May 2013|Vol 10|Iss 5

   
 
Case
 
   
A case of seventh Kent observation
 

 

Dr. Nagaraju. R.
M.D. part-II,
JSPS Govt. Homoeopathic Medical college,
Hyderabad-13

 
 
 

        A fifty eight years old male had pain in loins since three months. Additionally he had edema of both feet since 3 months. Pain dull aching
Heaviness ++
< at night and Evening
> morning
Disturbed sleep.

History of presenting complaints

       Patient was apparently well 3 months back gradually develop pain in right loin and then in left loin associated with constipation with hard stool bleeding per rectum after passing stool. After 2-3 days he developed swelling of both feet with heaviness and stiffness of both lower limbs approached to a physician underwent investigations diagnosed as chronic kidney disease with hypertension advised dialysis so he approached to our hospital to avoid dialysis.

Past History

       Met with accident while travelling in bull cart injury on back without any fracture
       No H/O Other Specific Illnesses, Operations.

Family History

       No relevant family history.

Personal history

Appetite-Moderate
Thirst-Moderate, 4-5 glasses/day
Urine- D/N -3/1
Bowels-Regular and satisfactory
Sleep –Refreshing, snoring, dreams of daily events
Thermal State- Chilly patient+++
Habits – smoking from the age of 17 used smoke 2-3 packets of cigarettes, stopped since 3 months.

Physical Examination

       Moderately built, well nourished with grey hair, edema of both feet clubbing -+ Vital data- BP-140/90 mm of Hg with Rx on anti-hypertensives, PR-72/min regular in rhythm, HR- 72/min , RR- 18/min, TEMP-A febrile.

Systemic Examination

       Abdomen –No organomegaly , pendulus abdomen. No tenderness.
       CVS,RESP, CNS –NAD.

Investigations

USG dated 4th feb 2013 –abdomen –bilateral renal parenchymal disease
Hb % - 8.o mg/dl
RBS-142 mg/dl
Serum.creatine -5.0 mg/dl
Urine - Albumin-++
3-4 pus cells/hp,1-2 epithelial cells

 

Clinical Diagnosis

       Bilateral Renal Parenchymal Disease-Chronic Kidney Disease.

Prescribing Totality

1. Pain in loins –dull aching <night.
2. Edema of both feet <night,>morning.
3. Disturbed sleep
4. H/O smoking
5. Chilly

Management

       Advised low salt diet, low protein diet. Monitoring of 24 hours urine output.

Remedy prescribed – Ars.alb 200

Follow up

1. 21/2/13.- Ars.alb.200

2. 23/2/13- swelling of feet reduced slightly. Pain in loin was reduced. Bp-140/80mm of hg .Rx – SL- 3 doses.

3. 24/2/13 -No specific improvement than yester day –Bp-130/80 mm of hg Rx – SL- 3doses.

4. 25/2/13- swelling of feet reduced, pain in loins was reduced. Bp- 140/80 mm of hg Rx-Ars.lab 200-1 dose. Advised for s.creatine levels and CBP, ESR,CUE.

5. 26/2/13- feeling better, edema is reduced, loin pain slightly present Bp- 140/80 mm of hg Rx- sl-3 doses.

6. 27/2/13-CUE-albumin-+
Serum creatinine 3.7 mg/dl
Feeling better but not complete relief RX- Ars.alb 200 – 1 dose
Patent was discharged advice for regular check up in OPD.

Discussion

       This was a case of one sided disease with poor function of both kidney Ars.alb 200 advised as partial similimum. Patient was improved but not completely. In this case Dr. kent’s 7th observation was observed amelioration of symptoms but no special relief. Because of gross pathological changes patient was improved some extent but not completely. This case was still on observation.