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Clinical tips for the management of urolithiasis

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Clinical tips for the homoeopathic management of urolithiasis

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Clinical tips for the management of urolithiasis

  2. 2. Definition The term Urolithiasis refers to the formation or presence of stony concretions or crystal aggregation in the urinary tract Stones may be present in • Kidney (Nephrolithiasis), • Ureter (ureterolithiasis), • Bladder(cystolithiasis), or • Urethra
  3. 3. Factors contributing to Urinary Stone formation • Reduced fluid intake resulting in reduced urine output • Exercise causing dehydration • Intake of drugs causing Hyperuricemia • History of Gout • Urinary stasis due to inadequate drainage of urine • Decrease in urinary citrate level leading to increased deposition of calcium • Deficiency of Vitamin A & C • Diseases like Ulcerative Colitis, Sarcoidosis, Hyperparathyroidism • Excessive intake of Proteins
  4. 4. Types of Urinary Stones Struvite These type of stones are usually associated with urinary infection. They can grow very rapidly forming cast in the urinary tract (Staghorn calculus). Left untreated these may cause chronic infection and permanent kidney damage Calcium stones These are composed of calcium compounds mostly calcium oxalate. Sometimes other minerals such as calcium phosphate may also form stones. Calcium Stones may be caused by high calcium level such as in Hyperparathyroidis m. High oxalate level can also cause increased risk for calcium stones Uric Acid Stones Uric Acid Stones are formed due to low urine output, excessive intake of proteins especially red meat, alcohol intake, inflammatory bowel disease, Gout. These form in acidic urine and are not visible in a plain X- RAY Cystine Stone These occur due to an inherited defect in amino acid transport, manifests as recurrent stones in young patients
  5. 5. Clinical Features Nephrolithiasis Recurrent episodes of severe colicky pain in flanks may be due to stone obstructing the ureteropelvic junction. Pain at costovertebral angle, haematuria Ureteric stone Stone passing through the ureter may cause ureteric colic i.e. sharp intermittent pain radiating from flank to umbilical region or perineum . This may be accompanied by nausea, vomiting, tachycardia Bladder stone Characterised by dysuria( pain or burning during micturition), frequency and urgency
  6. 6. Complications Renalfailure Pyelonephritis Perinephric abscess Extravasation of Urine Infection/sepsis Ureteral Stricture Nephrolithiasis can lead to chronic kidney disease or even end stage renal failure
  7. 7. Investigations Plain X-ray Useful in detecting radio-opaque calculi such as calcium oxalate and calcium phosphate but it is not suited for radioluscent stone like uric acid and cystine. Also non urologic radio-opacities like calcified mesenteric lymph nodes etc may be misinterpreted as calculi Sonology Ultrasound can detect calculi and also visualize hydronephrosis Intravenous pyelography Gives information about anatomy and functioning of urinary system as well as visualization of calculi as filling defects Non contrast helical CT Most sensitive and specific investigation
  8. 8. Management • Extra corporeal shock wave lithotripsy- non invasive technique using acoustic pulse to break down calculi • Ureteroscopy- endoscopic removal of calculi • Uretero- renoscopy • Percutaneous nephrolithotomy • Increase fluid intake, this helps in flushing out concretions as well as prevents further build up • Salt intake should be restricted • Depending on composition of stone, dietary restriction may be advised • Intake of animal proteins i.e. meat, eggs, fish should be restricted especially for persons who have hyperuricemia • Oxalate rich foods such as spinach, nuts, tomato, Brinjal, coffee etc. should be avoided especially by persons who have oxalate stones • Persons with hypercalciuria should avoid dairy products like milk, cheese etc. • Avoid large doses of Vitamin D AND Vitamin C supplementation • Increasing Citric acid intake from natural sources like lemon will reduce formation of stones .Acidic urine reduces formation of Calcium oxalate stones Interventional General Management
  9. 9. Homoeopathic Management Remedy Indications BERBERIS VULGARIS Wandering, radiating pain < on motion, standing. Pain in thighs and loins on urinating. Urethra burns when not urinating. Urine with bright red sediment. Bubbling sore sensation in kidneys. Renal colic usually left sided.Sensation as if some urine remained after urinating CALCAREA RENALIS prevents recurrence of renal calculi formation, usually used in 6c potency CANTHARIS Intolerable, constant urging to urinate. Urine scalds, passes drop by drop. Burning, cutting pain before, during and after urination COLCHICUM AUTUMNALE Uric acid diathesis, burning sensation urine, urine dark turbid EPIGEA REPENS Q Burning in neck of bladder while urinating and tenesmus after wards. Fine sand in urine of a brown colour. Indicated in Uric Acid calculi.Muco purulent and Uric acid deposit FRAGARIA prevents the formation of renal calculi. Used in 6c potency HEDEOMA PULEGIOIDES Q Left sided calculi, pain along left ureter. Burning pain from left kidney to bladder. Urging to urinate even after passing urine 1
  10. 10. Homoeopathic Management Remedy Indications HYDRANGEA ARBORESCENS Q Calculus with renal colic. Usually left side. Spasmodic stricture. Sharp pain in the loins. Haematuria. Urine hard to start, burning in urethra, frequent desire to pass urine, profuse deposits of white salts in urine HYGROPHILIA SPINOSA Renal calculus associated with hydronephrosis LYCOPODIUM Renal colic usually right sided. Heavy red sediment. Pain before urination. Pain relieved after passing urine. Also for uric acid calculi MILLEFOLIUM Stone in bladder, retention of urine, bloody urine NUX VOMICA Frequent, ineffectual urging to pass urine. Fastidious, irritable patient. Desire for stimulants, like fat foods OCIMUM CAN Q Renal colic usually right sided. Red sand in urine. Formation of spike crystals of uric acid PAREIRA BRAVA Violent pain in glans penis, pain down thighs during micturition. Constant urging with great straining. Can pass urine only when he goes on his knees, pressing head firmly against the floor 2
  11. 11. Homoeopathic Management Remedy Indications SARSAPARILLA Renal colic, pain from right kidney downwards. Urine dribbles while sitting, uric acid calculi. Urine scanty and bloody. Severe pain at the conclusion of urination. Urine dribbles while sitting. Cystitis. Prevents build up of stones SOLIDAGO V Renal colic extends forward to the abdomen and bladder. Difficult and scanty urine. Offensive urine with reddish brown thick sediment STIGMATA MAYDIS Q Medicine for renal lithiasis. Uric acid diathesis, blood and red sand in urine. Tenesmus after urination TABACUM Renal colic usually left sided. Violent pain along the ureter. Sometimes associated with vertigo and vomiting THUJA OCCIDENTALIS Renal calculus usually left sided. Frequent urination accompanying pain 3
  12. 12. Case History: Renal Calculi, Male, 55 years Submitted by Dr. Anubha Sikka Indications • Patient c/o left renal pain with mild burning micturition • Investigations- USG abdomen • Left ureterovesical junction causing mild hydroureteronephrosis, 7mm in size at lower end of left ureter Prescription Berb vulgaris 30 /tds & colocyth 200 / sos for 1wk. The patient was advised lots of fluids & less spicy food. The patient did not c/o pain .The prescription was repeated and he was advised USG which shows no calculi. Resolution took two months. 1
  13. 13. Case History: Renal Calculi, Male, 55 years Submitted by Dr. Anubha Sikka 1
  14. 14. Case History: Renal Calculi, Male, 55 years Submitted by Dr. Anubha Sikka 1
  15. 15. Case History: Uric Acid Calculus, Male, 28 years Submitted by Dr. Deepti Chawla Indications A 28 Year old male patient c/o recurrent episodes of pain in lumbar region both left and right since many years. Patient underwent many types of treatments , resulting in passage of a stone few years back. The biochemical analysis of this stone revealed that it was a Uric acid Calculus. Since then patient has been having episodes of pain in left lumbar region at times radiating to lower abdomen, he has been taking symptomatic allopathic treatment with temporary relief. Notable generals • Appetite- increased but eating small amount causes sensation of bloating • Desires - sweets2+, milk 1+ • Urine- occasional dysuria • Past h/o haematuria • Mental general were unremarkable • Previous USG reports are attached, these showed mild to moderate Hydronephrosis L kidney, with Hydroureter, one calculus 9mm at lower pole of Left Kidney and one 11.5 mm calculus at left lower ureter 2
  16. 16. Case History: Uric Acid Calculus, Male, 28 years Submitted by Dr. Deepti Chawla Treatment 27 August Started treatment as under • Lycopodium 200/ 3 doses • SL 30 /TDS/ 5 DAYS • Berberis Vulgaris mother tincture/ 10 drops / tds / 5 days Investigation advised • Serum Uric Acid Lab Report indicated raised Serum Uric Acid level-- 7.6 mg/dl symptoms were same Prescription was as follows: Lycopodium 200/ 3doses Colchicum 30/ tds/7days Berb Vulg tinct./ 10 drops /TDS/ 7 days 30 August 06 September Condition same, prescription was repeated 2
  17. 17. Case History: Uric Acid Calculus, Male, 28 years Submitted by Dr. Deepti Chawla Patient complained of sharp pain left loin Prescription: Lycopodium 1M/ 3 Doses Colchicum 30/tds/7days Berberis Vulg tincture/ 10 drops /tds/7 days Hydrangea Tincture/ 10 drops/ tds/ 7 days Patient reported passage of stone with urine few days back with relief in complaints Prescription and advise SL 30 / TDS / 7days ADVISED USG ABDOMEN 23 September 30 September USG Report Mild Hydronephrosis left kidney No report of any calculus 13 September 2
  18. 18. Case History: Uric Acid Calculus, Male, 28 years Submitted by Dr. Deepti Chawla 2
  19. 19. Case History: Uric Acid Calculus, Male, 28 years Submitted by Dr. Deepti Chawla 2
  20. 20. Case History: Uric Acid Calculus, Male, 28 years Submitted by Dr. Deepti Chawla 2
  21. 21. Contributors: Dr Jithesh T.K., C.M.O Dr Pradip Kumar Roy, S.M.O Dr Abakash Barik, M.O. Dr Anubha Sikka, M.O. Dr Sanjeev Aggarwal, M.O. Compiled & Edited by: Dr Deepti Chawla C.M.O, Dte. of AYUSH