|Year : 2021 | Volume
| Issue : 2 | Page : 155-161
A 15-mm urinary calculus expelled with homoeopathic medicine - A case report
Seema Rai1, KR Vineetha2
1 Department of Materia Medica, Dr. B. R. Sur Homoeopathic Medical College, Hospital and Research Centre, Nanak Pura, Moti Bagh, New Delhi, India
2 Department of Practice of Medicine, Nehru Homoeopathic Medical College and Hospital, New Delhi, India
|Date of Submission||27-Jun-2020|
|Date of Acceptance||28-May-2021|
|Date of Web Publication||29-Jun-2021|
Dr. Seema Rai
Department of Materia Medica, Dr. B. R. Sur Homoeopathic Medical College, Hospital and Research Centre, Nanak Pura, Moti Bagh (West), New Delhi
Source of Support: None, Conflict of Interest: None
Introduction: Renal or ureteric colic is an acute and severe pain caused by obstruction in the ureter. It usually occurs in the narrower areas of the ureter. It can be associated with severe pain, nausea, vomiting, urinary infections, haematuria, hydronephrosis, etc. Case Summary: A case of 15-mm calculus, lodged at the right ureterovesicular junction, presented with severe cutting pain extending downwards from the right lumbar region to the right groin area. The patient had severe pain at the conclusion of urination. Another calculus of size 10 mm in the lower calyx of the left kidney and 3.4-mm concretion in the right kidney was also detected. The homoeopathic medicine Sarsaparilla was given on the basis of totality of symptoms for 3 days. The pain reduced in 3 days and subsequent to an acute colicky pain and some bleeding, on the 11th day, the stone was expelled. This case report shows the potential of Homoeopathy in cases of large urinary calculi.
Keywords: Homoeopathy, Nephrolithiasis, Sarsaparilla, Ureterovesicular junction, Urinary calculi, Urolithiasis
|How to cite this article:|
Rai S, Vineetha K R. A 15-mm urinary calculus expelled with homoeopathic medicine - A case report. Indian J Res Homoeopathy 2021;15:155-61
|How to cite this URL:|
Rai S, Vineetha K R. A 15-mm urinary calculus expelled with homoeopathic medicine - A case report. Indian J Res Homoeopathy [serial online] 2021 [cited 2021 Oct 27];15:155-61. Available from: https://www.ijrh.org/text.asp?2021/15/2/155/319607
| Introduction|| |
Nephrolithiasis is the third most common disorder of the urinary tract after urinary tract infection and prostatic hyperplasia. Urolithiasis affects about 12% of the world population at some stage in their lifetime. It affects all ages, sex and races, but occurs more frequently in men than in women within the age of 20–49 years. In addition to the common potential sequelae associated with kidney stones, such as pain, infection and obstruction, nephrolithiasis is also considered a risk factor for chronic kidney disease.
Globally, kidney stone disease prevalence and recurrence rates are increasing, with limited options of effective drugs. The high prevalence and recurrent nature of kidney stones contribute to the large economic burden on society related to stone disease.
Current conventional treatment options include extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, retrograde intrarenal surgery and laparoscopic ureterolithotomy.
Homoeopathic literature provides a good scope for treating cases of urolithiasis and at the same time prevents recurrence. The presenting case shows the efficacy of homoeopathic medicine in expulsion of a large urinary calculus (15 mm) which is otherwise considered to be a surgical case. There was moderate pain and discomfort to the patient during the episode. The case also shows some reduction in size of other calculi present (apart from 15-mm calculus) after treatment with homoeopathic medicine.
| Patient Information|| |
A moderate, dark-complexioned male of 24 years of age reported to the outpatient department (OPD) of Nehru Homoeopathic Medical College and Hospital, New Delhi on 25 June 2019 with severe cutting pain in the right lumbar region which extended to the lower abdomen for 4 days.
The pain started gradually around 2 months back as a dull aching sensation in the right lumbar region. The pain continued as such for a month and was ignored by the patient as it was not severe. Subsequently, the pain intensity increased with dysuria and yellowish urine. There was increased frequency and urgency of urination. There was burning sensation while urinating and pain was more at the end of micturition. The pain had suddenly become severe with extension to the lower abdomen for 4 days before the initial presentation. The patient was much depressed due to pain. The urinary flow was interrupted and quantity of urine was reduced. He had taken a few doses of analgesics.
| Clinical Findings|| |
A thorough physical examination of the patient revealed no abnormal findings except moderate tenderness in the lumbar region.
Routine haemogram, serum calcium levels and renal function tests such as serum urea, creatinine, uric acid and serum albumin levels were found to be within normal range. Routine and microscopic examination of urine showed yellowish urine with 4–5 red blood cells. Ultrasound was done which revealed 'a calculus of 10 mm in the lower pole of the left kidney, a 3.4 mm concretion in the right kidney and a 16 mm calculus in the right ureterovesicular (UV) junction with upstream hydronephrosis' [Figure 1]a.
|Figure 1: (a and b) USG reports, before (25 June 2019) and after (16 August 2019) treatment|
Click here to view
Assessment of severity of disease condition was done at the first visit and then during all the follow-up visits. The Baseline Assessment Scoring Form, containing 8 items (pain, haematuria, dysuria, number of stones, size of stone, position of stone in kidney/ureter/bladder), was filled up during each visit as a part of a research study going on in renal stones. These symptoms were rated on a 4-point scale, based on the severity of symptoms, from '0' meaning 'absent' to '3' meaning 'severe'. A total of these symptoms' score was again rated under three categories of mild (score 1–7), moderate (score 8–14) and severe (score 15–23).
At the initial presentation, the symptom score of the patient was 16, i.e. severe. Symptoms of the patient were recorded and medicine was selected on the basis of acute symptom totality. Sarsaparilla turned out to be the leading medicine in the repertorisation analysis with synthesis repertory, covering maximum rubrics (7) and scoring highest points (17) [Figure 2]. Sarsaparilla was prescribed in the 30C potency thrice daily for 3 days. The patient was also advised for dietary management like intake of plenty of water, lime juice, avoidance of spinach, etc.
Follow-ups and outcomes
On the 2nd visit, the patient reported that the pain had reduced to a moderate level, but persisting. Sarsaparilla 30C was repeated for 3 days on follow-up visits [Table 1]. The stone was expelled on the 11th day with an acute colicky pain and slight bleeding. The stone was brought to the OPD by the patient. It was measured, the maximum length of which was 15 mm, whereas the maximum width was 10 mm [Figure 3]. The size of stone, as revealed in the first Ultrasound sonography test (USG) report, was 16 mm. There were some small particles as well which were the broken pieces of the big one. After expulsion of the stone, USG abdomen was performed in the next month only due to non-compliance by the patient earlier, which showed a calculus of size 8.8 mm in the lower calyx of the left kidney and concretions with size of 2–3 mm in the right kidney. There was no calculus in the right UV junction [Figure 1]b. There was also some reduction in the size of the calculus in the left kidney, which was reduced from 10 mm to 8 mm. The patient is undergoing homoeopathic treatment for the remaining stones. The follow-ups show no discomfort or pain to the patient till now. The dietary restrictions are being followed as such.
| Discussion|| |
Urolithiasis places a significant economic burden on the healthcare system, especially in industrialised countries where, owing to changes in lifestyle and diet, the incidence will probably continue to increase for a number of reasons, one of which is global warming. In various studies conducted by conventional medicine, it is shown that stones measuring 5–7 mm frequently pass spontaneously and stones larger than 10 mm do not pass spontaneously and referral to a urologist for active stone removal is warranted in almost all the large (>10 mm) stones and require procedural intervention.,,,,
All the procedures to deal with urinary calculus seem to have physical or surgical approaches and have limitations and may lead to complications. Under surgical approaches, the patients could have faced internal urinary injuries too.,, Recurrence of the diseases, incomplete cure, with side effects and high cost of remedies and interventions of the conventional medical science needs an alternative therapy such as Homoeopathy for treatment of ureterolithiasis.
Homoeopathic system of medicine has already proved its efficacy in combating various urinary diseases. There are several studies which have shown the effectiveness of the homoeopathic interventions prescribed in cases of nephrolithiasis and dissolution and expulsion of bigger stones through homoeopathic treatment.,,,,,, Homoeopathy treats the chronic cases including urolithiasis with the holistic approach where we follow the principle of law of similia. These cases were mostly treated successfully with polycrest remedies or medicines selected on the basis of constitutional totalities.
Many homoeopathic remedies such as Hydrangea arborescens, Berberis vulgaris, Ocimum canum, Lycopodium clavatum and Sarsaparilla are well-known medicines for treatment of calculus.
The present case report was aimed to present remarkable effect of Sarsaparilla in controlling renal calculi. The mention of this is found in homoeopathic literature too.,,,, The literature sources suggest its right-sided affinity for calculi, and in this case also, it has shown remarkable result with expulsion of a 15-mm stone; at the same time, it has acted on the calculus present in the left kidney, also leading to slight reduction in the size. Pain and discomfort did not require any painkillers. Selection of medicine was done on the basis of totality of symptoms. This case is in support of the earlier studies that showed effectiveness of homoeopathic intervention in urolithiasis cases on the basis of constitutional totality of the cases.,,,,,,
It is concluded that positive response and restoration of health in a gentle manner within specific time, without any surgical intervention, as observed in the present case study, signifies that the dissolution or expulsion of the stones is possible by the well-selected constitutional or individualised treatment and it shows the potential of Homoeopathy in difficult surgical cases.
| Conclusion|| |
The case report shows that a surgical case of urinary calculus can be well managed under homoeopathic treatment. We can see the potential of Homoeopathy in treating such difficult cases without surgery, which suggests the utility of homoeopathic medicines in urolithiasis. The case also shows some reduction in size of the stone, which could be due to the stone dissolving property of Sarsaparilla. There is a need for further research to find out the stone dissolving powers of homoeopathic medicines.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for reporting his images and other 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 identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
| References|| |
Chauhan CK, Joshi MJ, Vaidya AD. Growth inhibition of struvite crystals in the presence of herbal extract Commiphora wightii
. J Mater Sci Mater Med 2009;20 Suppl 1:S85-92.
Moe OW. Kidney stones: Pathophysiology and medical management. Lancet 2006;367:333-44.
Romero V, Akpinar H, Assimos DG. Kidney stones: A global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12:e86-96.
Edvardsson VO, Indridason OS, Haraldsson G, Kjartansson O, Palsson R. Temporal trends in the incidence of kidney stone disease. Kidney Int 2013;83:146-52.
Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, et al
. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: A consensus statement. J Nephrol 2016;29:715-34.
Knoll T. Epidemiology, pathogenesis and pathophysiology of urolithiasis. Eur Urol Suppl 2010;9:802-6.
Munjal YP. API Textbook of Medicine. Vol. I & II. Mumbai: JP Medical Ltd; 2015. p. 1800.
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. [Full text]
RADAR Computer Programme. Belgium: Version 10 Developed by Archibel Homoeopathic Software Company; 2009.
Walter L, Strohmaier WL. Recent advances in understanding and managing urolithiasis. F1000Res 2016;5:2651.
Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al
. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol 2016;69:468-74.
Wright PJ, English PJ, Hungin AP, Marsden SN. Managing acute renal colic across the primary-secondary care interface: A pathway of care based on evidence and consensus. BMJ 2002;325:1408-12.
Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR 2002;178:101-3.
Demehri S, Steigner ML, Sodickson AD, Houseman EA, Rybicki FJ, Silverman SG. CT-based determination of maximum ureteral stone area: A predictor of spontaneous passage. AJR Am J Roentgenol 2012;198:603-8.
Tchey DU, Ha YS, Kim WT, Yun SJ, Lee SC, Kim WJ. Expectant management of ureter stones: Outcome and clinical factors of spontaneous passage in a single institution's experience. Korean J Urol 2011;52:847-51.
Rubin JI, Arger PH, Pollack HM, Banner MP, Coleman BG, Mintz MC, et al
. Kidney changes after extracorporeal shock wave lithotripsy: CT evaluation. Radiology 1987;162:21-4.
Baumgartner BR, Dickey KW, Ambrose SS, Walton KN, Nelson RC, Bernardino ME. Kidney changes after extracorporeal shock wave lithotripsy: Appearance on MR imaging. Radiology 1987;163:531-4.
Misra A, Nayak C, Carcinosin PB. A boon for paediatric nephrolithiasis: Case reports. World J Pharm Res 2018;7:922-31.
Sharma S, Wadhwani GG. Experience with homoeopathy in a case of large urethral calculus. Indian J Res Homoeopathy 2013;7:176-80. [Full text]
Gupta AK, Gupta J, Siddiqui VA, Mishra A. Case record: A big urinary calculus expelled with homoeopathic medicine. Indian J Res Homoeopath 2008;2:50-5.
Sumithran PP. A case of multiple urinary calculi. Indian J Res Homoeopathy 2016;10:142-9. [Full text]
Chintamani N, Ratna SA, Chaturbhuja N, Umakanta P, Kumar HA, Biswaranjan P. A case report of ureteric calculus treated with homoeopathic medicine, Hydrangea arborescens 30. Indo American Journal of Pharmaceutical Sciences. 2018 ;5:627-33.1.
Gupta G, Acharya A, Nayak C. Urolithiasis and homoeopathy: a case series. World J Pharm Res. 2018;7:908-31.
Hering C. Guiding Symptoms of Our Materia Medica. New Delhi: B Jain Publishers Pvt. Ltd.; 1995.
Clarke JH. A Dictionary of Practical Materia Medica. Vol. II & III. New Delhi: B. Jain Publishers Pvt. Ltd.; 2005.
Farrington EA. A Clinical Materia Medica. 10th
ed. New Delhi: B Jain Publishers Pvt. Ltd.; 2006.
Hughes R. A Manual of Pharmacodynamics. New Delhi: B Jain Publishers Pvt. Ltd.; 1994.
Hahnemann S. The Chronic Diseases. New Delhi: B Jain Publishers Pvt. Ltd.; 1995.
[Figure 1], [Figure 2], [Figure 3]