Nephrolithiasis and Its Homoeopathic Management

Abstract

Renal calculi, also known as nephrolithiasis, are a surgical condition that can be managed using homoeopathic remedies. In situations of nephrolithiasis, it is essential to identify the aetiology as this aids in the treatment and prevention of the condition. Nephrolithiasis cases can therefore be efficiently addressed by combining knowledge of the illness with knowledge of homoeopathic remedies.

Keywords: Nephrolithiasis, renal calculi, homoeopathy.

Introduction

What is nephrolithiasis?

Nephrolithiasis, which precisely relates to renal calculi, is characterised by flank discomfort radiating to the groyne, gross or microscopic hematuria, nausea, and vomiting.

Aetiology and Pathogenesis ^[1]

1. Dietary: Stone can accumulate in a nidus created by the desquamation of the epithelium brought on by a vitamin A deficiency.
2. Altered urinary solutes and colloids: Solutes concentrate until they precipitate which occurs due to dehydration and decrease in urinary colloids.
3. Decreased urinary citrate: Insoluble calcium phosphate is converted into soluble form due to presence of citrate in urine and as the urinary citrate decreases causing increased insoluble calcium phosphate leading to precipation and stone formation.
4. Renal Infection: Urinary tract infection, particularly with urea-splitting streptococci, staphylococci, and Proteus, encourages the development of urinary calculi.
5. Inadequate urinary drainage and urinary stasis: Stones are easy to form when  urine is static.
6. Prolonged immobilisation: The effects of immobility include skeletal decalcification, increased urine calcium, and the development of calcium phosphate calculi.
7. Hyperparathyroidism: Hyperparathyroidism, which produces hypercalcemia and hypercalciuria, results in 5% of cases and is the cause of recurrent or frequent stones.

Clinical features ^{[1, 2]}

1. Silent calculus: Most of the patients present with no complaints and nephrolithiasis is found as a coinciental finding.
2. Pain: Pain is the most common complaint of nephrolithiasis. Fixed renal pain occurs in the renal angle, the hypochondrium, or in both which may be worse on movement.
3. Gross hematuria: Gross hematuria with pain in renal angle is characterstically indicative of nephrolithiasis.
4. Nausea and Vomiting: It occurs in case of irritation of nerves due to renal stone.

Investigations ^[2]

1. X-ray (KUB): The ‘KUB’ film shows the kidney, ureters and bladder. An opacity maintaining its position relative to the urinary tract during respiration is likely to be a calculus.
2. USG (KUB): USG offers the advantage of avoiding radiation and provides information on hydronephrosis, but it is not as sensitive as CT.
3. CT (KUB): Highly sensitive, and also allows visualization of uric acid stones (traditionally considered “radiolucent”).
4. Excretion urography: Also called IVU (Intravenous urogram) which will help in establishishing the presence and position of a calculus and the function of the other kidney.
5. Urine R/E (Routine/Examination): Here, pH is important to check as uric acid stones are formed in low urine pH.
6. Urine C/S (Culture/Sensitivity): To identify the bacteria in case of infection.
7. 24 hours Urine sampling for: Calcium, Urate, oxalate, phosphate and Cystine if suspected.
8. Serum creatinine, blood urea and uric acid: To evaluate the function of kidneys.
9. PTH (Parathormone) level: To exclude the diagnosis of hyperparathyroidism.
10. Routine Blood test and ESR: To evaluate the level of Hb and TLC, DLC, ESR in case of infection
11. Stone Analysis: Stone analysis is to be done to find out the type of stone so that the patient should be advised accordingly to prevent recurrence.

Homoepathic medicines useful in the management of nephrolithiasis ^{[3, 4, 5, 6, 7]}

1. Lycopodium clavatum: Renal colic, severe backache relieved by passing urine. Frequent urging to urinate. Rumbling and bloated feeling in abdomen. Pain extends down the right ureter to the bladder. Haematuria. Urine scanty, high colored. Deposits a red or yellowish red sandy sediment.
2. Berberis vulgaris: Burning, Cutting, Tearing Pains. Bubbling sensation Bilateral Renal calculi with radiating pain. Urine hot, dark yellow with thick mucus & bright red mealy sediment.
3. Hydrangea arborescens: A remedy for gravel, profuse deposit of white amorphous salts in urine. Calculus, renal colic, bloody urine. Pain in the lumbar region. Burning in urethra and frequent desire. Urine is hard to start. Sharp pain in loins, especially left. Gravelly deposits.
4. Cantharis vesicatoria: Renal region sore and sensitive to touch. Dull pressing pains in kidneys. Frequent urging to urinate; urine passes in drops. Burning and cutting pains before, during and after micturation. Urine scanty, dark-colored. Children pull constantly at penis from irritation of gravel extending down to that organ.
5. Pareira brava: Useful in renal colic. Pain going down thigh. Micturation difficult, with much pressing and straining only in drops with sensation as if bladder were full. Paroxysms of violent pains with strangury, can only emit urine when on his knees pressing head firmly against the floor for 10 to 20 minutes, sweat breaks out finally and urine drops out in interruptions.
6. Sarsaparilla officinalis: Painful retention of urine. urine dribbles away when sitting, and standing passes urine freely. passes gravel or small calculi, blood with the last of urine. the child screams before and while passing it. severe pain at the conclusion of urinaton; has to get up several times at night to urinate.
7. Calcarea carbonica: Cutting stitches in urethra with ineffectual desire to urinate after urinating, renewed desire with burning. Urine after standing looks turbid like lime-water. Copious white mealy sediment in urine.
8. Nitricum acidum: Urinary calculi consisting of oxalates. Scanty, dark brown, smelling strong like horse urine. Urine cold when it passes. Haematuria, blood flows actively.
9. Nux vomica: Renal colic, especially in right kidney extending to genitals and right leg < lying on right side,

>lying on my back. Spasmodic strangury. Paralysis vesicae, urine dribbles.

10. Tabacum: Renal colic; violent pain along ureter, left side. The nausea, giddiness, death-like pallor, vomiting, icy coldness, and sweat, with the intermittent pulse, are all most characteristic.
11. Sepia: Increased specific gravity of urine, depositing uric acid and urates. frequent nocturnal micturation. urine offensive, with white or dark brown sediment. weakness and aching in thighs and legs.

References

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2. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison’s principles of internal medicine (19th edition.). New York: McGraw Hill Education 2015.
3. Boericke W. Pocket Manual of Homoeopathic Materia Medica and Repertory. 9^th Edition. New Delhi: B. Jain Publishers (P) Ltd, 2009.
4. Phatak Dr SR Materia Medica of Homoeopathic Medicines. 2nd edition revised and Enlarged. NewDelhi:B Jain Publishers (P) Ltd, 2005.
5. Nash EB. Leaders in Homoeopathic Therapeutics with Grouping and Classification. Low price edition. New Delhi: B. Jain Publishers 2014.
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About the Author:

Dr. Pramod Kumar Singh,¹ Dr. Ankita Srivastava,² Dr. Somendra Yadav,³ Dr. Rishabh Dixit,³ Dr. Sakshi Sharma⁴

1. Professor, Department of Homoeopathic Pharmacy, Dr. M.P.K. Homoeopathic Medical College, Hospital and Research Centre, Jaipur, Rajasthan, India
2. MD Scholar, Department of Materia Medica, Dr. M.P.K. Homoeopathic Medical College, Hospital & Research Centre, Jaipur, Rajasthan, India
3. MD Scholar, Department of Homoeopathic Pharmacy Dr. M.P.K. Homoeopathic Medical College, Hospital & Research Centre, Jaipur, Rajasthan, India
4. MD Scholar, Department of Practice of Medicine Dr. M.P.K. Homoeopathic Medical College, Hospital & Research Centre, Jaipur, Rajasthan, India