Dr Hirannmayee V
INTRODUCTION
Urolithiasis or formation of urinary calculi at any level of urinary tract is the most common, painful, and costly clinical condition. Data indicates that up to 98% of urinary tract stones with size7mm almost always requires surgical intervention.[1] Annual approximate prevalence is 3-5% and approximate lifetime prevalence is 15-25%. Recurrence rates are estimated at about 10% per year, totally over 50% over a 5–10-year period and Above 75% over 20 years.[2]
It is estimated that renal colic affects about 10-20% of men, and 3-5% of women. In India, 12% of the population is expected to have urinary stones, out of which 50% may end up with kidney damage with a incidence of age between 30 – 60 years.[3] About 75%- 80% of renal stone are composed of either calcium oxalate or calcium Phosphate, another 10-15% are of Mg ammonium phosphate and 6% uric acid and 12% cystine stones. Risk factors include age, sex, hot climate, season, stress, less fluid intake, certain foods occupation, affluence, diet, genetic and metabolic changes, Obesity, DM and HTN. Urolithiasis can damage kidney tissue if left untreated and can be very painful.[4] Around 12.7% of India’s population rely solely on homeopathy for their health care[1]. Homeopathy is known to treat urolithiasis by its holistic approach with which it can relive the pain, dissolve the stone, and prevent recurrence and formation of urinary calculi.
UROLITHIASIS:[5]
The production of stones in the urinary tract, which includes the kidney, ureter, and bladder is known as urolithiasis. One of the most prevalent urological illnesses is kidney stones can occur at any point in the urinary tract, they are more commonly located in the kidney and ureter than in the bladder.
CLINICAL FEATURES [8,11]
Clinical presentation depends upon size, position, and type of stone. Large staghorn stones are usually asymptomatic.
- Common presentation is renal or ureteric colic; acute loin pain radiating to the groin with nausea, vomiting is classical; hematuria, microscopic or macroscopic, is invariably present.
- Stone moving down the ureter causes intermittent ureteric obstruction; presents with acute colicky pain.
- Urgency, frequency, strangury occur with stone at ureterovesical junction, presence of fever indicates infection.
- Ureteric stone in a single kidney or bilateral ureteric stones can cause complete anuria and rapid deterioration of renal function.
COMPLICATIONS [5,8,11]
- Hydronephrosis-Refers to reversible dilatation of the urinary tract; if left untreated, it can result in progressive irreversible nephron loss. Urinary tract obstruction refers to structural and functional changes in urinary tract that impede urine flow.
- Urethral stricture, Scarring and Stenosis
- Acute renal failure secondary to obstruction
- Urinary tract infections with renal obstruction- Obstruction by kidney stones in ureters creates a blockage which increases the risk of bacteria getting trapped and multiplying creating a infection. Symptoms are similar including swelling, pain uncomfortable bloody and burning urination. Patient may have fever with chills.
- Sepsis- if the obstruction is not treated with infection increases with spreading to blood and other organs. Low grade fevers with impairment of renal function.
HOMOEOPATHIC THERPEUTICS FOR UROLITHIASIS [12,13,14,15,16]
HYDRANGEA
Murphy and Boericke’s: Hydrangea is a remedy for gravel, profuse deposit of white amorphous salts in urine, Kidney stones with colic and bloody urine. It appears to act strongly on neck of bladder and ureters. Pain in Left kidney, ureter, radiating pains.
Pyelitis, Nephritis. Burning in urethra with frequent desire, stitching pain during urination, Bladder catarrh and stones. Frequent urination with incontinence. Urine – hard to start, heavy deposit of mucus. Spasmodic structure and gravelly deposits.
Clarke: Has a traditional reputation as a ‘Stone breaking remedy’, In physiological doses it produces giddiness, oppression of chest, as ac a cathartic, diuretic, sialagogue and narcotic, Hansen adds that it particularly useful for profuse deposits of white amorphous salts in urine, has arrested tendency to formation of calculi, relieves distress from renal calculus, with soreness over region of kidneys and bloody urine.
BERBERIS VULGARIS
Murphy, Clarke and Boericke’s: It causes Inflammation of kidneys with hematuria.
Kidney colic from kidney stones. Radiating, shooting pain from kidney to bladder, ureter or to liver and spleen arresting breathing. Bubbling sensation in region of kidneys. Urine-Turbid, bright red, yellow with thick mucus, sandy and slimy. Burning soreness in region of kidneys. Sensitiveness in region of kidneys worse from jarring. Frequent urination, Urethra burns when not urination. Pains in loins and thighs on urinating. Burning pains. Sensation as if some urine remained after urinating.
BENZOIC ACIDICUM-
The leading keynote of Benzoic acid is the occurrence strong smelling urine generally also Dark as a concomitant to any disease condition. Antisycotic. It produces and cures symptoms of uric acid diathesis with urine highly coloured and very offensive and gouty symptoms. Gouty and asthmatic. Kidneys Excess of uric acid. Cystitis. Renal insufficiency. Kidney stones. Retention of urine in infants. Urine is hot, dark reddish brown granular kind mucous mixed with phosphates in sediment. Strong foul odor of horse urine, ammoniacal. Bedwetting sheets are unusually stained brown. Enuresis, dribbling of urine. Offensive urine of old men. Vesical catarrh from suppressed gonorrhoea. Soreness, hot burning pain in left kidney.
LITHIUM CARBONICUM
Chronic rheumatism connected with heart complaints and asthenopia Uric acid diathesis, rheumatic nodes. Gout and tophi. Cystitis, sub-acute and chronic. Tenesmus. Soreness of bladder, pain in right kidney and ureter. Pain in bladder extending to spermatic cord after urination. While urinating, pressure in heart. Urine scanty with much thirst with red brown sediment, turbid urine with mucus Urine less despite taking normal drinks. Urine, free and colourless. Turbid urine with mucus, scanty and dark, acrid, sandy deposits.
PAREIRA BRAVA
Useful in renal colic, prostatic affections, and Catarrh of bladder. Sensation as if bladder were distended with pain. Pain going down thigh. Constant urging to urinate, violent pain in the glans penis and down the thighs during efforts of urination, must get on knees and hands pressing head firmly to the floor to urinate. Kidney colic, enlarged prostate with retention of urine and catarrh of the bladder. Dysuria. Urine contains thick, stringy, white mucus or red sand, black, bloody with thick mucus. Dribbling after micturition. Bruised pains in region of kidneys. Itching along urethra, urethritis.
LYCOPODIUM
Lycopodium affects nutrition, due to weakness of digestion. Symptoms run from right To left, acts especially on right side of body and are worse from about 4 to 8 p. m. In kidney affections, red sand in urine, backache in kidney region, worse before urination. Intolerant of cold drinks craves everything warm. Stones, gall stones, gravel. Lithic acid diathesis. Dropsy, ascites in liver diseases. Pain in back before urinating, ceases after flow, slow in coming, must strain. Retention. Child cries before urinating. Kidney colic in ureter (right) to bladder. Urine, scanty, cries before urinating, red sand, must strain, suppressed, retained. Urine, milky, turbid. Hematuria.
SARASPARILLA
Renal colic, marasmus, and periosteal pains due to venereal disease, eruptions following hot weather and vaccinations, boils, eczema. Urinary symptoms well marked. Marasmus, emaciation. Bladder distended and tender. Tenesmus of bladder. Pain from right kidney downward. Urging to urinate before menses. Severe pain at conclusion of urination. Gravel. Kidney colic. Child screams before and while passing urine. Sand on diaper. Can pass urine only when standing. Urine dribbles while sitting. Urine passes in thin, feeble stream. Pain at meatus. Urine scanty, slimy, flaky, sandy, pus, bloody. Crusty urinary sediment. Air passes from bladder during urination.
SEPIA
Sepia affects the venous circulation especially of the female pelvic organs and of digestive tract. It acts specially on the portal system with venous congestion. Stasis and ptosis of viscera. Chronic cystitis, slow urination with bearing-down sensation above pubis. Cutting pain in bladder before urination. Slow urination with bearing down sensation above pubis. Bedwetting during first part of sleep. Involuntary urination, worse coughing, sneezing, laughing, hearing sudden noise, fright, or inattention especially in women. Urine stream feeble, slow. Urine, thick, foul, white gritty. Red, adhesive, sandy sediment in urine. Urine, bloody, milky. All pains are from below up.
URTICA URENS
Urtica is one of the best remedies for burns of the first degree, used locally and given internally. Affects the breast glands, genitourinary organs, liver and spleen. A remedy for lack of breast milk and kidney-stones. Profuse discharge from mucous surfaces. Bee stings, Bedwetting and urticaria. Spleen disorders. Gout and uric acid diathesis. Haemorrhage from bladder. Acrid urine causing itching. Gravel. Uric acid toxaemia. Urine suppressed. Strangury, gravel, disease of bladder and kidneys. Symptoms return same time every year.
CALCAREA CARBONICUM
Irritable bladder. Kidney colic. Bedwetting, incontinence when walking. Polyps. Urine, dark, brown, sour, foul or strong odor. White urinary sediment with milky urine. Urine bloody. Cold damp feet, feel as if damp stockings were worn. Anti-psoric constitutional remedy. Persons of scrofulous type, who take cold easily with increased mucous secretions, children who grow fat, are large bellied with large head, pale skin, chalky look. The leuco-phlegmatic temperament.
CANTHARIS
Acute cystitis, nephritis, nephritic colic. Constant desire to urinate. Intolerable tenesmus, cutting before during and after urine. Dropsy. Kidney region very sensitive. Urine, burning, scalding with cutting pains and intolerable urging. Strangury. Atony of bladder from long retention of urine. Fearful tenesmus or dribbling. Bloody urine. Urine is passed drop by drop. Griping in bladder. Kidney colic. Membranous scales looking like bran in water. Urine jelly-like, shreddy. Its action is very rapid and intense. Inflammations are violently acute or Rapidly destructive in the mucous and serous membranes.
RUBRICS RELATED TO UROLITHIASIS
MURPHY REPERTORY [17]
STONES, KIDNEY – act-sp., ant-c., apoc., arn., bell., BENZ-AC., BERB., CALC.,
CALCULI-R., canth., chin-s., coc-c., coloc., eqius,. Eup-pur., hydrang., ipom., lach., LITH-C., LYC., med., mill., morg-g., nat-m., nat-s., nit-ac., nux-v., oci., PARERIR., petr., phos., SARS., SEP., sil., tab., ter., URT-U., uva.
KENT REPERTORY[18]
URINE – CALCULI – ant-c., arg-n., Benz-ac., Berb., Cact., calc., canth., card-m., chin., coc-c., colch., eup-per., lach., lith., Lyc., mez., mill., naja.,nat-m., nat-s., nit-ac.,nux-m., pareir., petr., phos., puls., raph., ruta., Saras., Sep., sil., tarent., thuj., zinc.
KENT’S REPERTORY:
KIDNEYS- CALCULI (see urine sediment)
URINE-SEDIMENT–
Renal calculi: Bell, Benz-ac, Berb, Calc, canth, coc-c, coloc, equis, hydrang, Lith, Lyc, mill, oci, Pareir, phos, Sars, sil.
BOGER- BOENNINGHAUSEN CHARACTERISTICS AND REPERTORY: [19 ]
URINARY ORGANS- KIDNEY
Calculi– Alu, amb, Ant-c, arn, Calc-c, can, canth, chin, lach, LYC, nat m, nit-ac, nux m, Nux-v, petr, Pho, Rut, Sep, Sil, SARS, sulp, thu, Zin
Colic – Arg-n, arn, atro, bell, berb, canth, coc-c, colo, dio, eup-p, lyc, mag-p, nux-m, nux-v, par, phyt, sars, tab, terb, urt-u, ver-a.
PHATAK’S REPERTORY: [20]
CALCULI (urinary, biliary etc) Formation, of, in general: Bell; Benz-ac; Berb; Bry; Calc; Chin; Coc-c; Colo; Dios; Dulc; Hyds; Lach; LYC; Merc; Nux-v; Oci-c; Par-b; Pod; Pul; Sars; Sep
CLARKE’S REPERTORY: [21]
Renal calculi- Ca.ren, Nux, Ocm, Thl
Renal colic- Ber, Calc, Dio, Ery.A, E.pu, Ind, Lyc, Med, Nx.m, Ocm, Prei, Sars, Urt, Zea.st
SYNTHESIS REPERTORY[22]
Act-sp, alum, am-c, am-m ,ambr, Ant-C, apoc, Arg-n.,arn.,baros.,bell.,bell-p, Benz-ac,Berb, Cact, cal-ren, cal-ren-p, Calc, cann-I, cann-xyz, Canth, cahm, chin, chin-s, chlf, cimic, cocc-c,Coli, coloc, Dios, epig, eqis-h, erig, ery-a, eup-pur, fab, frag, gali, guat, hed, hedeo, hep, hydrang, Ipom-p, kali-bi, kali-c, kali-i, lach, lipp, Lith-c, Lith-f, lith-met, Lith-p, Lyc, mag-p, med, mill, morg-g, nat-m, Nit-ac, nux-m, nux-v, oci, onis, op, oxyd, Pareir, petr, ph-ac, Phos, pipe, polyg-h, rub-t, Ruta, saroth, Sars, saxi, Sep, ser-a-c, Sil, solid, Stigm, sulfa, sulph, Tab, ter, thlas, thuj, urt-u, uva vesi, Zinc.
MIASMS [23,24]
COMPARISON OF THE URINARY SYMTOMS
Throughout the urinary tract we find all the three miasms acting.
PSORIC MIASM REPRESENTING FEATURES OF UROLITHIASIS:
Comprises of conditions relating to functional origin. Pain in kidney area with inflammation of functional origin, Nephritis, pyelitis, cystitis and urethritis, enuresis of functional origin. Stress incontinence. Sensation of fullness ore feeling of constriction in bladder, smarting and burning in urinary meatus or lumbar area. Urine – Generally dark but also yellowish or brownish. Anxiety, apprehension, and fear of incurable diseases. <<cold >> from natural discharges like urination
SYCOTIC MIASM REPRESENTING FEATURES OF UROLITHIASIS:
Here there is a general tendency for accumulation – like calcium, uric acid and oxalates getting deposited and forming stones in kidneys and urinary tract. Nephritic syndrome where oedema predominates. Renal calculi with Stitching and pulsating pains and wandering in character. Urinary cramps with contraction of urethra with child screaming on urinating. Frequent desire to urinate. Urine- yellowish , may have fishy brine odour.<<damp , rainy weather , changes of season.
SYPHILITIC SYMPTOMS OF UROLITHIASIS
Destructive, degenerative conditions of kidney and urinary tract.
Advanced conditions of kidney with pyogenic inflammation and associated with structural and pathological changes. Stricture of urethra. Burning and bursting sensations in bladder or loin area. Urine flow diminishes with frequent desire, burning and irritation during flow. Urine – Red with streaks of pus. Irritation and burning in parts wherever urine touches. [49,50]
BIBLIOGRAPHY
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Dr Hirannmayee V
MD Part 2,Dept Of Practice of Medicine
GHMC&H, Bengaluru.
Under the guidance of Dr Veerabhadrappa.C
Professor, Guide, Dept Of Practice Of Medicine
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