Saturday, September 12, 2009

Evidence Based Pilot Study On Role of Homeopathic Drugs In cases of Kidney Stones , Paper to be presented at 18th International Conference on 4 -5 Oct

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EVIDENCE BASED PILOT STUDY ON THE ROLE OF
HOMOEOPATHIC DRUGS IN CASES OF KIDNEY STONES


BY

Dr. Girish Gupta, B. Sc., G.H.M.S. (Gold Medalist), M.D. (Hom.)
Chief Consultant
GAURANG CLINIC AND CENTRE FOR HOMOEOPATHIC RESEARCH



ABSTRACT


A total of 1015 well followed – up cases of renal calculi comprising of 759 cases of Unilateral Renal Calculi and 256 of Bilateral Renal Calculi (including 6 and 3 cases of Urinary Bladder Calculi respectively) were assessed at GCCHR from December 1996 till December 2008. Ultrasonography and / or X–Ray of KUB region was the main diagnostic criteria. In follow–up, the same was repeated after symptomatic relief or after sufficient time gap. Treatment with Homoeopathic drugs showed positive response by dissolution/ fragmentation/ passage of stone in majority of cases. The period of treatment varied from case to case depending on size, type and location of stone.


INTRODUCTION

Nephrolithiasis or Urolithiasis is the formation of stones in kidney and urinary tract respectively. Kidney stones are developed from crystals that separate from the urine in the urinary tract. Normally, urine contains chemicals that inhibit crystal formation. When these chemicals do not work, crystals are formed. These crystals can grow through a process of accretion to form a kidney stone. [1] Stone formation is also related to decreased urine volume or increased excretion of stone–forming components such as calcium, oxalate, urate, cystine, xanthine and phosphate. Kidney stones may contain various combinations of chemicals like oxalate or phosphate of calcium. Struvite stones are formed by infection in the urinary tract. Uric acid and Cystine stones are rare. [2]


OBJECTIVE

1. To critically assess the efficacy of Homoeopathic drugs in patients of Renal and Ureteric calculi.

2. To treat the cases of recurrence after surgery and ESWL.

3. To generate standardized and quality controlled data to facilitate the validation of efficacy of Homoeopathic drugs in cases of renal stones.


TYPES OF STONES

1. Calcium oxalate stones: are the most common type of kidney stone occurring in about 80% of cases [7] and the factors that promote the precipitation of crystals in the urine are associated with the development of these stones. It is a misconception that consumption of too much calcium could promote the development of calcium stones. However, current evidence suggests that the consumption of low-calcium diets is actually associated with a higher overall risk for the development of kidney stones. [23] This is related to the role of calcium in binding ingested oxalate in the gastrointestinal tract. As the amount of calcium intake decreases, the amount of oxalate available for absorption into the bloodstream increases. This oxalate is then excreted in greater amounts into the urine by the kidneys. In the urine, oxalate is a very strong promoter of calcium oxalate precipitation, about 15 times stronger than calcium.

2. Uric acid (urate): About 5–10% of all stones are formed from uric acid. [7] Uric acid stones form in association with conditions that cause hyperuricosuria with or without high blood serum uric acid levels (hyperuricemia) or with disorder of acid/base metabolism where the urine is excessively acidic (low pH) resulting in uric acid precipitation. A diagnosis of uric acid nephrolithiasis is supported if there is a radiolucent stone, persistent undue urine acidity, and uric acid crystals in fresh urine samples. [24]

3. Other types: Other types of kidney stones are composed of struvite (magnesium, ammonium and phosphate); calcium phosphate; and cystine.

The formation of struvite stones is associated with the presence of urea-splitting bacteria, most commonly Proteus mirabilis (but also Klebsiella, Serratia, Providencia species). These organisms are capable of splitting urea into ammonia, decreasing the acidity of the urine and resulting in favorable conditions for the formation of struvite stones. Struvite stones are always associated with urinary tract infections.
The formation of calcium phosphate stones is associated with conditions such as hyperparathyroidism and renal tubular acidosis.
Formation of cystine stones is uniquely associated with people suffering from cystinuria, who accumulate cystine in their urine.
Urolithiasis has also been noted to occur in the setting of therapeutic drug use, with crystals of drug forming within the renal tract in some patients currently being treated with Indinavir, Sulfadiazine or Triamterene. [25]


CAUSES

Kidney stones form when there is a decrease in urine volume or an excess of stone-forming substances such as calcium, oxalate, urate, cystine, xanthine and phosphate in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.
Dehydration due to reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. Kidney stones can also result from infection in the urinary tract; such stones are known as struvite or infection stones. Different conditions that can lead to kidney stones are:

1. Gout: Increased amount of uric acid in urine can lead to the formation of uric acid stones. [7]

2. Hypercalciuria (high urinary calcium): Another inherited condition which causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine where it may form calcium phosphate or calcium oxalate stones. [7]

3. Kidney stones are common in patients with Hyperparathyroidism [10] and Crohn's disease. [12]

4. Kidney diseases such as renal tubular acidosis [7], Dent's disease [9] and Medullary Sponge kidney [11]. It is not only dietary calcium that cause stone but leaching of bone calcium as in renal tubular acidosis causes a chronic acidic state and also decrease urinary citrate levels (since citrates are normally present as potent inhibitors of stone formation) making individual prone stone formation.

5. Inherited metabolic conditions including cystinuria and hyperoxaluria.

6. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.

7. People with inflammatory bowel disease or who have had an intestinal bypass are also more likely to develop kidney stones.

8. Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids and the protease inhibitor Crixivan (indinavir), a drug used to treat HIV infection [18].

9. Fluoridation of water may increase the risk of kidney stone formation. In one study, patients with symptoms of skeletal fluorosis were 4.6 times as likely to develop kidney stones. [13] However, fluoride may also be an inhibitor of urinary stone formation. [14]


PREVALENCE

In United States, about 10–15% of adults suffer from kidney stone. [4] The incidence rate increases to 20–25% in the Middle East because of increased risk of dehydration in hot climates. (The typical Arabian diet is also 50% lower in calcium and 25% higher in oxalates compared to Western diets, increasing the net risk.) [6] Recurrence rates are estimated at about 10% per year, totaling 50% over a 5–10 year period and 75% over 20 years. [7] Men are affected approximately 4 times more often than women. Whites are more often affected than blacks. The prevalence of kidney stones begin to rise when men reach their 40s and it continues to climb into their 70s. A family history of kidney stones is also a risk factor for the development of kidney stones. One in every 20 people develop a kidney stone at some point in their life. Recent evidence has shown an increase in pediatric cases. [8]


SIGN AND SYMPTOMS [15] [16]

1. Renal Colic: Sudden onset of excruciating, cramping, intermittent, extreme colicky pain in back "loin to groin” which waxes and wanes in severity and is not relieved by change of posture, radiating from the back, down the flank, and into the groin with nausea and vomiting. [17] Obstruction in urinary tract due to calculus with dilatation of ureter and renal pelvis as well as spasm of muscle, trying to move the stone, can cause severe episodic pain (Renal Colic).

2. Haematuria: Blood in the urine due to minor damage to inside wall of kidney, ureter and / or urethra. [3]

3. Pyuria: Pus in the urine. [3]

4. Dysuria: Burning on urination due to infection or passage of stone with bad smelling cloudy urine with fever and chill. [3]

5. Nausea / Vomiting: Embryological link with intestine–stimulates the vomiting centre. [3]

6. Oliguria: Reduced urinary volume caused by obstruction of the bladder or urethra by stone causing hydronephrosis. [18]

7. Postrenal azotemia: When kidney stone blocks ureter. [19]


INVESTIGATIONS AND DIAGNOSIS

Clinical diagnosis is usually made on the basis of the location and severity of the pain which is typically colic in nature (comes and goes in spasmodic waves). Pain in the back occurs when calculi produce an obstruction in the kidney. [3] Imaging techniques (X–Rays [5], IVP/IVU (Intravenous Pyelogram/Intravenous Urogram), Retrograde Pyelogram and Ultrasonography are used to confirm the diagnosis. A number of other tests can be undertaken to help establish both the possible cause and consequences of the stone.

About 10% of stones do not have enough calcium to be seen on standard x-rays (radiolucent stones which are seen on Ultrasonography only). Ultrasonography is also instrumental in detecting hydronephrosis [5] and location of stone.

Other investigations include serum calcium levels, routine, microscopic and culture of urine [5]


TREATMENT IN MODERN SYSTEM OF MEDICINE

Most kidney stones eventually pass through the urinary tract on their own with ample fluid intake. Pain medications can be prescribed for symptom relief. There are several factors which influence the ability to pass a stone. These include the size of the stone, prostate enlargement, anatomical variation of urinary tract and pregnancy. Stones of 4 mms or less has an 90% chance of passage while a 5 mm stone has a 20% chance. Stones larger than 9-10 mm rarely pass on their own and usually require treatment. [20]

Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine and alpha blockers such as tamsulosin. These drugs may be prescribed to some people who have stones that do not rapidly pass through the urinary tract.

For kidney stones which do not pass on their own, surgical intervention is required. To avoid classical surgery, a procedure called Extra – corporeal shockwave lithotripsy (ESWL) is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system.

Surgical techniques have also been developed to remove kidney stones. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument known as an ureteroscope passed through the urethra and bladder upto the ureter.


MATERIALS AND METHODS

1. Patients: A total of 1015 well followed – up cases of renal calculi comprising of 759 cases of Unilateral Renal Calculi and 256 of Bilateral Renal Calculi (including 6 and 3 cases of Urinary Bladder Calculi respectively) were assessed at GCCHR from December 1996 till December 2008.

2. Diagnostic Parameter: Ultrasonography and / or X–Ray of KUB region. IVP in a few cases.

3. Assessment Criteria: Side, size, location and number of Renal Calculi.

4. Follow up Ultrasonography or X–Ray: After symptomatic relief or after sufficient time gap.

5. Software: An indigenous software was developed for data analysis.

6. Homoeopathic medicines: The main drugs used are mentioned with individual cases and in tabular form elsewhere.


INCLUSION AND EXCLUSION CIRTERIA

Inclusion Criteria:

1. Cases (symptomatic or asymptomatic) with ultrasongraphic / radiographic evidence of calculi in kidney / ureter / urinary bladder.
2. Size of calculi more than 5 mm.


Exclusion Criteria:

1. Moderate to severe hydroureteronephrosis.
2. Stag horn calculus.
3. Laboratory findings of uraemia (raised Blood urea and S. creatinine) / impaired kidney functions.
4. Recurrent urinary tract infection.
5. Pyonephrosis.
6. Gross haematuria.
7. Acute retention of urine for more than 24 hours.
8. Hyperparathroidism.
9. Gross developmental defects or structural abnormality of kidney.
10. Diseases of cardiovascular and endocrine system, systemic infections or on other therapies.


A FEW MODEL CASES


CASE – 1: REGN. NO.: P–05491 (AGE: 60 YEARS)

PRESENTING SYMPTOMS:

A sixty year old female was suffering from recurrent severe pain left side of lower abdomen with nausea and vomiting with H/O recurrent urinary tract infection (UTI).

PAST HISTORY:
o Cholecystectomy – 2000
o Urticaria – 2004

INITIAL ULTRASONOGRAPHY REPORT (10/12/2004):

A 13 mm calculus is noted in middle calyx of left kidney with focal caliectasis.






















RUBRICS FOR REPERTORISATION:

• Dreams : of unsuccessful efforts
unable to shriek in

• Anxiety about : health
family

• Desire for company
Amelioration from consolation
Sympathetic
Conversation aversion to
Offended easily
Mood changeable
Sentimental
Extrovert
Anger easily
Anger violent
Weeping tendency

• Desire for salty things

• Renal Calculi



RESULT OF REPERTORISATION

REMEDIES PHOS CALC CARB LYCO
TOTALITY 26 23 23
SYMPTOMS COVERED 13/17 13/17 11/17

Medicine Selected: Calcarea carbonica


DATE–WISE FOLLOW UP: REGN. NO.: P–05491

April 15, 2005:
Calcarea carbonica 1000 single dose was prescribed followed by Berberis vulgaris Q 10 drops in ½ cup water thrice daily for 2 weeks.

May 05, 2005:
Pain left side of lower abdomen reduced. Berberis vulgaris Q was repeated for 2 weeks.

May 26, 2005:
Pain abdomen much reduced. Berberis vulgaris Q was repeated for 4 weeks.

June 27, 2005:
Pain in left lower abdomen recurred. Calcarea carbonica 1000 single dose was repeated followed by Berberis vulgaris Q thrice daily for 3 weeks.

July 19, 2005:
Patient was clinically asymptomatic. Ultrasonography of KUB dated 19/07/2005 revealed normal left kidney with no evidence of any calculus.

























CASE – 2: REGN. NO.: I–00138 (AGE: 48 YEARS)

PRESENTING SYMPTOMS:

A forty eight year old female was suffering from recurrent moderate to severe pain right flank with nausea and vomiting.

PAST HISTORY:
o Cholecystectomy – September 2007
o Tubectomy – 12 years back

INITIAL ULTRASONOGRAPHY REPORT (29/09/2008)

A 11 mm calculus is noted in right renal pelvis at pelvi – ureteric junction with hydronephrosis.




















RUBRICS FOR REPERTORISATION

• Desire for company
Consolation aggravates
Offended easily
Weeping tendency
Fastidious
Anger tendency: Talk: indisposed to
Indisposed to talk

• Desire for salty things

• Thirstlessness

• Perspiration on palm

• Perspiration on sole




RESULT OF REPERTORISATION

REMEDIES NAT MUR NUX VOM PULS
TOTALITY 21 18 18
SYMPTOMS COVERED 11/11 8/11 8/11

Heat/Cold Reaction: Hot patient

Medicine Selected: Natrum muriaticum


DATE–WISE FOLLOW UP: REGN. NO.: I–00138

Nov. 11, 2008:
Natrum muriaticum 1000 single dose was prescribed followed by Berberis vulgaris Q 10 drops in ½ cup water thrice daily for 2 weeks.

Nov. 28, 2008:
Right flank pain reduced. Only Berberis vulgaris Q was repeated for 2 weeks.

Dec. 15, 2008:
Right flank pain much reduced. Only Berberis vulgaris Q was repeated for 4 weeks.

Jan. 19, 2009:
Pain right flank with nausea and vomiting. Ocimum 30 was prescribed twice daily and Berberis vulgaris Q was repeated for 2 weeks.

Feb. 04, 2009:
No flank pain. Only Berberis vulgaris Q was repeated for 2 weeks.

Feb. 26, 2009:

Patient was clinically asymptomatic. Ultrasonography of KUB dated 16/02/2009 revealed normal right kidney with no evidence of any calculus at pelvi – ureteric junction.






















CASE 3: REGN. NO.: P–05859 (AGE: 21 YEARS)

PRESENTING SYMPTOMS:

A twenty year old male was suffering from recurrent pain and heaviness right loin region for the last 1 year.

PAST HISTORY:
o Right renal calculus – 2005
o Cervical lymphadenopathy – 10 years back
(took Allopathic treatment)

INITIAL ULTRASONOGRAPHY REPORT (30/04/2006)

A 9 mm calculus is seen in central sinus of right kidney.


RUBRICS FOR REPERTORISATION


• Anxiety about : health

• Desire for company
Amelioration from consolation
Fastidious
Sympathetic
Disposition to contradict
Mood changeable
Sentimental
Extroverted
Remorse
Oversensitive to noise
Quiet disposition
Mildness
Weeping tendency
Memory active
Desire for open air

• Desire for salty things

• Renal Calculi


RESULT OF REPERTORISATION

REMEDIES PHOS PULS LYCO
TOTALITY 31 30 26
SYMPTOMS COVERED 16/18 14/18 14/18

Heat/Cold Reaction: Hot patient

Medicine Selected: Pulsatilla


DATE–WISE FOLLOW UP: REGN. NO.: P–05859

April 30, 2006:
Pulsatilla 1000 single dose was prescribed followed by Berberis vulgaris Q 10 drops in ½ cup water thrice daily for 4 weeks.

May 22, 2006:
Pain and heaviness right loin region reduced. Patient reported of burning at the conclusion of micturition. Sarsaparilla 30 was prescribed twice daily and Berberis vulgaris Q was repeated for 4 weeks.

June 30, 2006:
No pain was reported by the patient. Berberis vulgaris Q was repeated for 4 weeks.

July 27, 2006:
Patient was clinically asymptomatic. Ultrasonography of KUB dated 25/07/2006 revealed normal right kidney with no evidence of calculus.


CASE 4: REGN. NO.: A–01866 (AGE: 25 YEARS)

PRESENTING SYMPTOMS:


A twenty five year old male was suffering from recurrent pain both flanks with dysuria and vomiting off and on for the last 2 years.

INITIAL ULTRASONOGRAPHY REPORT (03/08/2008)

Single 5.4 mm calculus in middle calyx of right kidney. 5.9 mm calculus in lower calyx of left kidney and 7.2 mm calculus at left uretero – vesicular junction with hydroureteronephrosis.


RUBRICS FOR REPERTORISATION

• Ailment from : suppressed anger

• Fear : before examination

• Anxiety : in crowd
about future
about business
anticipating

• Nervousness
Desire for company
Obstinate
Weeping tendency
Sympathetic
Sentimental
Timidity/Mildness
Yielding disposition

• Desire for salty things


RESULT OF REPERTORISATION


REMEDIES LYCO PHOS NAT MUR
TOTALITY 22 22 20
SYMPTOMS COVERED 13/15 10/15 12/15

Heat/Cold Reaction: Hot patient

Medicine Selected: Lycopodium


DATE–WISE FOLLOW UP: REGN. NO.: A–01866

Aug. 06, 2008:
Lycopodium 1000 single dose was prescribed followed by Berberis vulgaris Q 10 drops in ½ cup water thrice daily for 2 weeks.

Aug. 21, 2008:
Flank pain reduced. No dysuria. Only Berberis vulgaris Q was repeated for 2 weeks.

Sept. 08, 2008:
No flank pain but dysuria recurred. Sarsaparilla 30 was prescribed twice daily along with Berberis vulgaris Q for 3 weeks.

Sept. 28, 2008:
Mild flank pain off and on. Dysuria much reduced. Only Berberis vulgaris Q was repeated for 5 week.

Nov. 04, 2008:
No flank pain or dysuria. Only Berberis vulgaris Q was repeated for 4 weeks.

Dec. 08, 2008:
Patient well. Ultrasonography of KUB dated 06/12/2008 revealed normal kidneys with no evidence of any calculus.


CASE 5: REGN. NO.: P–00604 (AGE: 57 YEARS)

PRESENTING SYMPTOMS:


A fifty seven year old male was having asymptomatic multiple left renal calculi for the last 2–3 years with poor, interrupted flow of urine with hesitancy off and on.

PAST HISTORY:
o Passage of calculus – once
o Sinusitis – 20 years back
o Urticaria – in childhood

INITIAL ULTRASONOGRAPHY REPORT (04/04/2008)

Few calculi of 5–8 mms are seen in upper and middle calyx of left kidney with left PUJ narrowing and moderate hydronephrosis

RUBRICS FOR REPERTORISATION

• Ailment : from suppressed anger

• Dreams : of animals
unable to shriek in
business of the day

• Anxiety about : future
family
business

• Aversion to company / Fond of solitude
Irritability
Mood changeable
Thinking of complaints aggravate
Restlessness
Egotism
Dictatorial
Nervousness
Frightened easily
Anger from contradiction
Aversion to work
Sleepiness

• Desire for open air
• Desire for sweet things



RESULT OF REPERTORISATION

REMEDIES LYCO NUX–VOM SEPIA
TOTALITY 41 37 35
SYMPTOMS COVERED 20/22 19/22 19/22

Heat/Cold Reaction: Hot patient

Medicine Selected: Lycopodium


DATE–WISE FOLLOW UP: REGN. NO.: P–00604

April 13, 2008:
Lycopodium 1000 single dose was prescribed followed by Berberis vulgaris Q 10 drops in ½ cup water thrice daily for 2 weeks.

May 19, 2008:
Left flank pain reduced and urinary flow improved. Only Berberis vulgaris Q was repeated for 8 weeks on different visits.

July 27, 2008:
Flank pain much reduced but urinary trouble increased with dysuria at times. Sarsaparilla 30 was prescribed twice daily along with Berberis vulgaris Q for 4 weeks.

Sept. 02, 2008:
Flank pain recurred with urinary trouble. Lycopodium 1000 single dose and Berberis vulgaris Q was repeated for 8 weeks.

Oct. 31, 2008:
No further reduction in flank pain and urinary trouble. Lycopodium 10M single dose was prescribed followed by Berberis vulgaris Q for 8 weeks on different visits.

Jan. 13, 2009:
Patient was clinically asymptomatic. Ultrasonography of KUB dated 28/12/2008 revealed normal left kidney with no evidence of any calculus.


RESULTS

1. Out of 820 stones in different locations of Unilateral renal calculi cases, positive response was obtained in 534 (65.12 %) patients. A total of 455 patients (55.49 %) were cured, 79 patients (9.63 %) improved, 221 patients (26.95 %) maintained status quo and 65 patients (7.93 %) did not improve. (Table – 6)

2. Out of 629 stones in different locations of Bilateral renal calculi cases, positive response was obtained in 366 (58.47 %) patients. A total of 286 patients (45.69 %) were cured, 80 patients (12.78 %) improved, 221 patients (35.30 %) maintained status quo and 39 patients (6.23 %) did not improve. (Table – 6)

3. Best response was obtained in Ureteric stones. Out of 358 Ureteric stones, positive response was obtained in 289 (80.73 %) stones (Table – 12). Better response was obtained in stones of urinary bladder in which out of 9 stones, positive response was obtained in 7 (77.78 %) (Table – 13), followed by 61.40 % in Upper calyx (Table – 8), 57.25 % in Middle calyx (Table – 9), 56.07 % in Pelvic – calyceal system (Table – 7), 54.90 % in Lower calyx (Table – 10). Minimum response 45.53 % was obtained in stones of renal pelvis. (Table – 11)

4. Largest stone cured was of 15 mm in left kidney and 12 mm in right kidney respectively in unilateral calculi cases while 11 mm in left and 26 mm in right was the size of stones in bilateral calculi cases.

5. Five (5) days was the minimum while 746 days was the maximum time taken in cure of a stone.

6. Married patients (67.59 %) outnumbered unmarried ones (32.41 %). However, no definite relation could be established between marital status and occurrence of renal calculi. (Table – 4)

7. Male patients (70.64 %) were more prone than female ones (29.36 %) to develop kidney stones. (Table – 3)

8. Occurrence of renal calculi was maximum between 20 – 35 years of age i.e. 50.15 % while minimum i.e. 11.63 % incidence was seen in patients of 50 years and above. 25.22 % patients were between 36 – 50 years of age while 13.00 % were below 20 years. (Table – 2)


TABLE – 1

DIVISION OF RENAL CALCULI CASES ACCORDING TO SITE AND SIDE

{Total Patients: 1015; Unilateral Renal Calculi: 759; Bilateral Renal Calculi: 256)


(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total patients: 759) (Total patients: 256)
LEFT RIGHT
(Total patients: 391) (Total patients: 368)
SN Position Number Percentage Number Percentage Number Percentage

1. Upper Calyx 43 05.20 % 48 05.81 % 137 21.78 %
2. Middle Calyx 104 12.59 % 91 11.02 % 205 32.59 %
3. Lower Calyx 98 11.86 % 79 09.56 % 160 25.44 %
4. Pelvis 34 04.12 % 51 06.81 % 38 6.04 %
5. Ureter 129 15.62 % 143 17.31 % 86 13.67 %
6. Urinary Bladder 6 00.73 % 3 0.48 %


TABLE – 2

DIVISION OF RENAL CALCULI CASES ACCORDING TO AGE

{Total Patients: 1015; Unilateral Renal Calculi: 759; Bilateral Renal Calculi: 256)


(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total patients: 759) (Total patients: 256)
LEFT RIGHT
(Total patients: 391) (Total patients: 368)
SN Age Number Percentage Number Percentage Number Percentage

1. Below 20 years 55 14.07 % 43 11.68 % 34 13.28 %
2. Between 20–35 years 185 47.31 % 176 47.83 % 148 57.81 %
3. Between 36–50 years 113 28.90 % 102 27.72 % 41 16.02 %
4. Above 50 years 38 09.72 % 47 12.77 % 33 12.89 %



TABLE – 3

DIVISION OF RENAL CALCULI CASES ACCORDING TO SEX

{Total Patients: 1015; Unilateral Renal Calculi: 759; Bilateral Renal Calculi: 256)

(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total patients: 759) (Total patients: 256)
LEFT RIGHT
(Total patients: 391) (Total patients: 368)
SN Sex Number Percentage Number Percentage Number Percentage

1. Male 269 68.80 % 255 69.29 % 193 75.39 %
2. Female 122 31.20 % 113 30.71 % 63 24.61 %



TABLE – 4

DIVISION OF RENAL CALCULI CASES ACCORDING TO MARITAL STATUS


{Total Patients: 1015; Unilateral Renal Calculi: 759; Bilateral Renal Calculi: 256)

(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total patients: 759) (Total patients: 256)
LEFT RIGHT
(Total patients: 391) (Total patients: 368)
SN Marital Status Number Percentage Number Percentage Number Percentage

1. Married 281 71.87 % 265 72.01 % 140 54.69 %
2. Unmarried 110 28.13 % 103 27.99 % 116 45.31 %



TABLE – 5

DIVISION OF RENAL CALCULI CASES ACCORDING TO SIZE OF STONE

{Total Patients: 1015; Unilateral Renal Calculi: 759; Bilateral Renal Calculi: 256)


(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total patients: 759) (Total patients: 256)
LEFT RIGHT
(Total patients: 391) (Total patients: 368)
SN Size of stone Number Percentage Number Percentage Number Percentage

1. Upto 10 mms 333 85.17 % 322 87.50 % 236 92.19 %
2. Between 11–15 mms 41 10.48 % 23 6.25 % 14 5.47 %
3. Between 16–20 mms 14 3.58 % 16 4.35 % 4 1.56 %
4. Above 20 mms 3 0.77 % 7 1.90 % 2 0.78 %



TABLE – 6

OVER ALL STATUS OF STONES (AFTER TREATMENT)

{Total Stones: 1449; No. of stones in Unilateral cases: 820; No. of stones in Bilateral cases: 629)


(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total stones: 820) (Total stones: 629)
LEFT RIGHT
(Total stones: 408) (Total stones: 412)
SN Status Number Percentage Number Percentage Number Percentage

1. Positive Response 269 65.93 % 265 64.32 % 366 58.47 %
1 A. Cured 230 56.37 % 225 54.61 % 286 45.69 %
1 B. Improved 39 09.56 % 40 09.71 % 80 12.78 %
2. Status Quo 114 27.94 % 107 25.97 % 221 35.30 %
3. Not Improved 25 6.13 % 40 09.71 % 39 6.23 %


TABLE – 7

STATUS OF STONES IN PELVI – CALYCEAL SYSTEM (AFTER TREATMENT)

{Total Stones: 1088; No. of stones in Unilateral cases: 548; No. of stones in Bilateral cases: 540)


(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total stones: 548) (Total stones: 540)
LEFT RIGHT
(Total stones: 279) (Total stones: 269)
SN Status Number Percentage Number Percentage Number Percentage

1. Positive Response 161 57.71 % 151 56.13 % 298 55.19 %
1 A. Cured 125 44.80 % 117 43.49 % 225 41.67 %
1 B. Improved 36 12.91 % 34 12.64 % 73 13.52 %
2. Status Quo 95 34.05 % 89 33.09 % 206 38.14 %
3. Not Improved 23 8.24 % 29 10.78 % 36 6.67 %


TABLE – 8

STATUS OF STONES IN UPPER CALYX (AFTER TREATMENT)

{Total Stones: 228; No. of stones in Unilateral cases: 91; No. of stones in Bilateral cases: 137)

(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total stones: 91) (Total stones: 137)
LEFT RIGHT
(Total stones: 43) (Total stones: 48)
SN Status Number Percentage Number Percentage Number Percentage

1. Positive Response 30 69.76 % 29 60.42 % 81 59.12 %
1 A. Cured 24 55.81 % 23 47.92 % 65 47.44 %
1 B. Improved 6 13.95 % 6 12.50 % 16 11.68 %
2. Status Quo 12 27.91 % 13 27.08 % 45 32.85 %
3. Not Improved 1 2.33 % 6 12.50 % 11 8.03 %


TABLE – 9

STATUS OF STONES IN MIDDLE CALYX (AFTER TREATMENT)

{Total Stones: 400; No. of stones in Unilateral cases: 195; No. of stones in Bilateral cases: 205)


(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total stones: 195) (Total stones: 205)
LEFT RIGHT
(Total stones: 104) (Total stones: 91)
SN Status Number Percentage Number Percentage Number Percentage

1. Positive Response 67 64.42 % 52 57.15 % 110 63.16 %
1 A. Cured 53 50.96 % 47 51.65 % 83 40.49 %
1 B. Improved 14 13.46 % 5 5.50 % 27 13.17 %
2. Status Quo 27 25.96 % 33 36.26 % 86 41.95 %
3. Not Improved 10 9.62 % 6 6.59 % 9 4.39 %


TABLE – 10

STATUS OF STONES IN LOWER CALYX (AFTER TREATMENT)

{Total Stones: 337; No. of stones in Unilateral cases: 177; No. of stones in Bilateral cases: 160)


(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total stones: 177) (Total stones: 160)
LEFT RIGHT
(Total stones: 98) (Total stones: 79)
SN Status Number Percentage Number Percentage Number Percentage

1. Positive Response 55 56.12 % 47 59.49 % 83 51.88 %
1 A. Cured 43 43.88 % 38 48.10 % 60 37.50 %
1 B. Improved 12 12.24 % 9 11.39 % 23 14.38 %
2. Status Quo 38 38.78 % 27 34.18 % 66 41.25 %
3. Not Improved 5 5.10 % 5 6.33 % 11 6.87 %


TABLE – 11

STATUS OF STONES IN PELVIS (AFTER TREATMENT)

{Total Stones: 123; No. of stones in Unilateral cases: 85; No. of stones in Bilateral cases: 38)


(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total stones: 85) (Total stones: 38)
LEFT RIGHT
(Total stones: 34) (Total stones: 51)
SN Status Number Percentage Number Percentage Number Percentage

1. Positive Response 9 26.47 % 23 47.10 % 24 63.16 %
1 A. Cured 5 14.71 % 9 17.65 % 17 44.74 %
1 B. Improved 4 11.76 % 14 27.45 % 7 18.42 %
2. Status Quo 18 52.94 % 16 31.37 % 9 23.68 %
3. Not Improved 7 20.59 % 12 23.53 % 5 13.16 %


TABLE – 12

STATUS OF STONES IN URETER (AFTER TREATMENT)

{Total Stones: 358; No. of stones in Unilateral cases: 272; No. of stones in Bilateral cases: 86)

(PERIOD: December 1996 – December 2008)
UNIILATERAL BILATERAL
(Total stones: 272) (Total stones: 86)
LEFT RIGHT
(Total stones: 129) (Total stones: 43)
SN Status Number Percentage Number Percentage Number Percentage

1. Positive Response 108 83.72 % 114 79.72 % 67 79.07 %
1 A. Cured 105 81.39 % 108 75.52 % 61 70.93 %
1 B. Improved 3 2.33 % 6 4.20 % 7 8.14 %
2. Status Quo 19 14.73 % 18 12.59 % 15 17.44 %
3. Not Improved 2 1.55 % 11 7.69 % 3 3.49 %


TABLE – 13

STATUS OF STONES IN URINRY BLADDER (AFTER TREATMENT)

{Total Stones: 9; No. of stones in Unilateral cases: 6; No. of stones in Bilateral cases: 3)


(PERIOD: December 1996 – December 2008)
(Total stones: 9)
UNILATERAL BILATERAL
(Total stones: 6) (Total stones: 3)
SN Status Number Percentage Number Percentage

1. Positive Response 5 83.33 % 2 66.67 %
1 A. Cured 5 83.33 % 2 66.67 %
1 B. Improved 0 0.00 % 0 0.00 %
2. Status Quo 1 16.67 % 0 0.00 %
3. Not Improved 0 0.00 % 1 33.33 %


TABLE – 14

MEDICINES USED IN PRESENT STUDY

SN POLYCREST ORGANIC INTERCURRENT TINCTURES


1. Calcarea carbonicum Ocimum Dioscorea Berberis vulgaris
2. Calcarea renalis Sarsaparilla Colocynthes Cantharis
3. Lycopodium clavatum Magnesia carbonica Cantharis Hydrangea
4. Natrum muriaticum Magnesia sulphurica Uva ursi
5. Phosphorus Kali carbonica
6. Pulsatilla
7. Sepia
8. Silicea
9. Sulphur


PREVENTION


Preventive strategies include dietary modifications and sometimes also taking drugs with the goal of reducing excretory load on the kidneys [21] [16]:

• Drinking enough water to make 2 to 2.5 liters of urine per day reduces the risk of kidney stones. (The National Institutes of Health recommend drinking up to 12 full glasses of water a day if a person is already having a kidney stone.) Water helps to flush away the substances that form stones in the kidneys.
• A diet low in protein, nitrogen and sodium intake. Protein from meat and other animal products is broken down into acids, including uric acid. The most available alkaline base to balance the acid from protein is calcium phosphate (hydroxyapatite) from the bones. The kidney filters the liberated calcium which may then form insoluble crystals (stones) in urine with available oxalate (partly from metabolic processes, partly from diet) or phosphate ions, depending on conditions. High protein intake is therefore associated with decreased bone density as well as stones. The acid load is associated with decreased urinary citrate excretion; citrate competes with oxalate for calcium and can thereby prevent stones. In addition to increased fluid intake, one of the simplest fixes is to moderate animal protein consumption. However, despite epidemiologic data showing that greater protein intake is associated with more stones, randomized controlled trials of protein restriction have not shown reduced stone prevalence.
• Restriction of oxalate-rich foods, such as chocolate, nuts, soybeans [22], rhubarb and spinach, plus maintenance of an adequate intake of dietary calcium. There is equivocal evidence that calcium supplements increase the risk of stone formation, though calcium citrate appears to carry the lowest risk.
• Taking drugs such as thiazides, potassium citrate, magnesium citrate and allopurinol, depending on the cause of stone formation.
• Some fruit juices, such as orange, blackcurrant, and cranberry may be useful for lowering the risk factors for specific types of stones. [23] [24]
• Avoidance of cola beverages. [25] [26]
• Avoiding large doses of vitamin C. [27]
• Avoiding alcohol. It has been claimed that diuretic effects of alcohol can result in dehydration. There are no conclusive data demonstrating any cause and effect regarding kidney stones. However, some feel that frequent drinkers create situations that set up dehydration, hangovers, poor sleep and stress. In this view, it is not the alcohol that create a kidney stone but it is the alcohol drinker's associated behavior that sets it up. [28]
• Alkalinization of the urine with citrates or sodium bicarbonate prevents uric acid stones.
• Though caffeine does acutely increase urinary calcium excretion, several independent epidemiologic studies have shown that coffee intake overall is protective against the formation of stones. [29]


DISCUSSION


Homoeopathic literature is full of medicines which are highly efficacious in dissolution / fragmentation / passage of stone with minimum discomfort. The results are maximized when constitutional homoeopathic medicines are prescribed on totality of symptoms after individualization. Though cases were repertorised and medicines were prescribed on totality, Berberis vulgaris Q was invariably prescribed in all the cases. Cantharis Q was given to patients with recurrent urinary tract infection and cutting, burning pain in renal area with painful urging to urinate. Uva ursi Q was prescribed in patients with profound urinary symptoms like haematuria, frequent urging with spasm of urinary bladder. Sarsaparilla was prescribed in patients reporting severe pain and burning at conclusion of micturition due to crystalluria. Ocimum was given to patient with uric acid diathesis and associated with nausea and vomiting. Intercurrent remedies like Dioscorea and Colocynthes were prescribed to tackle frequent renal colic.

Homoeopathy has been proved to be a boon for patients in whom surgery is risky such as – aged ones, hypertensives and diabetics or those who are in search of an alternative to surgery. The patient can take the treatment along with his routine activities without hospitalization or any inconvenience. Treatment with Homoeopathic drug is simple, cost effective and without any side effects with minimal chances of recurrence as compared to patients having undergone surgery or lithotripsy. In modern system of medicine, it is the “effect” of disease which is treated and not the “cause” whereas Homoeopathy treats the root cause of the disease which minimizes the chance of recurrence. Another advantage of Homeopathic treatment is that it can be taken simultaneously along with the allopathic treatment for any other ailment. Such clinical research studies should be further pursued by other Physicians to open new vistas in converting this surgical problem into medical one through judicious employment of already existing Homoeopathic medicines.


CONCLUSION


1. The result of the present study is highly encouraging and open new vistas for the medical treatment of renal calculi.

2. It is evident from the results that majority of cases of calculi in Kidney, Ureter and Urinary Bladder whether big or small, single or multiple can be cured effectively regardless of their location and composition.

3. By treatment through Homoeopathic system of medicine, post surgical complications can be avoided.

4. Homoeopathic drugs are cost effective and easy to use with no side effects.

5. Recurrence of kidney stones and lithotripsy after surgery is very common because the cause remains untreated. The recurrence rate after homoeopathic treatment is nil or very less as it annihilates the root cause of the malady.


REFERENCES
1. Chiras, Daniel D. (2007). Human Biology. Jones & Bartlett Publishers. ISBN 0763738433.
2. Collins, C. Edward (2005). A Short Course in Medical Terminology. Lippincott Williams & Wilkins. ISBN 0781747678.
3. Weaver, S. H.; Jenkins, P. et al (2002). "Chapter 14: Renal and Urological Care". Illustrated Manual of Nursing Practice (3rd ed.). Lippincott Williams & Wilkins. ISBN 1582550824.
4. Stamatelou, Kiriaki K.; Francis, Mildred E.; Jones, Camille A; Nyberg Jr., Leroy M.; Curhan, Gary C. (2003). "Time trends in reported prevalence of kidney stones in the United States: 1976–1994". Kidney International 63: 1817–1823. doi:10.1046/j.1523-1755.2003.00917.x.
5. Pietrow, Paul K.; Karellas, Michael E. (2006). "Medical Management of Common Urinary Calculi". American Family Physician 74 (1): 86–94. http://www.aafp.org/afp/20060701/86.html. Retrieved on 2008-05-20.
6. Potts, Jeannette M. (2004). Essential Urology: A Guide to Clinical Practice. Humana Press. pp. 129. ISBN 158829109X.
7. Moe, Orson W. (2006). "Kidney stones: pathophysiology and medical management". The Lancet 367 (9507): 333–344. doi:10.1016/S0140-6736(06)68071-9.
8. Tarkan, Laurie (2008-10-28). "A Rise in Kidney Stones Is Seen in U.S. Children". New York Times, The. http://www.nytimes.com/2008/10/28/health/28kidn.html.
9. Lloyd, S. E.; Pearce, S. H. S.; Fisher, S. E.; Steinmeyer, K.; Schwappach, B.; Scheinman, S. J.; Harding, B.; Bolino, A.; Devoto, M.; Goodyer, P.; Rigden, S. P. A.; Wrong, O.; Jentsch, T. J.; Craig, I. W.; Thakker, R. V. (1996). "A common molecular basis for three inherited kidney stone diseases". Nature 379: 445–449. doi:10.1038/379445a0.
10. Hyperparathyroidism. National Endocrine and Metabolic Diseases Information Service. May 2006.
11. Ginalski, J. M.; Portmann, L.; Jaeger, P. (01 Aug 1991). "Does medullary sponge kidney cause nephrolithiasis?". American Journal of Roentgenology 156 (4): 872–3. PMID 2115256. http://www.ajronline.org/cgi/content/abstract/155/2/299. Retrieved on 2008-03-12.
12. ccfa.org
13. National Research Council (2002). Fluoride in Drinking Water: A Scientific Review of EPA's Standard. New York: National Academies Press. ISBN 030910128X.
14. Smith, Donald Ridgeway; Tanagho, Emil A.; McAninch, Jack W. (2003). Smith's General Urology. McGraw-Hill Professional. ISBN 0071396489.
15. http://www.sciencedaily.com/releases/2008/05/080515072740.htm delete
16. Parmar, Malvinder S. (2004). "Kidney stones". British Medical Journal 328 (7453): 1420–1424. doi:10.1136/bmj.328.7453.1420. PMID 15191979.
17. Halabe A, Sperling O (1994). "Uric acid nephrolithiasis". Mineral and electrolyte metabolism 20 (6): 424–31. PMID 7783706.
18. www.utdol.com
19. Mayo Clinic (2008). "Kidney Stone Channel". U.S. News & World Report. http://health.usnews.com/usnews/health/pain/kidneystone/kidneystone.about.htm. Retrieved on 2008-04-23.
20. Reilly, Robert F. (2005). Nephrology in 30 Days. UNC Press. pp. 195. ISBN 1882886208.
21. Goldfarb, David S.; Coe, Fredric L. (November 15, 1999). "Prevention of recurrent nephrolithiasis". American Family Physician 60 (8): 2269–76. PMID 10593318. http://www.aafp.org/afp/991115ap/2269.html.
22. Hassell, Beverly (2001-08-28). "Too much soy could lead to kidney stones". EurekAlert. http://www.eurekalert.org/pub_releases/2001-08/acs-tms082801.php. Retrieved on 2008-06-28.
23. Kelera,, T.; Jansen, B.; Hesse, A. (2002). "Effect of blackcurrant-, cranberry- and plum juice consumption on risk factors associated with kidney stone formation". European Journal of Clinical Nutrition 56 (10): 1020–1023. doi:10.1038/sj.ejcn.1601442. http://www.nature.com/ejcn/journal/v56/n10/abs/1601442a.html. Retrieved on 2008-05-12.
24. Odvina, Clarita V. (2006). "Comparative Value of Orange Juice versus Lemonade in Reducing Stone-Forming Risk". Clinical Journal of the American Society of Nephrology 1 (6): 1269–74. doi:10.2215/CJN.00800306. PMID 17699358. http://cjasn.asnjournals.org/cgi/content/abstract/1/6/1269. Retrieved on 2008-05-12.
25. O'Connor, Anahad (January 22, 2008). "The Claim: Too Much Cola Can Cause Kidney Problems". The New York Times. http://www.nytimes.com/2008/01/22/health/nutrition/22real.html?_r=1&oref=slogin. Retrieved on 2008-04-23.
26. Saldana, Tina M.; Basso, Olga; Darden, Rebecca; Sandler, Dale P. (2007). "Carbonated Beverages and Chronic Kidney Disease". Epidemiology 18 (4): 501–506. doi:10.1097/EDE.0b013e3180646338. http://www.epidem.com/pt/re/epidemiology/abstract.00001648-200707000-00017.htm. Retrieved on 2008-05-12.
27. Taylor, Eric N. coauthors=Stampfer, Meir J.; Curhan, Gary C. (2004). "Dietary Factors and the Risk of Incident Kidney Stones in Men: New Insights after 14 Years of Follow-up". Journal of the American Society of Nephrology 15 (6): 3225–3232. doi:10.1097/01.ASN.0000146012.44570.20. PMID 15579526.
28. Rodman, John S.; Seidman, Cynthia (1996). No More Kidney Stones. Wiley. ISBN 0471125873.
29. Curhan GC, Willett WC, Rimm EB, Spiegelman D, Stampfer MJ (1996, February 1). "Prospective Study of Beverage Use and the Risk of Kidney Stones". Am Jour Epidemiology 143 (3): 240–247. PMID 8561157. http://aje.oxfordjournals.org/cgi/content/abstract/143/3/240.
30. Thomas B., Geeta R. (2006, December). “Nephrolithiasis”. Continued Medical Information of SBL - Renal Disorders and Homoeopathic Management 1 (2): 9 – 28.
31. Gupta G. (1997, February). “A Clinical study on cases of Kidney and Ureteric stones in response to homoeopathic drugs monitored by modern diagnostic parameters”. Souvenir – 9th AHML International Homoeopathic Conference – 1997: 22.

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