Chronic Kidney Disease – The Disease Spectrum & Homoeopathic Approach

Abstract

Chronic kidney disease has become one of the most common multisystemic disease of  this decades. Renal tissue destruction leads to decreased kidney function which ultimately tends to cause  cardiological, gastroenterological, haematological, neurological etc systemic symptoms. Homoeopathy  through its holistic mode of treatment can treat the cases with a rapid , gentle way. 

Introduction 

Chronic kidney disease (CKD) encompasses a spectrum of pathophysiologic processes  associated with abnormal kidney function and a progressive decline in glomerular filtration  rate (GFR). [1] Among the non-communicable diseases, chronic kidney disease (CKD) now  affects more than 500 million people worldwide, with 80% of those affected living in low to  middle income countries. In India, the prevalence of CKD has increased substantially in the  past two decades with significant cause of mortality and morbidity despite several medical  advancements. [2] 

CKD usually leads to a progressive decline in kidney function even if the inciting cause  can be identified and treated or removed. Destruction of nephrons leads to compensatory  hypertrophy and supranormal GFR of the remaining nephrons in order to maintain overall  homeostasis. As a result, the serum creatinine may remain relatively normal even in the face  of significant loss of renal mass and is, therefore, an insensitive marker for early renal damage  and scarring.[3] 

CAUSES OF CHRONIC KIDNEY DISEASE:- [3] 

• Glomerular Diseases 

1. Primary glomerular diseases 

Focal segmental glomerulosclerosis 

Membranoproliferative glomerulonephritis 

IgA nephropathy 

Membranous nephropathy 

Alport syndrome (hereditary nephritis) 

1. Secondary glomerular diseases 

Diabetic nephropathy 

Renal amyloidosis 

Postinfectious glomerulonephritis 

HIV-associated nephropathy 

Collagen-vascular diseases (eg, SLE) 

HCV-associated membranoproliferative glomerulonephritis

• Tubulointerstitial Nephritis 

Drug hypersensitivity 

Heavy metals 

Analgesic nephropathy 

Reflux/chronic pyelonephritis 

Sickle cell nephropathy 

Idiopathic 

• Cystic Diseases 

Polycystic kidney disease 

Medullary cystic disease 

• Obstructive Nephropathies 

Prostatic disease 

Nephrolithiasis 

Retroperitoneal fibrosis/ tumor 

Congenital/reflux 

• Vascular Diseases 

Hypertensive nephrosclerosis 

Renal artery stenosis 

Pathophysiology

CKD is a stage of diminished renal reserve or renal insufficiency, where decreased renal  function interferes with the natural renal ability to maintain fluid and electrolyte balance.  The main causes of renal injury are based on immunologic reactions (initiated by immune  complexes or immune cells), tissue hypoxia and ischaemia, exogenic agents like drugs,  endogenous substances like glucose or paraproteins and others, and genetic defects.[4] On the  course of pathological changes kidneys’ natural ability to concentrate urine declines early and  as a result ability to excrete excess phosphate, acid, and potassium also decrease. In advanced  condition ( GFR ≤ 15 mL/min/1.73 m2), the ability to effectively dilute or concentrate urine is  lost. In this condition urine osmolality is usually fixed at about 300 to 320 mOsm/kg, close to  that of plasma (275 to 295 mOsm/kg), and urinary volume does not respond readily in  accordance to variations in water intake. [5] 

STAGES OF CKD[3]

STAGES	DESCRIPTION	GFR (mL/min/1.73 m3 )
Stage 1	Kidney damage with normal or increased GFR	≥ 90
Stage 2	Kidney damage with mildly decreased GFR	60-89
Stage 3a	Mildly-moderate decreased GFR	45-59
Stage 3b	Moderate-severely decreased GFR	30-44
Stage 4	Severely decreased GFR	15-29
Stage 5	End-stage renal disease	<15

 

Clinical Features[6] 

Stage 1-4 CKD usually does not show much symptoms . Few systemic symptoms  can be seen among which Hypertension is the most common physical finding.  In case of advance stage when GFR is less than 5-10 mL/min/1.73 m3 , multi-systemic symptoms are observed. 

• Symptoms of Uremia: Fatigue, anorexia, metallic taste in mouth. 
• Neurological symptoms: Irritability, impaired memory, restless legs. • Gastrointestinal symptoms: Anorexia, nausea, vomiting, diarrhoea. 
• Skin manifestations: Dry skin, pruritus.
• Fatigue, increased somnolence.
• Malnutrition.
• Erectile dysfunction, decreased libido.

Laboratory Diagnosis

CKD is usually defined by abnormal GFR persisting for at least 3 months [3] . Recommended laboratory tests are- 

• Blood test for eGFR. 
• Urine test for Albumin. 
• Urine albumin to creatinine ratio. 
• Imaging: Ultrasonography of kidney to exclude any morphological change. • Biopsy. 

Complications 

1. Cardiovascular complication.
2. Hypertension.
3. Coronary artery disease
4. Heart failure.
5. Atrial fibrillation.
6. Disorders of Mineral metabolism.
7. Hematological complications:
8. Anaemia.
9. Coagulopathy.
10. Neurological complications.
11. Uremic encephalopathy.
12. Erectile dysfunction.
13. Restless leg syndrome.
14. Endocrine disorders.

Management

Dietary management. 

1. Protein restriction.
2. Salt & water restriction.
3. Potassium restriction.

Slowing Progression of the disease. [3] 

1. Treatment for Hypertension and Hyperglycaemia.
2. Obese patients should be encouraged to lose weight.
3. Management of traditional cardio vascular risk.
4. Proper follow up.

Medication as per the symptoms of the patient. ( Drugs with potential nephrotoxicity  e.g. NSAIDs should be avoided.) 

Treatment for End Stage Renal Disease: 

1. Dialysis. ( when GFR is near10mL/min/1.73m3)

– Hemodialysis or Perinoteal Dialysis as per requirement. 

2. Kidney transplantation.
3. Medicinal Management ( for very elderly persons).

Homoeopathic Approach 

CKD affecting the multiple systems of the body affects in general well-being, physical,  psychological, sexual and cognitive functioning of the suffering person. Homoeopathy being  the medical science of Holistic concept plays its marvellous therapeutic effect in this case.  Homoeopathy treats the patients as a whole and cures the disease in the shortest, most reliable  and most harmless way. But the treatment should always be done after considering the stage  of CKD along with its auxiliary managements. 

Therapeutic Approach: [7,8,9,10] 

1. Apis Mellifica: Urine scanty or suppressed. Urine high colored. Micturition frequent. Burning and soreness when urinating. Weakness. Dropsical swellings.
2. Arsenic Album : Useful in all stages of Chronic kidney disease. Pale skin, excess thirst and diarrhoea. There is dark shade of the urine, albuminous urine. Useful for dyspnoea attacks while lying down during the night. 
3. Belladonna: Useful in sudden piercing pain in the region of kidney. Pain comes  suddenly and goes suddenly. Fever with burning pain in lumber region. 4. Cantharis : Retention of urine, with cramp-like pains in the bladder. Urgent and ineffectual efforts to make water, with painful emission, drop by drop. Urine, pale yellow, or of a deep red color. Emission of blood, drop by drop. Purulent urine. Burning  smarting, on making water. Burning, stinging and tearing in the kidneys. Pressing pain  in the kidneys, extending to the bladder, along the ureters, relieved by pressing upon  the glans. Exceedingly painful sensibility of the region of the bladder on its being touched. 
4. Kali -carb: A great polychrest in case of CKD. Frequent micturition at night, but urine  flows only after long pressure. Urine foamy; with thick red sediment. Stitching pain in kidneys, going from buttocks to thighs. Abdomen distended with generalised weakness and anxiety. 
5. Lycopodium : Another polychrest medicine for CKD. Pain in back before urinating; ceases after flow; slow in coming, must strain. Retention. Polyuria during the night.

Heavy red sediment. Abdomen bloated with dyspepsia. Patient is sensitive in nature,  apprehensive. Malnutrition and general weakness. 

7. Nitric acid : scanty, dark, offensive. Smells like horse’s urine. Cold on passing. Burning  and stinging. Urine bloody and albuminous. Alternation of cloudy, phosphatic urine  with profuse urinary secretion in old prostatic cases. Bowel constipated. Patient is very  much irritable with putrid breath. 
8. Phosphorus: It is one of the most important remedies in Bright’s disease; the  characteristic symptoms are: lassitude of the whole body, hands and feet icy cold,  sleepiness. The patient is indisposed to work, forgetful and has a heavy headache; there  is oedema of the upper eyelids, a sickly oedema of the face, want of appetite, pressure  and burning in the stomach. Sensitiveness over the region of the right kidney, with suppression of urine. Dull heavy pain in the region of the kidneys. Bladder. Discharge of pure blood from the bladder. Tenesmus of the bladder 
9. Sarsaparilla : A great remedy for urinary system. Urine scanty, slimy, flaky, sandy, bloody. Gravel. Renal colic. Severe pain at conclusion of urination. Urine dribbles while sitting. Bladder distended and tender. Renal colic and dysuria in infants. Pain  from right kidney downward. Tenesmus of bladder; urine passes in thin, feeble stream.  Pain at meatus. 
10. Terebinth : Inflammation of kidney. Bright’s disease preceded by dropsy. Strangury, with bloody urine. Scanty, suppressed, odor of violets. Urethritis, with painful excretions. Inflamed kidneys following any acute disease. Constant tenesmus. 

Repertorial approach[11] 

KENT : KIDNEYS 

Kidneys  

Kidneys, inflammation, acute parenchymatous (See Albumen)  

Kidneys, pain, walking, while  

Kidneys, pain, contracting  

Kidneys, pain, stitching, morning  

Kidneys, suppuration (See Inflammation)  

CONCLUSION 

Chronic kidney disease has become one of the emerging diseases of these decades.  Homoeopathic medication can manage the cases with proper dietary management. Even in case of End stage renal disease of very old persons where surgical intervention cannot be done,  Homoeopathic medicine can be a safer choice of treatment along with proper care and  observation.

REFERENCES

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