Treatment of urolithiasis with a homoeopathic constitutional remedy: A case report

INTRODUCTION

The term renal calculi are derived from the Latin words renes, meaning kidney and calculi, meaning pebbles. Renal calculi are solid concretions or aggregations of crystals formed in the kidneys from dietary minerals in the urine.^[1] The first known evidence of urinary stones was found in a 5000-year-old mummy excavated at El Amrah, Egypt, in 1901. Urolithiasis affects 5–15% of the population worldwide and causes the hospitalisation of approximately 1/1000 Indians. Risk factors such as too many calcium supplements, high urine calcium levels, obesity, certain food habits, certain medicines, lack of fluid intake and hot climate predispose to the condition.^[2] Plain radiography of the kidney, ureter and bladder (KUB) region is a valuable diagnostic tool for renal calculi as 90% of calculi are radio-opaque. Ultrasonography is another vital diagnostic tool. Conventional treatment primarily includes surgical intervention. Homoeopathic literature has shown the importance of individualisation in homoeopathic prescription and the efficacy of homoeopathic medicines in eliminating renal calculi.^[3,4] In this case, to assess the likelihood of a causal relationship between homoeopathic intervention and clinical outcome, the modified Naranjo criteria for homoeopathy were used as a tool.

CASE REPORT

Diagnostic assessment

USG KUB investigation revealed a renal calculus [Figures 1 and 2; dated 17 May 2018 and 4 October 2018, respectively].

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Figure 1:

USG KUB (17 May 2018) – Before treatment with evidence of bilateral renal calculi.

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Figure 2:

USG KUB (4 October 2018) – After treatment with no renal calculi.

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Repertorial result [Figure 3]

Management plan

1. Nux vomica was selected as the similimum based on repertorisation as it covers the maximum number of rubrics (8) with the highest marks (18). Nux vomica covers the prominent mentals such as anxiety about business and unrefreshing sleep due to anxiety and physical symptoms such as spices aggravate followed by unsatisfactory bowel habit Natrium muriaticum covered the same number of rubrics but with fewer marks. Materia Medica^[7,8] differentiation yielded the fine points that the Nux vomica constitution emphasises a strong sense of duty and strongly values work ethics. The Nux individual is self-reliant rather than dependent, as seen in this patient. Therefore, Nux vomica 30 C was prescribed thrice a day considering the intensity of the symptoms and to avoid any unwanted aggravation^[6]

2. Rhus toxicodendron was used as an acute remedy for the upper respiratory tract infection [Table 2]

3. Along with the medication, the patient was advised to drink plenty of fluids and adopt a fibre-rich diet with salads for gastric complaints. Decreased sodium consumption was recommended as it increases the possibility of calculi formation. Finally, a regular brisk walk every morning for at least 3–4 km with yoga and meditation was recommended to relieve mental and physical stress.

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Figure 3:

Repertorisation of a case with the help of RADAR Version 10.0 using Synthesis Repertory.^[5]

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Table 2: Follow-up of the case.

Date	Change in symptomatology	Prescription	Justification
31 May 2018	After the first prescription of Nux Vomica 30/TDS, slight relief observed in general complaints	Placebo 30/2 for 14 days	Better in general symptoms
14 June 2018	Pain reappeared in bilateral lumbar region after eating oily and spicy food On examination, tenderness was felt by the patient over bilateral lumbar region but more toward the left side	Nux vomica 30/TDS for 14 days	Dietary factors: Oily and spicy food
28 June 2018	Better in general complaints Lumbar tenderness reduced compared to the previous visit	Placebo 30/2 for 14 days	Better in gastric troubles
12 July 2018	Amelioration in general complaints but had diarrhoea on eating spicy foods. General management advised including diet and regime	Placebo 30/2 for 28 days	Slight improvement; prescribed for 28 days as per the patient’s request as he was out of town due to his business work
09 August 2018	Amelioration in bilateral lumbar region pain. D3-4, loose and unsatisfactory stool. Headache associates whenever excessive flatulence occurred	Nux vomica 200/2D (H.S.) weekly followed by placebo 30/2 for 14 days	Due to recurrence and to accelerate recovery and establish a cure, the next higher potency was prescribed[6]
23 August 2018	The patient took medicines for 10 days and did not take them for 4 days due to fever and cold Watering of the nose: Discharge is thin and sticky Causation: Getting wet in rain. Blockage of nostrils aggravates after sunset. Vitals examination – temperature: 99°F; pulse: 90 bpm Systemic examination: ENT – mild swelling in turbinates and redness around fauces was observed	Rhus tox 200/BD for 3 days followed by placebo 30/3 for consecutive 7 days	Causation: Getting wet in rain (Prescribed as an acute remedy for the upper respiratory tract infection)
06 September 2018	Fever and cold reduced On ENT examination: Swelling of turbinates relieved and redness around fauces disappeared Flatulence in lower abdomen since 3 days ameliorated by passing flatus. Increased thirst (4–5 L in every half an hour) The patient has now become less anxious about his business as explained by himself and his attendant	Nux vomica 200/2D (H.S.) weekly followed by placebo 30/3 for 14 days	Toward improvement
20 September 2018	Amelioration in general complaints USG KUB advised	Placebo 30/3 for 14 days	Patient improved and was, therefore, observed
04 October 2018	General amelioration is attained On examination: No tenderness on abdominal palpation. Bloating relieved. USG KUB: Normal [Figure 3]	Placebo 30/3 for 14 days	Relief in symptoms

DISCUSSION

The patient was stressed due to the recurrence of renal calculi. While advised to undergo surgery, he refused due to his significant fear of needles and opted for homoeopathic treatment.

After the case taking was completed, he was reassured that he had made the right choice. The constitutional remedy Nux vomica provided marked relief in his emotional as well physical complaints that is, in general dyscrasia. In this case, Nux vomica was the individualised remedy that was effective in treating the patient with urolithiasis. A case report by Sumithran stated that Nux vomica acts on the circular fibres of the canal of the ureter, which increases the expulsion force and forces out the calculus at once.^[3] Moreover, the predisposing factors of a sedentary and busy lifestyle with a tendency to catch a cold and develop gastric disturbances further indicated Nux vomica.

After 4 ½ months of treatment, the patient reported marked improvement in all aspects [Table 2]; this was further confirmed using the modified Naranjo criteria of homoeopathy [Table 3]^[9] for evaluation. Both the calculi were expelled, as seen on the USG KUB performed on 4 October 2018.

Total marks obtained = 9/13, which shows that the constitutional remedy Nux vomica got its effective role in treating urolithiasis.

CONCLUSION

Based on this case report, homoeopathy is a safe and effective alternative in cases of surgical conditions like urolithiasis. We also determined that an individualised homoeopathic constitutional remedy prescribed on the basis of totality can be effective in cases of urolithiasis. Research into similar cases is required for further evaluation of the constitutional approach.