An evidence-based case of bilateral nephrolithiasis treated with individualised homoeopathic medicine: A case report

INTRODUCTION

Renal calculi are amongst the most prevalent urological issues.^[1] Approximately 2% of the population develops renal calculi at some point in their life, with a male-female ratio of 2:1. The highest occurrence is seen in people in their 20s and 30s.^[2] Urolithiasis occurs when urine solutes crystallise to form calculi due to factors such as low urine volume, anatomic features causing urinary stasis, dietary factors, infections, acidosis, medications, or genetic factors such as cystinuria. The main cause is inadequate hydration and low urine volume. Other common factors include hypercalciuria, hyperoxaluria, hyperuricosuria and hypocitraturia.^[3]

Renal calculi have different types, including calcium, struvite, uric acid, and cystine. Amongst these, calcium is the most common type, with a higher recurrence rate.^[4] Calculi can be asymptomatic or cause haematuria; moreover, when they pass, they may cause severe pain radiating from the loin to the groin, accompanied by nausea, vomiting, and light-headedness.

Most renal calculi are small enough to pass spontaneously. However, in case of larger calculi (6–7 mm or larger), extracorporeal shock wave lithotripsy or surgery may be required.^[5] Depending on the circumstances, a small calculus (<5 mm) can take 4–6 weeks to pass. However, if it fails to pass spontaneously, the physician can provide appropriate medication, such as an alpha-blocker and calcium channel blocker.^[6] Radiography of the kidney-ureter-bladder region detects 90% of radio-opaque renal calculi, while abdominal ultrasonography (USG) can find radiolucent ones. Computed tomography helps locate small missed ureter calculi.^[7]

Homoeopathy, which takes a holistic approach to treating the individual as a whole, can play an important role in properly managing renal calculi. According to studies, the disintegration or evacuation of calculi can be positively influenced by homoeopathic treatment. The Central Council for Research in Homoeopathy carried out a prospective, multi-centric observational study^[8] to determine the role of homoeopathic therapy in urolithiasis, in which 106 of 220 cases reported the expulsion of calculi. The individualised homoeopathic medicines (IHMs) reported to be effective in this study included Lycopodium clavatum, Sulphur, Pulsatilla nigricans, Nux vomica, and Cantharis.

CASE REPORT

Diagnostic assessment

Ancillary investigation of USG of the whole abdomen indicates multiple small calculi with varying sizes (2.4–3.3 mm) in both kidneys and grade I hepatic steatosis [Figure 1].

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Figure 1:

Ultrasonography report before treatment.

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This case was diagnosed as bilateral non-obstructive nephrolithiasis based on the investigation results. The diagnosis was coded GB70.0 according to the International Classification of Diseases, 11^th Revision classification; it stands for calculus of the kidney.^[9]

Analysis of the case and repertorial result

After conducting a thorough case-taking and analysing all the mental, physical, and particular symptoms, each symptom was evaluated based on its significance [Table 1].

Table 1: Analysis and evaluation.

Characteristic Mental Generals	(i) Irritability.
Characteristic Physical Generals	(ii) Appetite – easily satiate.
	(iii) Desire – raw onion, salty and cold food.
	(iv) Perspiration – offensive in odour.
	(v) Urination had a strong odour.
	(vi) Thermal relation – chilly.
Particulars	(vii) Burning sensation during urination.
	(viii) Pain in both lumber regions extending to the groin.
	(ix) Pain < before burning urination and > by motion.

In this case, repertorisation was carried out using the Zomeo computer software, using Kent Repertory.^[10] After repertorisation, the top-ranked medicines were Thuja (17/8), Phosphorus (16/7), Lycopodium (15/6), and Nitric acid (15/6). The repertorial result is shown in Figure 2.

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Figure 2:

Repertorial sheet. The numbers in brackets indicate the number of medicines containing that particular symptom. The number 1/2/3 indicates grading of symptoms as per Kent’s repertory.

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DISCUSSION

In this case, the patient had bilateral renal Calculi, that were successfully treated using homoeopathy. Although these calculi were non-obstructive or small sized, they had been bothering the patient for 6 months, prompting him to seek medical assistance. This case report followed the HOME-CASE guidelines^[13] for reporting the outcomes.

After a detailed case-taking and symptom analysis, Thuja Q1 was selected as the IHM for this case. Urine examination report at second visit (Jan 05, 2022) shows that RBC in urine was within normal limits [Figure 3]. After the initial prescription, the patient began to improve in his presenting issues within 1–2 months, and his complaints were fully resolved after 4 months. Thuja up to 0/5 was maintained, and a USG of the entire abdomen was conducted on May 04, 2022, revealing no renal calculi. Hepatic steatosis or fatty liver also got resolved with the same IHM [Figure 4]. Urine examination was done which shows no red cell in urine [Figure 5]. In one study, homoeopathic treatment was reported to be effective in renal calculi linked with fatty liver.^[14]

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Figure 3:

Urine report before treatment.

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Figure 4:

Ultrasonography report after treatment.

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Figure 5:

Urine report after treatment.

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There have been several studies that demonstrate positive results in treating cases of renal calculi with homoeopathy.^[15-18] Even large urinary calculi (16.9 mm) have also been reported to be eliminated by homoeopathic treatment.^[19] The homoeopathic medicine, i.e. Thuja, was also found to be beneficial in the treatment of renal calculi.^[20]

The case was assessed using modified Naranjo criteria (MONARCH Inventory),^[21] which revealed a positive correlation between homoeopathic treatment and the outcome [Table 3].

The approach to managing renal calculi requires a personalised strategy. Evaluating symptoms, medical history, and test results aid in determining the necessity for immediate surgery or medical intervention. For clinically stable individuals with non-obstructive calculi, individuals who frequently develop calculi, and those with underlying systemic conditions, medical management is the recommended course of action.^[22] Homoeopathy is a simple system of medicine that focuses on addressing the person as a whole, considering both physical and emotional aspects for effective healing.

CONCLUSION

In this case, multiple renal calculi were present bilaterally and were treated efficiently with IHM. While homoeopathy offers a potentially attractive alternative for managing renal calculi, the current scientific evidence is inconclusive. Further, high-quality research, including well-designed randomised controlled trials, is necessary to determine the true efficacy and safety of homoeopathic remedies in treating renal calculi.