTION:
Chronic renal failure is defined as either kidney damage or glomerular filtration rate less than 60 ml/min for three months or more. This is invariably a progressive process that results in end stage renal disease.²

K/DOQI CKD guidelines given by the American Kidney foundation define Chronic kidney disease as either kidney damage or GFR < 60 ml/min/1.3 m2  BSA for 3 months or more.³

PATHOGENESIS:
Renal disease is often attributed to classic antibody-mediated or cell-mediated immunologic renal injury. However, renal injury complicating such common disorders as diabetes and hypertension has no apparent immunologic basis. Therefore, the pathogenesis of injury in these conditions must occur by way of non-traditional (non immune) pathways, 16 Several non immune mechanisms of renal injury have recently been elucidated including alterations in circulating lipids, abnormal systemic and internal hemodynamics and disordered regulation of endogenous renal cell function⁴

This observation has advanced the hypothesis that nephron loss serves to promote further nephron loss, although the mechanisms responsible for this inexorable course remain incompletely understood. It is thought that adaptive changes occur in the remaining functional nephrons and promote progressive renal scarring. loss of renal function, and the relative reduction in total renal mass correlates with the rate of progressive renal injury.

STAGES OF KIDNEY DISEASE
Glomerular filtration rate (GFR) is accepted as the best index of overall kidney function in health and disease. Several stages of CKD, defined as structural abnormalities of the kidney that can lead to decreased GFR, are recognized.

KIDNEY DAMAGE

This stage is defined as the presence of structural or functional abnormalities of the kidney, initially without decreased GFR, which over time can lead to decreased GFR.

• Mild reduction in GFR (60 to 89 mL/min/1.73 m2)/Early CRF
• Moderate reduction in GFR (30 to 59 mL/min/1.73 m2 )/Moderate CRF
• Severe reduction in GFR (15 to 29mL/min/1.73 m2)/Pre-ESRD
• Kidney failure (GFR, < 15 ml/min/1.73 m2 )/ESRD ^2,3

CLINICAL MANIFESTATIONS

• Electrolytes:  Edema, hyponatremia, hyperkalemia, hyperphosphatemia, metabolic acidosis, hyperuricemia, hypocalcaemia.
• Gastrointestinal :  Anorexia, nausea, vomiting, malnutrition.
• Cardiovascular :  Accelerated atherosclerosis, systemic hypertension, pericarditis.
• Hematological :  Platelet dysfunction, anaemia, immune dysfunction.
• Musculoskeletal :  Renal osteodystrophy, muscle weakness, growth retardation in children, amyloid arthropathy caused by beta2- microglobulin deposition.
• Neurological :  Encephalopathy, seizures, peripheral neuropathy
• Endocrine :  Hyperlipidemia , glucose intolerance caused by insulin resistance ,amenorrhea and infertility in women, impotence.
• Skin :  Pruritus, dry skin.⁵

COMPLICATIONS
Uremic syndrome consists of an array of complex symptoms and signs that occur when advanced kidney failure prompts the malfunction of virtually every organ system. However, the onset of uremia is slow and insidious, beginning with rather nonspecific symptoms such as malaise, weakness, insomnia and a general feeling of being unwell. Patients may lose their appetite and complain of morning nausea and vomiting. Eventually, signs and symptoms of multisystem failure are evident

Gastrointestinal complications
Anorexia, nausea, and vomiting are common in advanced kidney failure⁴²

Neurological complications
The function of the central and peripheral nervous systems may be disturbed in chronic renal failure. Cerebrovascular accidents of all types are common in CKD. Encephalopathy is a feature of severe uremia and is characterized by a decline in higher mental functions, causing confusion, loss of memory, apathy, and irritability.⁶

Cardiovascular complications
Hypertension almost invariably develops in patients with CKD and is usually volume-dependent. Less often, high levels of renin and angiotensin are important contributory factors⁷

Hematologic complications
A normochromic and normocytic anaemia, defined as haemoglobin levels lower than physiologic norms, starts to develop in most patients when the GFR falls below 60 mL/min/1.73 m2 ⁸

DIAGNOSIS
Blood test – Blood test may be ordered to determine whether waste substances are being adequately filtered out. If levels of urea and creatinine are persistently high, the doctor will most likely diagnose end-stage kidney disease.

Urine test – Urine test helps find out whether there is either blood or protein in the urine.

Kidney scans – Kidney scans may include a magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, or an ultrasound scan. The aim is to determine whether there are any blockages in the urine flow. These scans can also reveal the size and shape of the kidneys – in advanced stages of kidney disease the kidneys are smaller and have an uneven shape.

Kidney biopsy – Small sample of kidney tissue is extracted and examined for cell damage. An analysis of kidney tissue makes it easier to make a precise diagnosis of kidney disease.

Chest X-ray –  Aim here is to check for pulmonary edema (fluid retained in the lungs).

Glomerular filtration rate (GFR) – GFR is a test that measures the glomerular filtration rate – it compares the levels of waste products in the patient’s blood and urine. GFR measures how many milliliters of waste the kidneys can filter per minute. The kidneys of healthy individuals can typically filter over 90 ml per minute.²

HOMEOPATHIC TREATMENT

Remedies for Chronic kidney disease : Am-c., apis., apoc., ars., asc-c., bapt., bell., canth., carb-ac., cic., cupr., cupr-ac., dig., gels., glon., hell., hydr-ac., hyos., kali-br., kali-s., morph., mosch., op., phos., pic-ac., piloc., plb., queb., ser-ang., stram., ter., urea.,urt-u., verat-v.

APIS MELLIFICA : Useful for chronic kidney disease with edematous swelling on the face, paleness, headaches, pain in the back and limb, edema. Useful when there are dull aches in the kidney, reduced urination and micturition. Given for urine contains albumen in high levels and blood corpuscles.

AMMONIUM CARB: Heaviness in all organs, swelling of glands, acid reactions; prostration; frequent desire to urinate with tenesmus; urine white, scanty, bloody copious turbid and fetid.

ARSENIC ALBUM : Useful in all stages of Chronic kidney disease. More useful in later stages of the disease when the patient’s skin becomes pale, and he develops a waxen appearance, excess thirst and diarrhoea. There is dark shade of the urine and full of albumen. Useful for dyspnoea attacks while lying down during the night.

AURUM MUR : Useful to cure renal diseases such as morbus brightii caused from a gout or from syphilis. Helpful in digestive and nervous problems with great irritability. Vertigo may also be caused.

BELLADONA : Useful homeopathic medicine for treating inflammation of the kidneys accompanied by piercing or burning pain in the lumbar region of the kidney. Given when pain reappears repeatedly with increased intensity each time.

CICUTA:  Frequent micturition; the urine is propelled with great force. Retention of urine. Convulsions with violent distortion of body.

CUPRUM MET: Suppression of urine. Passes clear watery urine during or after spasms. Urgent desire to urinate with scanty emission. Frequent emission of fetid, viscid urine, Burning shootings in the urethra, during and subsequent to the emission of urine. Wetting the bed at night.

CONAVALLARIA : Useful in cases of nephritis occurring due to heart disorders. Given in irregular heart functions and also in anasarca and ascites because of mitral insufficiency.

CANTHARIS : The whole urinary organs and genitalia are in a state of inflammation and irritation. Cantharis Homeopathic medicine for chronic renal failure. Discharge of bloody urine burns like fire. Intensity and rapidity are the features of this remedy. medicine for chronic renal failure having dull pressing or paroxysmal cutting and burning pains in both kidneys: very sensitive to slightest touch. Urging to urinate. Painful evacuation, by drops, of bloody urine, or pure blood. Intolerable urging, before, during and after urination.

CUPRUM ARS:  Kidney inefficiency and uremia. Garlic odor of urine. Urine of high specific gravity increased, Contains acetones and diacetic acid.

KALI CARB:  This homeopathic remedy used in the case of kidney stones, and is a general solution for problems in the kidneys.

PHOSPHORUS: Urine turbid, brown, with red sediment. Uremia with acute atrophy of brain.

PICRIC ACID: Complete anuria, nephritis with profound weakness.

PLATINA: Red urine with a white cloud, or else which becomes turbid, and deposits red sediment. Slow but frequent emission of urine.

SANICULA: Best homeopathy medicine and used when the bladder is swollen, there are kidney stones and kidney irritation.

TEREBINTHINUM :  “Congestive kidneys, with dull aching, and smoky-looking urine.” Violent burning and drawing pains in kidneys, bladder and urethra. Pressure in kidneys when sitting; relieved by motion. Stiff all over; heaviness and pains in region of kidneys. Renal disease producing dropsy. Rapid attack with lumbar pain. Urine greatly diminished: loaded with albumen: contains casts and blood. Urine smoky: with “coffee grounds” or thick, slimy, sediment. “Haemorrhages from all outlets, especially in connection with urinary or kidney troubles.” Kidneys inflamed: feet swollen. ^9,10

SOME IMPORTANT RUBRICS

KENT : KIDNEYS (p. 662-667)

• Kidneys (p. 662)
• Kidneys, inflammation, acute parenchymatous (See Albumen) (p. 663)
• Kidneys, pain, walking, while (p. 664)
• Kidneys, pain, contracting (p. 665)
• Kidneys, pain, stitching, morning (p. 666)
• Kidneys, suppuration (See Inflammation) (p. 667)

KENT : URINARY ORGANS (p. 645-680)

• Urinary organs (p. 645)
• Bladder (p. 645)
• Bladder, fullness, sensation of, without desire to urinate (p. 646)
• Bladder, pain, sitting, while (p. 647)
• Bladder, pain, burning, neck (p. 648)
• Bladder, pain, pressing, lying, while (p. 649)
• Bladder, pain, stitching, stinging, extending from kidney to bladder (See Kidneys) (p. 650)
• Bladder, retention, children, in, every, time child catches cold (p. 651)
• Bladder, tenesmus, night (p. 652)
• Bladder, urging, night, 4 a.m. (p. 653)
• Bladder, urging, frequent, cutting pain from umbilical to ovarian region (p. 654)
• Bladder, urging, painful, child jumps up and down with pain, if cannot be gratified (p. 655)
• Bladder, urination, dribbling, morning (p. 656)
• Bladder, urination, dysuria, pain in the sphincter vesicæ, with hyperæsthesia… (p. 657)
• Bladder, urination, frequent, morning, rising, after (p. 658)
• Bladder, urination, interrupted, violent contraction in region of bladder, by (p. 659)
• Bladder, urination, involuntary, flatus, expelling, when (p. 660)
• Bladder, urination, retarded, listening to music, can pass urine only when (p. 661)
• Bladder, urination, unsatisfactory, bladder were not emptied, as if, with dribbling (p. 662)
• Kidneys (p. 662)
• Kidneys, inflammation, acute parenchymatous (See Albumen) (p. 663)
• Kidneys, pain, walking, while (p. 664)
• Kidneys, pain, contracting (p. 665)
• Kidneys, pain, stitching, morning (p. 666)
• Kidneys, suppuration (See Inflammation) (p. 667)
• Prostate gland (p. 667)
• Prostate gland, inflammation (p. 668)
• Urethra (p. 669)
• Urethra, discharge, gleety, morning (p. 670)
• Urethra, discharge, purulent, drop of pus before urinating (p. 671)
• Urethra, hæmorrhage, coition, during (p. 672)
• Urethra, itching, meatus, voluptuous (p. 673)
• Urethra, pain, biting, urination, after, as if a drop were forcing its way out (p. 674)
• Urethra, pain, burning, urination, beginning to urinate, when (p. 675)
• Urethra, pain, burning, meatus, urination, after (p. 676)
• Urethra, pain, drawing (p. 677)
• Urethra, pain, stitching, drawing, when not urinating (p. 678)
• Urethra, pain, tearing (p. 679)
• Urethra, swelling, region of neck of bladder (p. 680)¹¹

 

REFERENCES:

11. Like RG. Chronic renal failure. Goldman : Cecil Textbook of Medicine, 21st ed. Philadelphia : W.B. Saunders Company, 1998 ; 571-578
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17. Buckalew Vm Jr, Berg RL, Wang S-R, et al. Prevalence of hypertension in 1,795 subjects with chronic renal disease : the modification of diet in renal disease 71 study baseline cohort. Modification of diet in Renal Disease Study Group. Am J Kidney Dis 1996 ; 28(6) : 811-2.
18. Bright R : Cases and observations illustrative of renal disease accompanied with the secretion of albuminouas urine. Guys Hosp Rep 1 : 338-400, 1836 (abstract).
19. Allen.H.C, Allen’s keynotes rearranged and classified with leading remedies of the materia medica and bowel nosodes, 10 th edition,Newdelhi, B.Jain publishers.
20. Boericke William , Pocket manual of homoeopathic materiamedica and repertory comprising the characteristics and guiding symptoms of all remedies (clinical and pathogenetic) including Indian drugs, 9 th edition, Newdelhi,  B.Jain publishers.
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Dr. Prathibha K
PG Scholar, Department of Practice of Medicine
Government Homoeopathic Medical College & Hospital, Bangalore. Dr. Siddhaiah Puranik Road, Basaveshwar Nagar, Bengaluru, 560079

Under the Guidance of Dr. Veerabhadrappa.C Associate Professor and PG guide Department of Practice of Medicine.