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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 10  |  Issue : 2  |  Page : 142-149

A case of multiple urinary calculi


Central Research Institute for Homoeopathy, Kottayam, Kerala, India

Date of Submission10-Jun-2016
Date of Acceptance10-Jun-2016
Date of Web Publication11-Feb-2016

Correspondence Address:
P Paul Sumithran
Central Research Institute for Homoeopathy, Sachivothamapuram P.O., Kottayam - 686 532, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7168.176164

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  Abstract 

A patient with urinary calculi of sizes 16 mm in the right renal pelvis and 9 mm in the right mid-ureter, presenting with complaints of pain in right iliac region extending to genitals and legs with dribbling urine and painful micturition reported in the OPD of the Central Research Institute for Homoeopathy, Kottayam, Kerala. Patient had not undergone treatment before. Based on the presenting symptoms Nux vomica 30C was prescribed, which proved to be effective in the dissolution and expulsion of both the stones.

Keywords: Homoeopathy, Nux vomica, Urinary calculi


How to cite this article:
Sumithran P P. A case of multiple urinary calculi. Indian J Res Homoeopathy 2016;10:142-9

How to cite this URL:
Sumithran P P. A case of multiple urinary calculi. Indian J Res Homoeopathy [serial online] 2016 [cited 2019 Aug 21];10:142-9. Available from: http://www.ijrh.org/text.asp?2016/10/2/142/176164


  Introduction Top


Urolithiasis is the process of forming stone in the urinary tract, that is, kidney, ureter and bladder (KUB). Urolithiasis affects 5-15% of the population worldwide. [1] In India, upper and lower urinary tract stones occur frequently but the incidence shows wide regional variation. [2] Stones of less than 5 mm diameter usually pass spontaneously. [3] Stones of size 5-7 mm have a 50% chance of passage and those >7 mm almost always require surgical intervention. [4] There is a large interest in alternative medical treatment modalities since noninterventional treatments are the most appealing to patients. [5]

Around 12.7% of India's population depends solely on Homoeopathy for their health care. [6] The usefulness of a single homoeopathic medicine in the treatment of multiple urinary calculi is highlighted in the present case.


  Case Report Top


A 48-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 Nux vomica 30C was given.

Family History: No family history of urolithiasis.

Personal History: She had the dietary habit of taking oysters, rice, tapioca, milk, and drinking less quantity of liquids.

Totality of symptoms: The totality of symptoms arrived were absent-mindedness, tendency to get angry easily, offended easily, aversion to mental work after getting angry, aversion for reading, aversion for coffee and drinks, aversion to food in general and loathing after eating little, also loathing with hunger, desires milk, 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.

On Examination: no abnormal finding

Investigations done

  • Serum Calcium level- 11.1 mg/dl
  • Urine Microscopy- Presence of Calcium oxalate crystals


Ultrasonography-KUB [Figure 1] revealed a 16 mm calculus in right renal pelvis along with 9 mm calculus in the right mid-ureter.
Figure 1: Ultrasonography-kidney, ureter and bladder (multiple stones): Stones in the right renal pelvis and right mid-ureter

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Repertorisation: The repertorisation was done using Hompath Classic 8.0 (Kent Repertory). Nux vomica was the highest scoring medicine by covering maximum rubrics (18) and also scoring highest points (48) [Figure 2].
Figure 2: Repertorisation table: Repertorisation of homoeopathic medicines using Hompath Classic 8.0

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Prescription: After case taking and repertorisation, two doses of Nux vomica 30C were prescribed on the day of visit along with placebo for 3 days since the pain was continuing.

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 water.

Follow ups

During the first follow-up the patient reported that a stone had passed in the evening on the next day after the first visit. On analysis it was found that the stone was almost entirely made up of calcium oxalate. This stone's measurement was 6.09 mm × 4.79 mm [Figure 3]. The pain was better but there was mild irritation in the urethra at the time of passing stone. In the second follow-up, one dose of Nux vomica 30C was given as she complained of painful micturition. Placebo was also prescribed. In the third follow-up visit, the USG - KUB report revealed the presence of a 16 mm calculus in the right renal pelvis causing mild hydronephrosis proximally [Figure 4]. The serum calcium level was normal but the urine microscopy showed the presence of calcium oxalate crystals. In this visit she felt better and hence placebo was prescribed.
Figure 3: Stone measurement (6.09 mm 4.79 mm): Measurement of the stone expelled from the right mid-ureter

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Figure 4: Ultrasonography-kidney, ureter and bladder (16 mm stone in right renal pelvis): Stone in the right renal pelvis

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During the fourth follow-up, the patient complained of painful micturition. A dose of Nux vomica 30C was prescribed along with placebo for 15 days. In the fifth follow-up, she reported that a big stone was passed in the evening of the fourth follow-up visit. The patient experienced mild pain in the urethra at the time of expulsion of the stone. The stone's size was 15.4 mm × 4.35 mm [Figure 5] and was made up almost entirely of calcium oxalate. In the subsequent follow-up visits [Table 1] she said that she was feeling better. The subsequent ultrasound reports [Figure 6],[Figure 7],[Figure 8] and [Figure 9] confirmed that there was no stone in the KUB region. The serum calcium level was normal and there were no calcium oxalate crystals present. Nux vomica 200C was prescribed during the thirteenth follow-up visit because the patient complained of flatulence aggravating after eating. In the following six follow-ups, no new symptoms were reported.
Figure 5: Stone measurement (15.4 mm × 4.35 mm): measurement of the stone expelled from the right renal pelvis

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Figure 6: Ultrasonography kidney, ureter and bladder on October 01, 2012: No stones in the right renal pelvis and right mid ureter

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Figure 7: Ultrasonography kidney, ureter and bladder on December 28, 2012: No stones in the right renal pelvis and right mid ureter

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Figure 8: Ultrasonography kidney, ureter and bladder on April 27, 2013: No stones in the right renal pelvis and right mid ureter

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Figure 9: Ultrasonography kidney, ureter and bladder on September 26, 2013: No stones in the right renal pelvis and right mid ureter

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Table 1: Follow-up - list of the follow-up visits with details about the main symptoms, ultrasound report and laboratory findings and the prescribed medicine

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In the twentieth follow-up visit, Nux vomica 200C was prescribed because the patient complained of flatulence aggravating after eating. In the subsequent follow-ups, no stones were found in the USG of KUB region [Figure 10] and [Figure 11] and no new symptoms were reported. The clinical investigations also confirmed a normal study.
Figure 10: Ultrasonography kidney, ureter and bladder January 22, 2014: No stones in the right renal pelvis and right mid ureter

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Figure 11: Ultrasonography report after treatment

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  Discussion Top


This case highlights the usefulness of homoeopathic medicines in the expulsion of urolithiasis. The patient had not undergone any treatment before. The patient responded positively to the homoeopathic treatment and was relieved of her urinary calculi, with the dissolution and expulsion of the stones. Based on the presenting symptoms one dose of Nux vomica was prescribed. Lycopodium clavatum, Pulsatilla nigricans, Sulphur, Causticum, Natrum muriaticum and Belladonna were other high scoring medicines.

These drugs can be differentiated from Nux vomica are Lycopodium clavatum, Pulsatilla nigricans, Sulphur, Causticum, Natrum muriaticum and Belladonna on the basis of following rubrics (based on Repertorium Homeopathicum Syntheticum). [7]

Lycopodium clavatum-reading desires-unable to read-written what he has; mental exertion-agg: Fatigues-impossible-aversion to; alcoholic drinks-agg, bread-agg, cabbage-agg, carrots-agg, beer-agg, and coffee-agg.

Pulsatilla-anger - answer, when obliged to; beside oneself, being; conversation, from; taciturnity, with; mental exertion-agg, aversion to, desire for: Evening; bread-agg, coffee-agg, eggs-agg, beer-agg desire, milk-agg; urination during, burning, sore, bruised, and restless sensation.

Sulphur-reading desires: Medical books, to read; mental exertion-agg. Fatigue, aversion to, desire for literary work; wine desire; anger - morning, waking-forenoon 11 h, alternating with repentance, quick, mistakes, about his, past events, about, violent; kidney-paroxymal, stooping: On, after long, drawing ureters, pulsation: Restless sensation; bladder-cold, from taking, pressing, pressure in night, stool before, stitching, stinging, neck: Morning, afternoon, urination during.

Causticum-anger-alternating with; cheerfulness-beside oneself, being, violent, waking on; mental exertion-agg, impossible, aversion to; beer-agg desire, coffee-agg aversion, fruit agg, aversion, heavy food-agg; kidney-aching: Region of, cramping.

Natrum muriaticum-reading - unable to read; mental exertion - agg, impossible: Exertion, after; alcoholic drinks-agg, desire, beans, agg, bitter drink - agg, desire, bitter food, desire, bread-agg., butter-agg, chocolate desire, coffee-agg, smell of coffee, fish desire, honey-agg, salt. aversion; bladder-company, unable to pass urine in presence of; kidneys-burning region of, drawing, ureters, stitching-extending to uterus; bladder-pressing, pressure in. stool: Before, urination during after during: Stitching, stinging, urination: During walking, while.

Belladonna-mental exertion-agg, aversion to, desire for; kidneys-pain: Morning, apyrexia, during-coughing, sneezing-agg, extending to bladder, tearing extending to downwards, ureters, extending downwards, touch motion and inspiration-agg, stones-suppression of urine-fever, with-perspiration, with; alcoholic drinks: Agg-bread desire-coffee, aversion.

Both the stones viz., the 16 mm stone in the right renal pelvis and the 9 mm stone in the right mid-ureter were dissolved and expelled with only four doses of Nux vomica. The repertorisation clearly shows that total marks scored for Nux vomica was 48 whereas the next highest scoring medicine, Lycopodium clavatum only scored 29. In this case, Nux vomica covered the mental symptoms such as absent-mindedness, tendency to get angry easily, offended easily, aversion to mental work after getting angry, aversion for reading, aversion to food in general and loathing with hunger and desires milk which were not covered by Lycopodium clavatum. Nux vomica covered the mental symptoms which developed at the time of urolithic complaints.

In a Repertory of Urolithiasis with respect to kidneys, Nux vomica is a first grade medicine [8] and covered top marks for calculus in right kidney and is also second grade [9] for the right side of the ureter. Nux vomica 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 Delhi. [10] The mechanism of action of Nux vomica is such that it relaxes the circular fibres of the canal of the ureter and the pressure from behind forces the calculus out at once. [11]

The 30 th potency was found to be useful in this case. Only four 30C doses were required for stone expulsion. Interestingly, in only a short period, that is, 1-month and 10 days of treatment, the ultrasound report revealed no stone in the KUB. 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 tract. Of the true chronic miasms, psora and sycosis take an active part in the production of diseases in these organs. [12] In Miasmatic Prescribing, [13] Nux vomica covers psoric (+++) and sycotic (++) miasm. This case also identifies usefulness of Nux vomica in psoric and sycotic miasmatic presentation.

This case assumes importance since there were multiple stones in the kidney and ureter, all of which dissolved and were eliminated. It also signifies the importance of individualisation in Homoeopathic prescription. However, it would not be appropriate to generalize on the basis of this study.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Moe OW. Kidney stones: Pathophysiology and medical management. Lancet 2006;367:333-44.  Back to cited text no. 1
    
2.
Siddiqui VA, Singh H, Gupta J, Nayak C, Singh V, Sinha MN, et al. A multicentre observational study to ascertain the role of homoeopathic therapy in Urolithiasis. Indian J Res Homoeopathy 2011;5:30-9.  Back to cited text no. 2
  Medknow Journal  
3.
Asplin JR, Ceo FL, Favus MJ. Nephrolithiasis. In: Braunwald E, Hauser SL, Fauci AS, Kasper DL, Longo DL, Jameson JL, et al., editors. Harrisons Principle of Internal Medicine. 17 th ed., Vol. 2. New Jersey: McGraw Hill Medical Publishing Division; 2008. p. 1816-7  Back to cited text no. 3
    
4.
Zarse CA, McAteer JA, Sommer AJ, Kim SC, Hatt EK, Lingeman JE, et al. Nondestructive analysis of urinary calculi using micro computed tomography. BMC Urology 2004;4:15.  Back to cited text no. 4
    
5.
Michel MC, de la Rosette JJ. Alpha-blocker treatment of urolithiasis. Eur Urol 2006;50:213-4.  Back to cited text no. 5
    
6.
Singh P, Yadav RJ, Pandey A. Utilization of indigenous systems of medicine and homoeopathy in India. Indian J Med Res 2005;122:137-42.  Back to cited text no. 6
    
7.
Frederik S. Synthesis 7.1. Repertorium Homeopathicum Syntheticum. Homeopathic Book Publishers, London; 1998. p. 8.   Back to cited text no. 7
    
8.
Mohanty N. Repertory of Urolithiasis. Disease Monograph-5, Urolithiasis. New Delhi: CCRH; 2011. p. 156.  Back to cited text no. 8
    
9.
Mohanty N. Repertory of Urolithiasis. Disease Monograph-5, Urolithiasis. New Delhi: CCRH; 2011. p. 159.  Back to cited text no. 9
    
10.
Siddiqui VA, Singh H, Gupta J, Nayak C, Singh V, Sinha MN, et al. A multicentre observational study to ascertain the role of homoeopathic therapy in Urolithiasis. Indian J Res Homoeopathy 2011;5:36.  Back to cited text no. 10
    
11.
Kent JT. Lectures on Homoeopathic Materia Medica. Kent′s Materia Medica. New Delhi: Jain Publishing Co.; 1971. p. 808.  Back to cited text no. 11
    
12.
Allen JH, The Chronic Miasms Psora and Pseudo-Psora. Reprinted Edition. Vol. I and II. New Delhi: B Jain Publishers Pvt. Ltd.; 2002. p. 239-41.  Back to cited text no. 12
    
13.
Kumar BS. Part VI. Miasmatic Weightage of Medicines. Miasmatic Prescribing. Allen College of Homoeopathy 2001. p. 246.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]
 
 
    Tables

  [Table 1]



 

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