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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 15  |  Issue : 2  |  Page : 147-154

A case report of hyperuricaemia with nephrolithiasis treated with homoeopathy


Regional Research Institute for Homoeopathy, Under CCRH, Guwahati, Assam, India

Date of Submission21-Jan-2021
Date of Acceptance28-May-2021
Date of Web Publication29-Jun-2021

Correspondence Address:
Dr. Pooja Gautam
Regional Research Institute for Homoeopathy, Under CCRH, Guwahati, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrh.ijrh_6_20

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  Abstract 


Introduction: Hyperuricaemia is serum urate concentration exceeding the limit of solubility, leading to its precipitation and predisposing the affected persons to gout. The increased level of uric acid in urinary excretion can also lead to nephrolithiasis. It has also been implicated as an indicator for diseases such as metabolic syndrome, diabetes mellitus, cardiovascular disease and chronic renal disease. Whereas homoeopathic literature enlists many medicines for this condition, there is a paucity of evidence-based published studies. Case Summary: The case presented here reported with the complaint of renal stone secondary to high serum uric acid levels. A single homoeopathic medicine Lycopodium was prescribed after thorough case taking which led to improvement in subjective symptoms and objectively reflecting in gradually decreasing levels of serum uric acid after elimination of stone. During the course of treatment, old symptoms also re-appeared depicting improvement in accordance with Hering's law of cure. The Modified Naranjo Criteria score after treatment was 8, which explicitly shows the positive causal attribution of the individualised homoeopathic medicine Lycopodium in this case. Homoeopathic treatment has shown favourable results in this case and demonstrates the scope of Homoeopathy in such cases.

Keywords: Homoeopathy, Hyperuricaemia, Lycopodium, Nephrolithiasis, Uric acid


How to cite this article:
Gautam P. A case report of hyperuricaemia with nephrolithiasis treated with homoeopathy. Indian J Res Homoeopathy 2021;15:147-54

How to cite this URL:
Gautam P. A case report of hyperuricaemia with nephrolithiasis treated with homoeopathy. Indian J Res Homoeopathy [serial online] 2021 [cited 2021 Oct 23];15:147-54. Available from: https://www.ijrh.org/text.asp?2021/15/2/147/319612




  Introduction Top


The prevalence and disease burden of gout and hyperuricaemia are rising globally. The prevalence of hyperuricaemia in India was 44.6% according to the study published in 2012, which was reduced to 25.8% in 2018.[1] In other epidemiological study, the annual incidence of urolithiasis was 0.3% in patients with asymptomatic hyperuricaemia and 0.9% in patients with hyperuricaemia and gout.[2]

Gout is a common condition managed with conventional treatment approaches including management of the inflammatory pain associated with flares, urate-lowering therapies and patient education. However, patients can be benefited more if treatment paradigm shifts further towards active management of hyperuricaemia as it has also been implicated as an indicator for diseases such as metabolic syndrome, diabetes mellitus, cardiovascular disease and chronic renal disease.[3],[4] The goal of treatment is to reduce the body's total uric acid pool and consequently, to reduce the complications.[5] At present, available drugs, including allopurinol and febuxostat, may have significant adverse effects such as hypersensitivity drug reactions, and they are now not indicated for broad use in many hyperuricaemia-related diseases also.[6]

Homoeopathic literature enlists many medicines for gout or hyperuricaemia such as Colchicum, Benzoic acid, Ledum palustre and Lithium benzoicum. Among the published evidence based studies on gout only four preclinical studies[7],[8],[9],[10], five clinical trials[11],[12],[13],[14],[15] and two case reports[16],[17] could be found which shows promising results in reduction of serum uric acid.

A case report on hyperuricaemia with nephrolithiasis successfully treated with single homoeopathic medicine Lycopodium is presented here. This case highlights the effectiveness of Homoeopathy for the treatment of hyperuricaemia and its associated conditions, following the basic principles of Homoeopathy.


  Patient Information Top


A 51-year-old, lean, thin man reported in the Outpatient Department of Regional Research Institute for Homoeopathy, Agartala on 6 June, 2019, with a complaint of on and off cramping pain in the right groin and burning during micturition in the past 2 weeks with uninterrupted – clear urine flow. The patient was a known case of renal calculi with a history of right-sided renal colic twice in the past 4 months for which he underwent few investigations on physician's advice and took conventional treatment also with temporary relief.

The patient did not suffer from any other major illness in the past, except from some gastric disturbances. Family history was not significant.

The patient was a Government employee belonging to a middle-class socioeconomic group.

He consumed alcohol occasionally.

Mental generals

The patient was very well behaved. During childhood, he was average in studies, and although he had limited friends, he interacted with everyone. He felt anxious before starting new work but performed well once he started. He had cordial relations with all his work colleagues. He disliked being alone at home, though he did not interact with his children much. He was forgetful, forgot things after keeping them and had marked habit of forgetting his usual road directions. Very often, he used to forget the way back home while returning from school. His mother had to accompany him for this reason. This was also seen during the college life and continued infrequently. He was married for 24 years and had three children. His relations with wife were good, except sometimes when he was tensed.

Physical generals

The patient had a thermal reaction towards hot, wore minimal woolens during winter and bathed with cold water throughout the winters. His appetite was good and he always preferred warm food. He had the desire for sweet and spicy things with moderate thirst. There was constipation in the past 4–5 years with ineffectual urging for stools, had to go 3–4 times a day. It was often accompanied by burning pain during and after defecation for last few days, which remained for 10–15 min. He was prone to have gastric disturbances with bloating of the abdomen 2–3 times/week, mostly towards evening in the past 2–3 years. He passed urine 4–5 times a day with burning during micturition for 2 weeks. He perspired moderately. Sleep was usually adequate, refreshing with non-specific sleep posture and dreams.

Clinical findings

Blood pressure was normal. Nothing abnormal was detected except for a mild deep tenderness in the right groin area. Pulse rate was 74/min; he was afebrile and weighed 64 Kg.

Diagnostic assessment

The patient was already a diagnosed case of hyperuricaemia, and serum uric acid was tested again to know about the present status. His investigations revealed following significant findings:

  • Serum uric acid was 8.0 mg% (21 May 2019).
  • Urine examination revealed 8–10 red blood cell's/ high power field (HPF) and trace proteins (25 April 2019).
  • Ultrasonography – kidney, ureter and bladder was suggestive of right renal tiny echogenic foci (0.28 cm) near lower pole probably renal calculus (1 February, 2019).


On further enquiry, the patient reported of having occasional pain in small joints of feet although there was no history of an acute gout episode.

Therapeutic intervention

Detailed case taking was done as per Hahnemannian guidelines of case taking given in Organon of Medicine followed by analysis and evaluation of the symptoms.[18] Totality of symptoms was erected, and repertorisation was done taking into account only the most striking mental generals, physical generals and uncommon particulars using Kent's repertory in RADAR 10.5. Repertorisation result is shown in [Figure 1]. Following symptoms were considered for repertorisation:
Figure 1: Repertory sheet

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  1. Feels anxious before starting new work
  2. Dislikes being alone
  3. Habit of forgetting the streets
  4. Prefers warm food
  5. Desire for sweets
  6. Desire for spicy things
  7. Constipated with ineffectual urging for stools
  8. Flatulence in evening.


After repertorisation, the top medicines were Lycopodium, Nux vom, Merc.Sol, Pulsatilla and Sepia. After carefully analysing the mental and physical generals of patient, considering the repertorial result, and referring back to homoeopathic materia medica similimum was prescribed. The patient was hot and Lycopodium has uric acid diathesis which further confirmed the selection of medicine. Individualised homoeopathic treatment was started with single dose of Lycopodium 30 followed by placebo following the law of minimum dose. Medicine was not repeated as long as the improvement in symptoms of the patient continued. During follow-up, changes in the signs and symptoms were assessed and serum uric acid was advised from time to time. Case was psoro-sycotic in nature pertaining to the nature of disease condition i.e., accumulation within the body. The patient was instructed to take plenty of water and limit the intake of all non-vegetarian and purine-rich food, although the patient informed that he took non-vegetarian foods only occasionally.

First prescription (06 June, 2019): Lycopodium 30/1 dose was prescribed on the basis of reportorial analysis.

Follow-up and outcomes

Follow-up of the patient was assessed regularly as required. Date-wise detailed follow-ups with result in investigations are summarised in [Table 1]. [Figure 2] gives the timeline of the case.
Table 1: Follow-up and Outcomes

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Figure 2: Timeline

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In this case, the total score of outcome as per Modified Naranjo Criteria score after treatment was 8, which is close to the total score of 13, and explicitly shows the positive causal attribution of the individualised homoeopathic medicine Lycopodium [Table 2].
Table 2: Assessment by Modified Naranjo criteria score

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Improvement in the patient started immediately after medicine in appropriate potency was given to patient. Improvement was subjective in terms of relief in overall sign and symptoms such as burning during defecation disappeared completely, marked reduction in bloating and flatulence, as well as objective as evident by expulsion of calculi [Figure 3] within few days followed by gradual decline of serum uric acid levels from 8.8 mg% to 6.2 mg%.
Figure 3: Expelled calculi

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No adverse events were reported during the whole duration of treatment.


  Discussion Top


Homoeopathy is a system of medicine which embraces a holistic approach in the treatment of sick. In Homoeopathy, detailed case taking is done to elucidate the constitutional makeup of the patient and a single remedy is selected on the basis of totality of symptoms.

At the first instance, the present case appeared to be a simple case of renal calculus. However, upon carefully exploring the history, hyperuricaemia was revealed as the cause behind stone formation i.e., alteration of purine metabolism. After considering the totality of symptoms, homoeopathic medicine Lycopodium was selected as similimum. When prescribed in appropriate dose, it resulted in healing in the reverse order of appearance of symptoms. A single remedy took care of both, the manifestation (renal calculi) and causation (hyperuricaemia) by re-establishing the homoeostasis in purine metabolism which was manifested in gradually decreasing serum uric acid levels after expulsion of stone and thus preventing reformation of stone and probably other comorbidities also. Improvement in other unassociated symptoms was also observed during the course of treatment. Homoeopathy treatment is very commonly sought when patients see no hope in conventional system of medicine, which is generally towards the terminal stages of incurable diseases. This case report as an evidence in preclinical condition highlights the use of Homoeopathy right from the beginning of disease.

Here, our case differs from another case report where antisycotic drug was prescribed in the beginning of case to get the clearer picture because the case was one sided. It was followed by change of medicine on basis of repertorisation with intercurrent and acute prescription when needed.[16] While, in our case, totality of symptoms was very clear right from the beginning, and as continuous improvement was observed, change of medicine was not required, and a single remedy completed the cure which was similar to another case report.[16] This is due to different presentations of the cases.

Clinical outcomes are very frequently assessed by homoeopathic physicians using Hering's law of cure. It suggests that following a homoeopathic constitutional remedy, healing occurs from the head down, inside out, most important to the least important organs and reverse order of symptoms in which they first appeared. But unfortunately, not much scientific reporting could be found depicting this law in clinical trials, except for a study on 35 patients of rheumatoid arthritis where 'healing from centre to periphery' was the most commonly reported response and 'reversal of order of symptoms' was reported least.[19] The present case is a classical case supporting this law and the same thing is reflected in miasmatic plane also where disappearance of sycotic manifestations was followed by appearance of psoric symptoms.

In the present case, possibility of spontaneous expulsion of stone due to its small size and decline in serum urate levels due to dietary modifications (less intake of purine rich food) could not be ruled out. Other limitation is inability to keep a check on persisting normal serum urate levels through long-term follow-up of case. Although homoeopathic treatment has shown favourable results in this case and undoubtedly thrown some light on scope of Homoeopathy and possible answer in this unexplored area, controlled studies with long-term follow-up and large sample size are required for validation of the effects of the homoeopathic treatment in such cases.

The outcome of interest, in this case, was reduction in serum urate levels and prevention of possible associated complications, which was successfully achieved while adhering to the basic fundamental principles of Homoeopathy.

Acknowledgement

The author is grateful to Dr. Anil Khurana, Director General, CCRH, for his constant motivation and guidance in writing evidence based scientific articles. The patient is also acknowledged for his compliance in continued follow-ups.

Declaration of patient consent

The author certifies that she has obtained appropriate patient's consent. In the consent, the patient has given his consent for reporting his clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

None declared.



 
  References Top

1.
Raja S, Kumar A, Aahooja RD, Thakuria U, Ochani S, Shaukat F. Frequency of Hyperuricemia and its Risk Factors in the Adult Population. Cureus. 2019;11:e4198. doi:10.7759/cureus.4198.  Back to cited text no. 1
    
2.
Dincer HE, Dincer AP, Levinson DJ. Asymptomatic hyperuricemia: To treat or not to treat. Cleveland Clinic Journal of Medicine 2002;69:594-608.  Back to cited text no. 2
    
3.
Benn CL, Dua P, Gurrell R, Loudon P, Pike A, Storer RI, et al. Physiology of hyperuricemia and urate-lowering treatments. Front Med (Lausanne) 2018;5:160.  Back to cited text no. 3
    
4.
George C, Minter DA. Hyperuricemia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459218/. [Last accessed on 2019 Jun 04].  Back to cited text no. 4
    
5.
Li Q, Li X, Wang J, Liu H, Kwong JS, Chen H, et al. Diagnosis and treatment for hyperuricemia and gout: A systematic review of clinical practice guidelines and consensus statements. BMJ Open 2019;9:e026677.  Back to cited text no. 5
    
6.
Chen C, Lü JM, Yao Q. Hyperuricemia-related diseases and Xanthine Oxidoreductase (XOR) inhibitors: An overview. Med Sci Monit 2016;22:2501-12.  Back to cited text no. 6
    
7.
Shaukat A, Hussain K, Bukhari NI, Shehzadi N. Acid Uric 3×Tablet: Standardization and pharmacological evidence of uric acid use as anti-gout medicine. J Pharm Pharmacogn Res 2020;8:501-14.  Back to cited text no. 7
    
8.
Yashwanth BM, Rai SS, Gowda KP. Effect of bryonia alba homeopathic formulation in mono sodium urate induced gouty arthritis and potassium oxonate induced hyperuricemia in experimental animals. World J Pharm Pharm Sci 2014;4:1120-34.  Back to cited text no. 8
    
9.
Shaffique S, Ahmed S, Rehman T, Mumtaz W, Anwar H, Hussain G. Anti-hyperuricemic potential of Rhododendron tomentosum Harmaja syn. Ledum palustre L. 30c and 1M in potassium oxonate induced rat model. Indian J Tradit Knowl 2018;17:724-311.  Back to cited text no. 9
    
10.
Smulders H. The homoeopathic simillimum treatment of acute arthritis in primary gout in terms of the illness intrusiveness scale, blood uric acid levels using the uricase conversion method as well as the acupulse homeostat machine. 2001. Available from: https://openscholar.dut.ac.za [Last accessed on 2019 Jun 04].  Back to cited text no. 10
    
11.
Saha S, Sarkar P, Chattopadhyay R, Saha S. An open-label prospective observational trial for assessing the effect of homoeopathic medicines in patients suffering from gout. Indian J Res Homoeopathy. 2019;13:236-43.  Back to cited text no. 11
    
12.
Nayak C, Pattanaik N, Chattopadhyay A, Misra P, Bhar K, Michael J. et al. Individualized homeopathic medicines and Urtica urens mother tincture in treatment of hyperuricemia: an open, randomized, pragmatic, pilot trial, Journal of Complementary and Integrative Medicine (published online ahead of print 2020. 20200129. doi: https://doi.org/10.1515/jcim-2020-0129.  Back to cited text no. 12
    
13.
A Deep, A Kumar. Homoeopathic management of hyperuricemia in primary gout: Arandomized single blind placebo controlled study. International Journal of Homoeopathic Sciences2020;4: 73-77.  Back to cited text no. 13
    
14.
Cara R, Tikky M, Solomon EM, Deroukakis M. Homeopathic Treatment of Acute Gout. Am J Homeopathic Med 2007;100:40-9.  Back to cited text no. 14
    
15.
Henriette Smulders. The homoeopathic simillimum treatment of acute arthritis in primary gout in terms of the illness intrusiveness scale, blood uric acid levels using the uricase conversion methodas well as the acupulse homeostat machine. - openscholar.dut.ac.za. 2001  Back to cited text no. 15
    
16.
Bala R, Shrivastava A. case report on hyperuricemia presenting as one-sided disease. Homœopathic Links. 2019;32:105-111.  Back to cited text no. 16
    
17.
Rajan SS, Shibina K. A case of gout trated with Homoeopathic constitutional remedy. International Journal of Homoeopathic Sciences 2020;4:365-8.  Back to cited text no. 17
    
18.
Hahnemann S. Organon of Medicine. 5th ed. New Delhi: B. Jain Publishers; 2002.  Back to cited text no. 18
    
19.
Harrison H. The development and use of Hering's Law Assessment Tool (HELAT) in clinical trials. HRI Res Artic 2012;18:1-3.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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