Homoeopathic Approach to Kidney Stone

Abstract

Renal calculi, commonly known as kidney stones, are a significant source of pain and morbidity. Homeopathy offers an alternative approach to managing these stones, focusing on individualized treatment and natural remedies. Key homeopathic medicines like Berberis vulgaris, Lycopodium, and Sarsaparilla are frequently used to alleviate symptoms, promote stone expulsion, and prevent recurrence. Although anecdotal evidence and case studies suggest potential benefits, including pain relief and reduced stone formation, rigorous scientific validation is still needed. This abstract highlights the potential of homeopathy as a complementary therapy in the holistic management of renal calculi.

Keywords

Renal calculi, urolithiasis, nephrolithiasis, flank pain.

Introduction:

Nephrolithiasis or urolithiasis is formation of urinary calculi at any level of the urinary tract. The term renal calculus is from the Latin ‘renes’, meaning “kidneys”, and ‘calculus’, meaning “pebble”. A distinction between nephrolithiasis and urolithiasis has to be made because not all urinary stones (uroliths) are formed in the kidney; they can also be formed in the bladder. But the distinction is often clinically irrelevant (with similar disease process and treatment either way) and the words are thus often used loosely as synonyms.(1)

History

Urinary calculus disease is one of the oldest known to man. Egyptian mummies from 3500 BC have been found to have renal and bladder calculi. Practical and ingenious methods of stone management have evolved over the millennia. Anticipating modern lithotripsy, the Egyptians used gum to attach a diamond to the tip of a hollow reed, inserted it into the bladder through the urethra, and the patient then walked, allowing the diamond to fragment the more fragile bladder stone. In ancient Greece, the seriousness and ubiquity of stone disease stimulated the development of a specialty of practitioners, non-physicians, who treated the problem, leading Hippocrates to include in his oath the promise of physicians not to ‘cut for stone but to leave that to the practitioners of the art’. The Arab physicians, renowned pharmacologists during the European Dark Ages, were reported to have developed solvents to dissolve calculi; unfortunately, their formulas have been lost to history. During the Middle Ages, itinerant barber–surgeons, many of whom were clergymen, developed a technique for the perineal removal of bladder stones that relieved many sufferers and killed many others. The technique required the patient to be held by strong men in the exaggerated lithotomy position. A perineal incision was made and, in under 1 min, a long knife was used to incise the plane between the rectum and prostate, creating a perineal vesicostomy. Using abdominal pressure, the bladder stone was pushed towards the perineum and grasped by two fingers inserted in the perineum. The most famous of these stone surgeons was Frère Jacques of nursery-rhyme fame. Over the centuries, more sophisticated methods of stone crushing were developed. With the advent of anaesthesia in 1846, surgical removal of calculi evolved as the most common treatment for stones that could not be passed spontaneously. Surgical treatment of upper urinary calculi and stone-crushing forceps placed in the bladder through the urethra remained the technique of choice until the last decade, when less invasive methods of stone management were developed.(2)

Incidence

Stone disease is more common in northern India due to various etiopathological factors prevailing there. The trends are changing in southern India. This may be due to changes in socioeconomic or dietary pattern of the population consequent to the emigration to the gulf countries. Urinary stone is commonly seen in the age group of 20 to 50 years. 90% of the stone patients are males in India. After 50 years it is equitant in both age group because of androgen more menopausal women. This is more common among sedentary lifestyles. Higher incidences of stone disease are noted in summer months.

There is a recurrence rate of approximately 7 to 8 per cent a year; within 5 years, the first-time stone former has a 40 percent chance of developing another. Although the disease is more common in family members, with the exception of cystine stones (autosomal recessive) there is no genetic pattern in the usual forms of calculus disease^.

Etiopathogenesis :

Basics of Stone Formation:  Normal urine contains both solvents and solutes; imbalance of their relative concentrations results in and precipitation of solutes, leading to pathological crystallisation which occurs in three stages

Stages of stone formation:

• Stage I -‘Under saturation’ – when crystals remain dissolved

• Stage II- ‘Saturation’ in which urine is saturated with crystals

• Stage III- ‘Super saturation’ when urine becomes oversaturated with crystals. 

‘Nucleation’ is an important initial step, followed by crystal aggregation and stone formation; anchoring of crystals on tubular epithelium may occur, e.g. calcium oxalate anchoring on calcium phosphate (Randall’s plaque).

Role of Stone Promoters and Inhibitors: Calcium, oxalates, phosphates, uric acid are stone promoters; their supersaturation is prevented by inhibitors like citrate, magnesium and pyrophosphate; citrate forms a soluble complex with calcium; magnesium and pyrophosphate inhibit calcium crystallisation. 

Risk Factors for Nephrolithiasis 

Diet	Calcium deficient diet leads to up-regulation of oxalate absorption High animal protein intake lowers urine pH favouring crystallisationHigh salt intake increases urinary calcium excretionOxalate rich foods (vide infra) and vitamin C intake may increase stone formation since vitamin C gets metabolised to oxalateLow potassium diet reduces citrate excretion.
Fluids	Urine output < 1L per day, due to less fluid intake, trace elements like fluorides in water, increase stone tendency by 5-fold.
Genetic factors	One in four persons with renal stone has a family history of nephrolithiasis; cystinuria and familial renal tubular acidosis .
Systemic diseases	20% primary hyperparathyroidism 60% of goutCrohn’s disease, diabetes mellitus, hypertension.
Infection	Urinary infection, caused by urease producing organisms (Proteus, Klebsiella, Pseudomonas, Ureaplasma) increases the risk of struvite stones.Matrix stones seen in proteus infections are composed of coagulated mucoids.
Miscellaneous	pH of urine – uric acid and cystine stones are pH dependent,Anatomical abnormalities pelviureteric junction (PUJ) obstruction, horse shoe kidney, calyceal diverticulum, ureterocoele vesico-ureteral reflux,

Types of  Renal Stones

Salient Features of Urinary Calculi^(4),(5)

SL NO	Type	Incidence	Etiology	Pathogenesis
1	Calcium stones	75%	Hypercalciuria with or without hypercalcaemia Idiopathic	Supersaturation of ions in urine, alkaline; pH of urine; low urinary volume, oxaluria and hyperuricosuria
2	Mixed (struvite) – stones	15%	Urinary infection with urea . splitting organisms like Proteus	Alkaline urinary pH produced by ammonia from splitting of urea by bacterially produced urease
3	Uric acid	6%	Hyperuricosuria with or without hyperuricemia a high intake of purine foods (fish, legumes, meat).	Acidic urine (pH below 6) decreases the solubility of uric acid in urine and favours its precipitation
4	Cystine stones	2%	Genetically-determined defect in cysteine transport	Cystinuria containing least soluble cystine precipitates as cystine crystals
5	Other types	< 2%	Inherited abnormalities of amino acid metabolism	Xanthinuria

Symptoms of Renal Calculi:

Renal calculi, also known as kidney stones, can cause a variety of symptoms depending on their size, location, and whether they are causing an obstruction. Common symptoms include:

1. Severe Pain:
   • Flank Pain: Sharp pain in the back or side, typically just below the ribs.
   • Radiating Pain: Pain may spread to the lower abdomen, groin, and genital areas.
   • Colicky Pain: Comes in waves, fluctuating in intensity.
2. Hematuria:
   • Presence of blood in the urine, which may be visible (gross hematuria) or detectable only under a microscope (microscopic hematuria).
3. Nausea and Vomiting:
   • Often due to severe pain or the body’s response to the kidney stone.
4. Urinary Symptoms:
   • Frequent urination.
   • Urgency to urinate.
   • Pain or burning sensation during urination (dysuria).
   • Cloudy or foul-smelling urine.
5. Fever and Chills:
   • Indicates an infection, which can occur if a stone blocks the flow of urine and causes a urinary tract infection (UTI).
6. Inability to Urinate:
   • If a stone is blocking the ureter, it can prevent the passage of urine, leading to discomfort and an urgent need to urinate but inability to do so.
7. General Malaise:
   • Feeling unwell or fatigued.

Homoeopathic Review:

As our master Hahnemann said in § 94, the individual’s mode of living, diet, occupation, domestic situations and so forth are considered as the maintaining causes of chronic diseases. In order that by their removal the recovery may be promoted. In many cases, making a few lifestyle changes can prevent kidney stones.

As Dr. Stuart Close has said, homoeopathy is an art and science; a successful homoeopath must be both artist and scientist. In cases of renal or hepatic colic, for example: If the physician is firm and calm as well as skillful, and possesses the entire confidence of the patient and his family and friends, he may be able to alleviate the agonizing pain and carry such cases through to a happy termination by the use of Homoeopathic remedies alone. It has often been done and, when possible, is the ideal way.⁷

According to Dr. Kent’s lesser-writings, the remedy that suits the constitution has a tendency to prevent the manufacture of more stones and relieves the spasm that occasions the pain. After the remedy there may be an outpouring of the kidney stones. In his one of the cases a teaspoonful of stones was discharged in one or two days. The fibers were relaxed and the kidney was emptied of stones. Thus, the remedy does when aimed at the patients. The constitutional remedy is the best thing for the patient.

General Management

1. Drink plenty of fluid: 2-3 quarts/day
   • This includes any type of fluid such as water, coffee and lemonade which have been shown to have a beneficial effect with the exception of grapefruit juice and soda.
   • This will help produce less concentrated urine and ensure a good urine volume of at least 2.5L/day
2. Limit foods with high oxalate content
   • Spinach, many berries, chocolate, wheat bran, nuts, beets, tea and rhubarb should be eliminated from your diet intake
3. Eat enough dietary calcium
   • Three servings of dairy per day will help lower the risk of calcium stone formation. Eat with meals.
4. Avoid extra calcium supplements
   • Calcium supplements should be individualized by your physician and registered kidney dietitian
5. Eat a moderate amount of protein
   • High protein intakes will cause the kidneys to excrete more calcium therefore this may cause more stones to form in the kidney
6. Avoid high salt intake
   • High sodium intake increases calcium in the urine which increases the chances of developing stones
   • Low salt diet is also important to control blood pressure.
7. Avoid high doses of vitamin C supplements
   • It is recommend to take 60mg/day of vitamin C based on the US Dietary Reference Intake
   • Excess amounts of 1000 mg/day or more may produce more oxalate in the body

Homoeopathic Management

RIGHT SIDE	LEFT SIDE
SARSAPARILLA	BERBERIS
LYCOPODIUM	CANTHARIDES
DIOSCOREA	TABACUM

Berberis Vulgaris

Renal colic < left side. Stitching, cutting pain from left kidney following course of ureter into bladder & urethra. Burning & soreness in region of kidneys. Bubbling sensation in region of kidneys.─Lancinating or tearing pulsative pain in the region of the kidneys; worse when stooping and rising again, sitting or lying; better when standing.─Violent sticking pains in the bladder, extending from the kidneys into the urethra, with urging to urinate.─Frequently recurring, crampy, contractive pain, or aching pain, in the bladder, when the bladder is full or empty.─Urine thick, yellowish, like whey, or clay-coloured water.─Urine of a deep yellow, with abundant sediment.─Urine dark yellow, red, becoming turbid, copious; mucous sediment, or transparent, jelly-like reddish, bran-like sediment (which is easily crushed and dissolved between the fingers).─Greenish urine, depositing mucus.─Urine reddish, as if inflamed, with abundant sediment.─Urine reddish, sanguineous, with slimy, mealy, and abundant sediment, of a bright red colour.

Cantharides
Constant urging to urinate, passing but a few drops at a time, which is mixed with blood. Intolerable urging before, during & after urination. Violent paroxysms of cutting & burning in the whole renal region. Violent tenesmus & strangury. Urine scalds him & is passed drop by drop. Membranous scales looking like bran in water. Urine jelly-like, shreddy. Pain raw, sore, burning in every part, internally & externally. Over sensitiveness of all parts. Drinking even small quantities of water increases pain in the bladder. ─Inflammation and ulceration of the kidneys, of the bladder, and of the urethra.─Exceedingly painful sensibility of the region of the bladder on its being touched.

Lycopodium
Renal colic, right sided. Pain shooting across the lower abdomen from right to left. Pain in back is relieved by urinating. Urine slow in coming, must strain. Polyuria during night. Red sand in urine. Uric acid diathesis. ─A very severe pain is felt in the back every time before urinating; causing patient to cry out; retention of urine; patients will get into position to urinate, but wait a great while before the water comes, accompanied by the characteristic pain in the back, which ceases when the urine flows; children often cry out with pain before urinating.─Turbid, milky urine, with an offensive purulent sediment; dull pressure in region of bladder and abdomen; disposition to calculi; cystitis.─Hæmaturia from gravel or chronic catarrh.─Renal stone.

Sarsaparilla
Passage of small calculi or gravel, renal colic, stone in the bladder. Excruciating pains from right kidney downwards. Severe almost unbearable pain at the conclusion of urination. Urine bloody, scanty, slimy, flaky, sandy, copious, passed without sensation, deposits white sand. Frequent and profuse emission of pale urine, day and night, often without any sensation in urinary organs.─Turbid urine, like clay water.─Fiery, scanty, red urine.─Thread-like flakes in urine.─Blood in urine towards the end of an emission (after which the pain, when urinating, abates).─Urine charged with gravel or small pebbles.─(Nephritic calculi.).─Where the patient has gravel, and there is considerable deposit in the urine which looks like grey sand; also pus in urine.─Great pain just as the urine ceases to flow; excessive pain in urethra which may run back into abdomen.─The infant cries before and during micturition, passes large quantities of sand.─Can pass urine only when standing; when he sits it dribbles.─ 

Tabacum
Renal colic, violent spasmodic pains along the ureter, left side. With deathly nausea & vomiting. Vomiting violent, with cold sweat, at least motion, with faintness > open air. Nausea incessant as if seasick > in fresh cold air. Vertigo, death like pallor, on opening the eyes. Face pale, blue, pinched, sunken, collapsed. Terrible, faint, sinking feeling at the pit of stomach. Icy coldness of surfaces. ─Paralysis of sphincter, constant dribbling.─Enuresis.─Urine yellowish-red, with increased secretion.─Inflammation of the orifice of the urethra.

Colocynth
Pains on urinating over the whole abdomen. Vesical catarrh, discharge like fresh white of egg. Red hard crystals. Renal colic < left side. Agonising pain in abdomen causing patient to bend double, with restlessness, twisting & turning to obtain relief. > hard pressure. Pains < eating & drinking > warm application. Shooting pains like electric shocks. Complaints from anger, indignation, mortification.

Dioscorea
Renal colic with pains radiating to the extremities. Colic pains < bending forward & while lying. > on standing erect or bending backwards. Violent twisting colic, occurring in regular paroxysms as if abdomen were grasped & twisted by a powerful hand. Pain suddenly shift to different parts, appear in remote localities as fingers & toes. Writhing, with dry and crampy pains, with passing of renal calculus (R).─Spasmodic stricture of urethra, with pain about navel > by pressure; pressure on rectum, paroxysmal colic.

Hydrangea
Hydrang. has a traditional reputation as a “stone-breaking” remedy having been used in calculous diseases for many years.Renal calculi, gravel, profuse deposit of white amorphous salts in urine. Renal colic, sharp pain in loins, especially left. Burning in urethra & frequent desire. Urine hard to start. Bloody urine, heavy deposit of mucus. Great thirst with abdominal symptoms & enlarged prostate.

Pareira brava

Renal colic, pain going down the thighs. Neuralgic pain in the anterior crural region. Constant urging, great straining. Can emit urine only when he goes on his knees, pressing head firmly against floor. Black, bloody, thick mucus urine. Dribbling after micturition. Urethritis, prostatitis.

Thlaspi
Renal colic. Accumulation of gravel. Brick dust sediment. Urine heavy, phosphatic. Dysuria & spasmodic retension. Uric acid diathesis. Renal & vesical irritation. Urethritis, urine runs away in little jets. Haematuria & albuminuria.─Strangury after accouchement; dribbling of urine

Solidago
A very old and good kidney medicine”.─Pains in kidneys.─Region of kidneys painful on pressure.─Pains in kidneys which extend forward to abdomen and bladder.─Dysuria; scanty and difficult.─Urine: dark, red-brown, with thick sediment; dark with sediment of phosphates; slightly sour, neutral, or alkaline; with numerous epithelial cells or small mucous particles; epithelial cells with gravel of triple phosphates or phosphate of lime.─Bright’s disease.─Clear, stinking urine.

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