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September 2009 | Vol 6 | Issue 9

September 2009 | Volume 6 | Issue 9

 

case
 
A case of Nephrolithiasis
 

 


Dr. Syed Afsar Ali, M.D.(hom)
National Institute of Homoeopathy
West Bengal.
E-mail: afsar.syed@rediff.com

    Introduction:

       Dr. Syed Afsar Ali is an young enthusiastic physician doing his post graduation at National Institute of Homoeopathy Kolkata, West Bengal. He is highly dedicated for the development of Homoeopathic System and he presents a case of case Nephrolithiasis.

    A male aged 32 years had treatment for renal stones

    Presenting Complaints

    A) As narrated by the patient
        Pain in right loin from last 10 months to 1 year
        Acidity, flatulence from last 2 years, with indigestion

    B) Present complaints in details

         Pain in right loin from last 10 months to 1 year. The pain is mild in nature. better little from urination, by rubbing on the region. Frequent urination though small in amount. There is a history of passing tiny particles through urine.

        Indigestion with acidity and flatulence from last 2 years. The complaints aggravated in afternoon and last up to 6 or 7 pm. Nauseating tendency in morning, sour taste in mouth, sour eructation, occasionally sour vomiting.

    C) Complaints on further enquiry: burning in palms and soles and generalized weakness

    Past History

       Chicken pox in early childhood
       Jaundice-about 4 years back (2005?)

    Family History
       Father suffered from arthritis
       Mother has hypertension.
       Paternal Uncle –Kidney disease problem(did not tell definite diagnosis)

    Personal History
       Married
       Irregular mode of living
       Semi urban habitat
       Lower middle class
       Occupation - Grocer

    Mental General
       Dislike company
       Very irritable
       Consolations <
       Anxious about future
       Memory: Weak, Forgetful

    Physical General
       General modalities time: acidity, flatulence aggravates at afternoon
       General sensations and complains (including burning etc.) Burning in palms and    soles. Intolerance to tight clothing.
       General Tendencies : Easily susceptible to cold, < change of weather

    Other physical general
       Thermal reaction: Hot
       Intolerance to sun heat
       Appetite: Normal, easy satiety
       Thirst: Moderate
       Perspiration: from arm pits, sweaty warm palms & soles.
       Bowel: on alternate days, unsatisfactory, hard offensive.
       Urine: offensive, frequent of little quantity.
       Burning at beginning of urination.
       Sleep: Sound. Sleeps on rt. Side. Feels worse after waking in morning.
       Dreams: of daily business.
       Craving: fat, sweet, salt, warm food
       Aversion : Meat

    Other particulars
       Taste: Sour taste in mouth.
       Tongue: flabby imprinted, trembling.
       Sexual function: Normal.

    Clinical Examination
    General Survey
       Fair complexioned, wrinkled in the skin of forehead. Average body built. Pulse-78 /min. BP-130/80 mm. of Hg. Resp.-22/min. Sweaty warm palms and soles. Tongue large flabby, salivated, trembling. Rest within normal limit.

       Systemic Examination: P/A- NAD except mild sore ness on right loin on palpation.

    Laboratory Examinations
    Haemoglobin: 11.5 gm/dl
    Total count- Erythrocytes: 3.9 Mill. /cmm
    Leucocyte: 9,800 /cmm
    Differential Leucocytes count - Neutrophils: 76%
    Lymphocytes: 20%
    Monocytes: 01%
    Eosinophils: 03%
    Basophils: 00%
    Plasma Glucose (Fasting): 88mg/dl
    Urea: 30 mg/dl
    Serum lipase: 37 U/L

    USG of whole abdomen reveals- (02/04/08)
    Hepatomegaly. Multiple small calculi in right kidney and multiple sand like tiny calculi in left kidney. Right sided mild hydronephrotic changes
    No calculus is seen in upper visible part of right ureter. But some obstruction by small calculus might be present in poorly visible middle part of right ureter. (Suggested I.V.P for further a evaluation)
    Creatinine: 1.1mg/dl (04/04/08)
    Intravenous pyelogram/intravenous urography (Digital)-Right ureteric calculus at its lower end.-08/04/08

    Diagnosis
    Renal calculus with hydronephrotic changes

    Miasmatic diagnosis
    Multimasmatic with sycotic predominance.

    Conversion of symptoms in to rubrics [using Synthesis repertory]
    Mind - Irritability
    Mind - Company- aversion to
    Mind – Consolation – agg.
    Mind - Anxiety – future about.
    Mind – Memory - weakness of memory.
    Generalities – food and drinks – sweets - desire.
    Generalities – Food and Drinks – Salt – desire.
    Generalities – Food and Drinks – warm food – desire.
    Generalities - Heat sensation of
    Generalities - cold, taking a- tendency.
    Generalities-weakness-waking on.
    Face-wrinkled-forehead.
    Stomach-eructation, type of -sour
    Stomach – eructations - afternoon
    Urinary organ – urine – odor – offensive .

    Repertorisation
    Sepia 30/15, Lyco 28/15, Nat mur 29/15, Nux vom 24/15,
    Calc. 23/15, Sulph 23/15, Ars 20/15, Chin 20/15, Kali carb 18/15, Phos 24/15.

    Analysis of repertorial result
       Though Sepia carries the highest mark during repertorisation, prominent generalities are covered by the polycrest medicine Lycopodium.
    Final selection of medicine (after consultation of materia medica and with reasons)
    Lycopodium carries 28 marks covering 15 symptoms, it was selected as the final medicine for prescription as it covered the important characteristic physical generals and characteristic particulars.

    First prescription                   10/04/08
    Rx
    Lycopodium 0/1, 16 doses, OD

    Date Observation Interpretation Prescription
    26.04.08 little better regarding uneasiness in the loin, acidity and flatulence The complaints have decreased in intensity.
    Medicine is correct. So higher potency of 1st prescription is prescribed.
    Lycopodium
    0/2/16 Doses/OD..
    14/05/08 All the complaints are better. Patient have informed that with urine little particle like sand grain passed. Patient is on the way to cure. So medicine was continued. Lycopodium
    0/3/16 doses/OD.

        As the patient was improving under Lycopodium he was given the same upto 0/10 in the same manner till September. Pain in right loin is absolutely absent, appetite is improved, acidity and flatulence is better. No burning in palms and soles. Sound sleep with feeling of refreshness on waking in morning. He was advised to do USG of whole abdomen which reveals the following report-01/09/08 Mild Hepatomegally(?) Left renal calculus. No renal calculus is seen in rt. Kidney. No hydronephrotic change. Right ureter is not dilated.


    Before

    After