Multiple Renal Calculi – Case Report

 

Lily Deo*, Rita Sangtani, Rima Kumar, Ayush Kumar Gupta, Sneha Pawar

Dr D Y Patil Homoeopathic Medical College and Research Center, Pimpri, Pune – 411018.

Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune – 411018.

*Corresponding Author E-mail: drlilydeo@gmail.com

 

ABSTRACT:

A patient with urinary calculi measuring 4.3mm and 4.5mm in the lower pole of the right kidney, and a calculus measuring 4.5mm in the lower pole of the left kidney, presented to the OPD of Dr D Y Patil Homoeopathic Medical College and Research Centre, Pune, Maharashtra, with complaints of pain in the right iliac region extending to the genitals and legs, dribbling urine, and painful micturition. The patient had never received therapy previously. Generally, the stones in the lower pole of the kidneys do not pass spontaneously and require active treatment. Regular follow-ups were taken and USG-KUB was repeated. Lycopodium Clavatum 30C was administered based on the presenting symptoms & the constitutional totality and it proved efficient in the disintegration and expulsion of all the stones. Hence Homoeopathy proves efficacious in the fragmentation and expulsion of Renal calculi if the correct simillimum is administered.

 

KEYWORDS: Homoeopathy, Lycopodium Clavatum, Urinary Calculi, Case Report.

 

 


INTRODUCTION: 

The production of stones in the urinary tract, which includes the kidney, ureter, and bladder, is known as urolithiasis (KUB). One of the most prevalent urological illnesses is kidney stones. In India, one out of every ten people is afflicted. Furthermore, because recurring stone development is a regular feature of medical therapy, patients' financial burden is increased1,2,3,4. The cause is complex, however it is closely linked to a sedentary lifestyle. Urinary stones of both the upper and lower urinary tract are frequent in India, but the occurrence varies substantially by region5,6,7,8. Stones between 5 and 7mm in diameter have a 50% chance of passing spontaneously, whereas stones bigger than 7 mm almost always require surgery9,10,11,12. Alternative medical therapy techniques have a lot of attention since non-interventional therapies are the most appealing to patients13,14. Lycopodium Clavatum has been identified to be one of the most useful medicines in the dissolution and expulsion of calculi in a multicentre observational study conducted by the CCRH, New Delhi14. The present study is in support of the earlier studies that showed the effectiveness of homoeopathic interventions in urological disorders.

 

For around 12.7 percent of India's population, homoeopathy is their only source of health care14. The current case illustrates how a single homoeopathic medicine can be used to treat a variety of urinary calculi.

 

Patient Information:

A 28‑year‑old housewife presented with acute pain in right iliac region extending to genitals and legs, frequent and painful urination with pain and sensation of fullness in the lower abdomen. Patient also experienced urging to urinate frequently with pain in lower abdomen (Right side) aggravating during urination and straining to urinate. These complaints were there since 3 days but had worsened on the day of reporting to the OPD. Due to the acute pain and as per the above symptoms a dose of Lycopodium Clavatum 30°C was given.

 

Family History:

No family history of urolithiasis or any other medical or surgical illness.

 

Personal History:

FTND -2. No other medical or surgical history.

 

Food/drink- Desires/Aversions:

She had the dietary habit of taking coffee frequently and has an aversion to alcoholic drinks.

 

Thirst:

She also has a habit of drinking less quantity of liquids.

 

Mentals:

Patient is absent-minded and gets angered very easily on trifles. Is timid and does not like to face a crowd. Lacks self-confidence whenever has to face an unknown crowd. She gets offended very easily and cannot bear insults. Also has a morbid fear of ghosts. Patient is a housewife and generally does not like any task involving responsibility.

 

Clinical Findings:

Physical Examination: Murphy's punch sign test – positive - eliciting a costo-vertebral angle tenderness on the right and left side.

 

Diagnosis:

Multiple Renal Calculi.


       

Figure 1: Ultrasonography report before treatment                           Figure 2: Ultrasonography report before treatment

 

Figure 3: UltrasonographyKidneys (multiple stones): Stones in the lower poles of the right and the left kidney

Figure 4: UltrasonographyKidneys: Small right renal calculus in the lower pole of the right kidney

 

 

Figure 5: Ultrasonography report after treatment                             Figure 6: Ultrasonography report after treatment                          

 

  

Figure 7: UltrasonographyKidneys: No stones in the lower pole of the right kidney

Figure 8: UltrasonographyKidneys: No stones in the right and the left kidney

 


Therapeutic Intervention:

Totality of symptoms:

The totality of symptoms arrived were absent‑mindedness, tendency to get angry easily, offended easily, aversion to responsibilities, bashfulness, lack of self-confidence, fear of ghosts, desire for coffee, aversion to alcoholic beverages, urination dribbling by drops, frequent urination, dysuria, painful retention of urine, sensation of fullness of bladder, frequent morbid desire urging to urinate, pain in the right side of abdomen (area of) ureters and pain during urination.

 

Ultrasonography‑Abdomen and Pelvis [Figure 1] [Figure 3] revealed a 4.3mm and 4.5mm calculus in lower pole of the right kidney along with 4.5mm calculus in the lower pole of the left kidney.

 

MATERIALS AND METHODS:

Repertorisation:

The repertorisation was done using Hompath Zomeo (Complete Repertory). Lycopodium Clavatum was the highest scoring medicine by covering maximum rubrics (15) and also scoring highest points (50) [Figure 9].


 

Figure 9: Repertorisation table: Repertorisation of homoeopathic medicines using Hompath Zomeo Homoeopathic software.

 


Prescription:

After case taking and repertorisation, one dose of Lycopodium Clavatum 30C were prescribed on the day of visit – 25/12/2020 along with placebo for 15 days.

 

Remedy Differentiation based on Materia Medica15:

Pulsatilla Nigricans ‑ Weeps easily. Timid and indecisive. Fears of being alone in the evening, dark, and scary. Enjoys sympathy. Children enjoy being fussed over and caressed. Disappointed easily. Obsessive fear of the opposite sex. Melancholy over religion. Susceptible to extremes of pleasure and anguish. Extremely emotional. Cannot tolerate fatty foods, warm foods, and beverages. Eructation; after ices, fruits, and pastry, the taste of food lasts a long time. Bitter taste, overall food flavour is lessened. Increased desire, which is exacerbated by lying down. Burning in the urethral orifice during and after micturition. Involuntary micturition in the middle of the night, while coughing or passing flatus. Spasmodic pain in the bladder after passing urine.

 

Nux Vomica- Irritated and sensitive to all perceptions. Ugly and malevolent. Can't stand noises, odours, light, and so on. Doesn't like being touched. Time moves far too slowly. Even the smallest ailment has a significant impact on her. Disinclined to criticise others. Sullen, looking for flaws. Irritated bladder caused by a spasmodic sphincter. Haematuria. Spasmodic and strangury urging, ineffective. Renal colic with dribbling urine that has spread to the genitals. Itching in the urethra and pain in the bladder neck while peeing. Several hours after eating, the epigastrium became swollen, with stone-like pressure. Stimulant cravings Fats are something he enjoys and tolerates well. Dyspepsia caused by consuming a lot of coffee.

 

Arsenicum album- Great agony and agitation. Continually shifts location. Fears of death and being alone Fearful, with chilly sweat. Feels taking medicine is pointless. Suicidal. Scanty, scorching, and uncontrollable. The bladder appears to be paralysed. Albuminous. Epithelial cells, fibrin clots, pus globules, and blood globules Feeling of weakness in the abdomen after urinating. Bright's illness Diabetes. Gastralgia caused by the smallest amount of food or drink. Dyspepsia caused by vinegar, acids, ice cream, ice water, and cigarettes. The negative effects of a veggie diet, melons, and watery fruits in general. Milk is desired.

 

Calcarea Carb – Fearful; worst in the evening; worries loss of reason, misfortune, communicable diseases forgetful, perplexed, and pessimistic Anxiety accompanied by palpitation. Obstinacy; even a minor mental exertion results in a hot head. Afraid of labour or exertion. Dark, brown, unpleasant, foetid, abounding in white debris, and bloody. Irritating bladder. Enuresis. A cut in the abdomen; a swollen abdomen Flatulence while incarcerated. Distension accompanied by hardness.

 

Sulphur‑ Terrible forgetter. Difficult to think about. Delusions; believes rags are beautiful and that he is extremely wealthy. I'm always on the go. Adults with childish snobbishness. Irritable. Affections are tainted; there is a complete loss of or an overwhelming appetite. Eructations that are vile. The food tastes very salty. Drinks lot and eats little. Milk is adamantly opposed. A strong yearning for sweets. Micturition on a regular basis, especially at night. Enuresis, particularly in scrofulous, unruly children. The burning sensation in the urethra during micturition lasts for a long time. Mucus and pus in pee; painful regions over which it flows; must haste, strong urge to urinate a large amount of colourless urine.

 

General Management:

The patient was advised to avoid oxalate foods such as spinach, chocolates, nuts, whole cereal flours, milk, oysters, tapioca, etc., She was also advised to avoid overeating and was asked to take plenty of water16,17.

 

Follow-ups and outcome:

Follow-ups were taken, monthly and on occasions bi-monthly. During first follow-up the patient still complained of painful micturition and pain was radiating down the groins, hence one dose of Lycopodium Clavatum 30C was repeated along with placebo for 15 days. She was asked to report after 15 days. During the second follow-up the USG- Abdomen & Pelvis [Figure 2] [Figure 4] revealed that there was only a 4mm calculus noted in the lower pole of the right kidney. The patient said that there was still slight pain in the groins and painful micturition occasionally especially in the morning. Hence one dose of Lycopodium Clavatum 30C was repeated for 2 days along with placebo for 30 days. During the 3rd, 4th, 5th follow-up visit, [Table 1] she said that she was feeling better, though there was painful micturition and heaviness in the bladder region with sensation of fullness and strangury. The subsequent ultrasound report in June 2021 and September 2021 [Figures 5,6,7,8] confirmed that there was no stone in the kidney, ureter and bladder region. During this 6th follow-up visit patient said that there was much relief in the pain during micturition and strangury. Although she experienced a fullness sensation in the stomach along with distension. Hence Lycopodium Clavatum 30C was repeated; 1 dose, followed by placebo for subsequent 30 days. In the following five follow‑ups, i.e., 4 months, no new symptoms were reported and patient felt better. The USG was repeated twice, once during the 7th and then the 10th follow-up which showed absence of renal calculi and no recurrence of the calculi in the kidneys, ureters and bladder region respectively. Also, the patient was mentally more confident, anger was reduced considerably and she was stable, timidity and bashfulness was improved markedly and she was also now able to take her own decisions confidently.


 

Table 1: Follow‑up – list of the follow‑up visits with details about the main symptoms, ultrasound report and the prescribed medicine.

DATE

SYMPTOMS

USG REPORTS

PRESCRIPTION

10/01/2021

(1st follow-up)

C/o Pain in right iliac region extending to genitals and legs, c/o frequent and painful ++ urination with pain and sensation of fullness in the lower abdomen. Patient also experienced urging ++ to urinate frequently++ with pain in lower abdomen (Right side) aggravating during urination and straining++ to urinate.

Mentally- patient felt better, absent mindedness was reduced, she was less angry and timidity was also reduced. Her self-confidence improved.

USG-Abdomen and Pelvis - 10/10/2020 – Calculi measuring 4.3mm and 4.5mm noted in the lower pole of the right kidney. And 4.5mm calculi in the lower pole of the left kidney.

Lycopodium Clavatum 30C x 1 dose

Placebo x BD x 15 days

25/01/2021

(2nd Follow-up)

 

 

 

Intensity of the pain has reduced although some pain + is still persisting in the groins. Dysuria. Frequency – SQ.

Mentally: Anger > +3, self -confidence improved, and now she has begun to take responsibilities. Bashfulness and timidy also reduced considerably. Absent mindedness – was reduced.

---

Placebo x BD x 15 days.

08/02/2021

(3rd Follow-up)

Overall pain during urination reduced.

Pain in the groins >++

Frequency reduced as compared to before.

Distension with sensation of fullness in the lower abdomen – SQ

Mentally- Stable and improved.

USG- Abdomen & Pelvis -  06/02/2021

Calculus measuring 4.0 mm noted in the lower pole of the right kidney

No presence of calculus in the left kidney.

Lycopodium Clavatum 30C x 1 dose

Placebo x BD x 30 days

15/03/2021

(4th Follow-up)

Overall pain during urination >+

No pain in the groins.

Frequency reduced as compared to before>+

Distension with sensation of fullness in the lower abdomen – SQ

Mentally- Stable and improved.

----

Placebo x BD x 30 days

20/04/2021

(5th Follow-up)

Overall >++

No new complaints

Mentally- Stable and improved.

----

Lycopodium Clavatum 30C x 1 dose

Placebo x BD x 30 days

21/05/2021

(6th Follow-up)

Overall >++

No new complaints

C/o Distension with sensation of fullness in the lower abdomen +

Mentally- Stable and improved.

----

Lycopodium Clavatum 30C x 1 dose

Placebo x BD x 30 days

29/06/2021

(7th Follow-up)

Overall >++

No new complaints

Mentally- Stable and improved.

USG- Abdomen & Pelvis - 29/06/2021

No calculus noted in both kidneys. Normal study.

Placebo x BD x 30 days

30/07/2021

(8th Follow-up)

Overall >+++

No new complaints

Mentally- Stable and improved.

----

Placebo x BD x 30 days

31/08/2021

(9th Follow-up)

Overall >+++

Occasional bloating and distension in abdomen. Flatulence+

Mentally- Stable and improved.

----

Lycopodium Clavatum 30C x 1 dose

Placebo x BD x 15 days

06/09/2021

(10th Follow-up)

Overall >+++

No bloating and distension in abdomen. No flatulence

Mentally- Stable and improved.

USG- Abdomen & Pelvis - 06/09/2021

No calculus noted in both kidneys. Normal study.

Placebo x BD x 15 days

04/10/2021

(11th Follow-up)

Overall >+++

No new complaints

Mentally- Stable and improved.

----

Placebo x BD x 30 days

 


Table 2: Response of the patient to medication based on modified Naranjo Criteria (Maximum possible score = +13, Minimum score = - 6

Modified Naranjo Criteria No.

Grading of response to medication

1

2

2

1

3

0

4

1

5

0

6a

1

6b

1

7

0

8

1

9

2

10

1

Total

+10

 

RESULTS AND DISCUSSION:

This case demonstrates the effectiveness of homoeopathic drugs in the treatment of urolithiasis. The patient had never been treated previously. The patient reacted effectively to the homoeopathic treatment and was cured of her urinary calculi, which were expelled. Based on the constitutional totality, one dose of Lycopodium Clavatum 30C was recommended. Other remedies that followed included Pulsatilla, Nux vomica, Arsenic album, Calc Carb, and Sulphur.

 

All the three stones viz., the 4.5 mm and 4.3mm in the lower pole of the right kidney and the 4.5mm stone in the lower pole of the left kidney were expelled with only four doses of Lycopodium Clavatum. The repertorisation clearly shows that total marks scored for Lycopodium Clavatum was 50 whereas the next highest scoring medicine, Pulsatilla Nigricans only scored 48. In this case, Lycopodium Clavatum covered the mental symptoms such as absent‑mindedness, tendency to get angry easily, offended easily, and fear of ghosts, which was not covered by Pulsatilla Nigricans. Also, responsibility- aversion to was not covered by Pulsatilla Nigricans, Nux Vomica and Arsenicum Album while Lycopodium Clavatum covered the symptom. Also, timidity and bashfulness were not covered up by Arsenicum album. Lycopodium Clavatum covered the mental symptoms which developed at the time of urolithic complaints. In a Repertory of Urolithiasis with respect to kidneys, Lycopodium Clavatum is a first-grade medicine18 and covered top marks for affections in right kidney and is also the top scoring remedy19 for the right side of the ureter. The mechanism of action of Lycopodium Clavatum is such that the mucous membranes take on an atonic condition; congestion, catarrhal inflammation results with flatulence and distension of the intestines, urination is painful, the urine contains a brick dust sediment, and an excess of uric acid20. 30th potency was found to be useful in this case. Only two doses of 30C were required for the expulsion of two stones. Interestingly, in a period 5 months and 15 days of treatment, after 4 consecutive doses, i.e., in the 7th follow-up, the ultrasound report revealed no stone in the kidney, ureter, and bladder region. The USG was repeated again after 2 months and 15 days, i.e., in the 10th follow-up which showed no recurrence in the symptoms and absence of calculi in the kidneys, ureters and bladder region. Also, the patient showed significant improvement regarding mental symptoms. From Miasmatic perspective, it has been reported that there are latent symptoms of all miasms throughout the whole urinary tract21,22. Of the true chronic miasms, psora and sycosis take an active part in the production of diseases in these organs. In Miasmatic Prescribing23. Lycopodium Clavatum covers psoric (+++) and sycotic (++) miasm. This case also identifies usefulness of Lycopodium Clavatum in psoric and sycotic miasmatic presentation.

 

The strengths of this case lie in the fact that a single medicine which was chosen on the basis of symptom totality which includes mental generals, physical generals, physical particulars and the pathology, with minimal repetition and without any surgical intervention was successful in such pathological cases in eliminating all the calculi. This case assumes importance since there were multiple stones in the kidney, all of which were eliminated. It also signifies the importance of Individualisation in Homoeopathic prescription. However, the limitation would be that it would not be appropriate to generalize on the basis of this study. However, a prospective research study on a larger sample size is suggested for scientific validation as this was a single case report.

 

CONCLUSION:

The general concept in Homoeopathy towards treatment of the sick is ‘Treat the patient not the disease.23. I have concluded that Individualized constitutional remedy when well selected is not only successful in expulsion of multiple renal calculi but also improves the mental well-being of the patient. Hence this case affirms that the law of similar is the universal law.

 

Informed Consent:

Informed consent was obtained from the patient on her first visit to the hospital after she filled up the form and agreed to undergo homoeopathic treatment for her ailments.

 

SOURCE OF FUNDING: 

Nil.

 

CONFLICT OF INTEREST:

There are no conflicts of interest in between the authors

 

ACKNOWLEDGEMENT:

I would like to extend gratitude towards my college, Dr D Y Patil Homoeopathic Medical College and Hospital, Principal Dr D B Sharma, my professors, mentors for their support and cooperation in accomplishment of this article.

 

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Received on 13.01.2022             Modified on 29.03.2022

Accepted on 09.05.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2023; 16(3):1127-1133.

DOI: 10.52711/0974-360X.2023.00188