Introduction
Homeopathy is built on the principle that diseases can be cured with medicines that have comparable symptoms. The active substance has usually been significantly diluted with water or alcohol to the point where none or only a few molecules of the active ingredient remain. It's been linked to a higher chance of kidney failure in the end stages.1 Kidney stones are a complex disease, therefore their occurrence, prevention, and recurrence are all difficult to predict. Larger stones, especially those with a diameter of 7mm or more, are known to cause obstruction along their site of occurrence with a slight change in dietary and fluid intake. However, larger stones, especially those with a diameter of 7mm or more, are known to cause obstruction along their site of occurrence with a slight change in dietary and fluid intake.2 Bigger the size and more complicated the site of occurrence greater are the chances of complications including infections, excruciating pain, hematuria etc. Such conditions require aggressive treatments which include Shock Wave Lithotripsy (SWL) and/or surgery.2 SWL is done to shatter or fragment the larger stones breaking them into smaller pieces, facilitating expulsion. Though this method is used more commonly in the US and some European countries as a first line of treatment for bigger stones, it involves more cost to the patient and is not without risk of damaging kidney or contributing to other form of renal injury, depending on the condition of the patient.3 (International Journal of Current Advanced Research) Although the above-mentioned treatments are the first line of treatments for bigger stones globally, there is certain class of patients who still do not prefer surgical intervention for the disease for many reasons. These patients then rely on some orthodox medicine or even many superstitions and malpractices are followed to which the normal patient falls prey to.
The present review thereby wants to bring to the limelight the wonderful results that homeopathy is offering in case of urolithiasis in a very non-invasive and economical way which is not yet popularized.
Pathophysiology of renal stones
Kidney stones form from additional saturation of salts in urine, salts change from a liquid to a solid-state and crystals grow. This leads to the formation of stone which has to be excreted. Stones can be calcium stones (when a patient is hypercalcemic), struvite stones which are formed from magnesium-ammonium-phosphate, or uric acid stones.4 This type of the urinary stones begins as Randall's plaque at the junction of the nephron's collecting tubule and the renal pelvis in the papilla. These plaques start sub-urothelial and then gradually grow until they break through into the renal pelvis. After continuous contact with urine, layers of calcium oxalate typically start to form on the calcium phosphate nidus. The all Randall’s plaques which are composed of calcium phosphate.5 When urinary pH is less than 7.2 it will tends to form calcium oxalate stones. Although, calcium phosphate will form in the more alkaline pH of urine.
Hyperparathyroidism and other metabolic abnormalities, such as renal tubular acidosis, commonly result in calcium phosphate stones that are mostly or considerably constituted of calcium phosphate. Uric acid stones are caused by urine that is too acidic (not hyperuricosuria).6
The majority of the renal calculi are made of calcium, followed by calcium oxalate crystals. In all cases of renal calculi supersaturation of urine. In all cases of renal calculi supersaturation of urine is the common denominator. Calcium oxalate stones may deposit in the renal papilla in some cases. Calcium phosphate stones typically precipitate in the basement membrane of the thin loop of Henle and may erode into the interstitium. The colicky pain is usually due to the dilatation and spasm of the ureter.
Symptoms
The occurrence of kidney stone is formed due to the dehydration, changes in the diet, changes in hormones and due to the kidney infection. The symptoms include renal pain, blood in urine, pus in urine, and fever. The size of stones is plays very important role in the disease. Smaller kidney stones pass naturally through urination before causing any symptoms and may not require treatment. However, in cases of larger stones, where symptoms are seen, treatment is recommended to alleviate the symptoms as well as to get rid of the stones. These larger size of kidney stones can block urine flow and cause painful symptoms such as follows:
Pain in the abdomen or lower back, which is intermittent and severe radiating to groin, and testis in males is the most striking feature
Pain worsens during movement
Blood in urine
Pus in urine
Fever
Difficulty in urination, feeling of urgency, frequent, painful, burning urination
Nausea, vomiting, chills and fever are seen in case of infection
Urinary retention
Types of kidney stones
The chemical composition of stones depends on the chemical imbalance in the urine composition. These kidney stones differ in size, shape and chemical compositions.6 Based on differences in mineral composition and pathogenesis, kidney stones are generally classified into following types - 1) Calcium stones, 2) Struvite or Magnesium Ammonium Phosphate Stones, 3) Uric Acid Stones or Urate, 4) Cystine Stones, 5) Drug-Induced Stones 6) Cholesterol stones and 7) Lecithin kidney stones.
Calcium stones- Predominant renal stones which are Calcium Oxalate and Calcium Phosphate comprise about 80% of all urinary calculi.7 Calcium oxalate is the most common type of kidney stones and exists in the form of CaOx monohydrate (COM, termed as mineral names: whewellite, CaC2O4·H2O), and CaOx dihydrate (COD, weddellite, CaC2O4·2H2O), or the combination of both which accounts for greater than 60%.8 Numerous aspects contribute to CaOx stone formation such as hypercalciuria (resorptive, renal leak, absorptive and metabolic diseases), hyperuricosuria, hyperoxaluria, hypocitraturia, hypomagnesuria, and hypercystinuria (Cellular and molecular gateways to urolithiasis) normally, urinary pH between 5.0-6.5 promotes calcium stone formation. The calcium phosphate stones from when pH is greater than 7.5 or alkaline environment.9 The recurrence of calcium stones is the highest amongst all other types of kidney stones.
Struvite or magnesium ammonium phosphate stones- Struvite stones occurs to the extent of 10 to 15% and have also been referred to as infection stones and triple phosphate stones. It arises among patients with chronic urinary tract infections that produce urease, the most common being P. mirabilis and less common pathogens include K. pneumonia, P. aeruginosa, and Enterobacter.[6] Urease is an enzyme which plays important role to split/break urea to ammonia and CO2, it makes urine more alkaline which promotes pH (typically > 7). Phosphate is less soluble at alkaline v/s acidic pH, so phosphate precipitates on to the insoluble ammonium products, yielding to a large staghorn or coral stone formation.10 Women’s are most probable to develop this type of stone than the male. E. coli is not capable of splitting urea and is not associated with struvite stones.11
Uric Acid Stones or Urate- Uric acid stones are a type of kidney stones which are formed when excess uric acid is produced in the body. Too much uric acid in the body leads to small stones formation, which can cause pain and blood in the urine when patient urinate. Uric acid stones of a small size may pass on their own. For larger stones, physicians may use minimally invasive or non-invasive treatments such as PCNL and shockwave lithotripsy.6 One other popular way is dietary modifications diet with high in purines especially those containing animal protein diet such as meat and fish, results in hyperuricosuria, low urine volume, and low urinary pH (pH < 5.05) which exacerbates uric acid stone formation.9 People with gouty arthritis may form stones in the kidneys. The idiopathic nephrolithiasis is the most common cause of uric acid nephrolithiasis.11 And uric acid stones are more common in men than in women.
Cystine Stones- Among all the stone types, these stones account for less than 2%. It is a genetic disorder of the transport of an amino acid which is cystine. It results in an excess of cystinuria,6 which is an autosomal recessive disorder caused by a defect in the rBAT gene on chromosome-212 this results in impaired renal tubular absorption of cystine or leaking of cystine into urine. Cystine stones are formed when it doesn’t dissolved in urine.9 A homozygous individual with cystinuria excretes more than 600 millimoles of insoluble cysteine per day. The urinary excretion of cystine is the only clinical manifestation of this cystine stone disease.12
Drug-Induced Stones- A numeral medications used to treat a variety of situations may cause urinary calculi. In some cases, these drugs cause embolic abnormalities that may facilitate the formation of stones, such as guaifenesin, triamterene and atazanavir. For example, individuals who takes protease inhibitor indinavir sulphate, a drug used to treat HIV infection, may go on to develop kidney stones.13 Some lithogenic drugs or their metabolic products can deposit to form a nidus or crystallize on the renal calculi already present.14
Best Drug Homeopathic Treatment for Urolithiasis.
Berberis vulgaris (30C) - For left-sided kidney stones homeopathic medicines is one of the best medicine. For the left side kidney stones, Berberis Vulgaris is hugely popular in homeopathic medicines. Some literature highlighted 12.6 x 6.3 mm stone expelled while urinating in 3 months. The symptoms that guide homeopathic medicine prescriptions Berberis Vulgaris is discomfort that radiates from the left kidney to the ureter, urinary bladder and urethra. The discomfort extends all the way down to the thighs. The pain may be accompanied by a burning feeling. It’s also useful for treating gall stones by treating the gallbladder condition with Berberis Vulgaris as well as green or red urine with thick mucus. Kidney pain is worsened by motion and jerking.1, 15, 16
Lycopodium- For the right-sided kidney stones Lycopodium is most reliable homeopathic medicines. Lycopodium is one of the most reliable Homeopathic medicines for kidney stone of the right side. Lycopodium showed 60% of cases were cured and 33% of cases showed improvement. It has shown proven ability to successfully dissolve right-sided kidney stones. Severe backache before peeing, which reduces after voiding urine, is the main symptom that guides the use of Lycopodium. Patients who needs prescription of Lycopodium complains of urgency to urinate, frequent calls to pass urine at night or more incidence of retained urine. Red, yellow sediments may accumulate in urine. Acute right-sided renal colic definitely needs Lycopodium prescription as the most suitable among Homeopathic medicines for kidney stone. Lycopodium is the answer for those suffering from gastric troubles along with wind in the abdomen. Wind in the abdomen may be accompanied by a right-sided kidney stone. The herb can help patients live a life without surgery and be at ease.16, 17, 18
Hydrangea “the stone breaker- Homeopathic medicines such as Hydrangea is one of the most well accepted homeopathic remedy and it is popularly known as “stone breaker”. Those who practice it swear by its results and say the title is justified since, it also eliminates recurrent kidney stones. Hydrangea has proved itself over and over again and is one of the most frequently used Homeopathic medicine for kidney stone, especially in cases where white sediments are observed in abundance in the urine. Urine calls may become more frequent and there may be blood in the urine. These symptoms are accompanied by sharp back ache.1, 16, 17
Example- Hydrangea arborescens 30 can dissolved 8mm stone within duration of 3 months. It is evident that Homeopathic organ specific medicines are also equally effective in treating renal calculi when prescribed on symptoms.
Cantharis- Cantharis is one of the wonderful homoeopathic medicines used for kidney stones with marked burning during urination. For example, a total of 220 cases showed marked improvement. 106 cases out of 220 reported were reported as the calculi were completely expelled. On the other hand, the remaining 114 cases showed the size of the calculi had been reduced. Cantharis is a homoeopathic medicine which demonstrates its greatest efficacy in the treatment of kidney stones when urination is accompanied by marked burning. Patients who have kidney stones and are suffering from severe burning in the urethra are ideal candidates for prescribing Cantharis. The burning occurs before, during and even after urination. Cantharis medicine is effective against kidney stones on either side, but it especially works well in cases where burning is the hallmark symptom. A persistent urge to pass pee also exists, although only a small amount of urine is passed. The urine passes drop by drop in a few cases. Blood is also seen in the urine along with a lot of scalding. In such circumstances, a violet intense tearing sensation is observed in the kidney.1, 16
Pareira brava- Pareira brava is a top-grade homeopathic treatment for kidney stones that required straining and are accompanied by severe pain. Homeopathic remedy Pareira Brava is prescribed for the most sever kidney stone pain with strangury (painful urine in drops). The affected individuals must make excruciating, never-ending efforts to urinate and the procedure is painful. Homeopathic remedy Pareira Brava is prescribed for the most severe kidney stone pain with strangury (painful u/rine in drops). The affected person must make excruciating, never-ending efforts to urinate, and the procedure is painful. Urine is passed with a lot of effort and in drops. The tension is so great that the patient may scream in anguish. The major indication that recommends use of Pareira Brava as the most effective Homoeopathic treatment for kidney stone is renal pain extending down the thighs or even down to the foot.1, 16, 17
Urtica urens- Among the homeopathic treatments for kidney stones with high uric acid levels, this one is particularly effective (gout). Homeopathic medication is used. Urtica urens should be considered in all cases of kidney stones involving a high uric acid levels. In such instances, Urtica urens is the best homeopathic remedy for kidney stones since, it removes the stone effectively.1
Ocimum can- Ocimum can is also most common homeopathic medicines for kidney stone pain accompanied by vomiting. This homeopathic remedy immensely helpful for kidney stone in cases where vomiting is typically observed along with the pain. It can help with both left and right-sided kidney stone pain, but only if the discomfort is accompanied by vomiting. Urine may be saffron-coloured, reddish-purulent and exceedingly unpleasant.
Phosphorus 30C and 200C- For kidney stone treatment Phosphorus 30C and 200C is also most effective homeopathic medicine. In some literature have reviewed that, within month 12 mm stones removes by Phosphorus 30C and 200C.1
Homoeopathic medicines for right-sided kidney stones
Lycopodium, Sarsaparilla and Nux Vomica – These three are considered the best Homeopathic medicines for kidney stone of the right side. When urination causes severe lower back pain that improves after voiding urine, Lycopodium is used to relieve the pain. In some studies Lycopodium clavatum showed expelled 23 mm stone. In cases of right-sided kidney stones with burning pain while passing the last drops of urine, this remarkable results showed by Sarsaparilla.
Sarsaparilla reduces the size of the stone from 16 to 9.4 millimetres. Homeopathy is a type of medicine that is used to treat Nux Vomica is most effective when there is frequent, unsatisfactory urging for faeces, as well as pain from kidney stones. Tree medicines can be considered as an effective alternative and non-invasive treatment option for patients suffering from these critically ill diseases.
Table 1
Patient’s treatment and follow up
Table 2
Repertorisation report of patient report of patient
Homoeopathic Medicines for Left-Sided Kidney Stone
Berberis vulgaris, tabacum and pareira brava
For kidney stone of the left side, Berberis vulagris, Tabacum and Pareira Brava are well indicated homeopathic medicines. Homeopathic medicines such as Berberis vulgaris, Tabacum and Pareira Brava are well indicated medicines for kidney stone of the left side. Berberis vulagaris is indicated where pain in the left kidney extends down the ureter and bladder. Blood may appear in the urine. When left-sided kidney stone discomfort is accompanied by nausea and vomiting, tabacum works well. When it comes to kidney stones on the left side, Pareira Brava is the best homoeopathic remedy to use if you're having trouble urinating due to strong pains and a lot of straining.1, 16, 17
Jaiswal A, (2017) in their literature have highlighted, the effectiveness of homoeopathic treatment in the expulsion of urolithiasis. On the basis of the totality of the symptoms, the deep acting, antimiasmatic, constitutional, similimum, homoeopathic medicine was needed after careful repertorisation and final selection with the help of Materia Medica. The medicine thus selected was Berberis Vul. 30C and was prescribed. Sulph., Nux Vom., Ammon., Arsenic., Belladonna, Plumb., Pulsatilla., Merc. Sol and Lycopodium were other high scoring medicines. These drugs can be differentiated on the basis of their characteristics in the Materia Medica. After the proper medication for around 3 months, a stone was expelled through the urethra during urination and the patient didn’t report any urinary complaint thereafter. The expelled stone was characterized in order to analyse its microstructural features and the elemental composition of the corresponding areas using SEM and EDS respectively. Scanning electron microscope (model EVO MA10 operated at 20KV) and energy dispersive spectrometer was used for (model INCA 250) for investigation of expelled stone. Under the high magnification the images revealed sharp blade and some conical shape particles. In kidney stones existence of elements in the EDS spectra such as Ca and O are most common and are found in the form of calcium oxalates and Mg in the form of struvite. Presence of Si and Mg is further noticed in the stone with higher percentage as compared to the EDS spectra. The presence of Si might have acted as a catalyst in initiating and helped in the further growth of the kidney stone. Detection of silicon in the elemental examination may be the new stone promoter and may be because of the result of increasing air pollution/ food adulteration and impure water.
Case presentation
A 32-year-old male presented to the clinic with severe right flank pain radiating to the right lower quadrant. The pain aggravates on motion and ameliorates on rest. Complaint has started gradually and it may be due to stone(s) in left kidney. The patients had some chief complaints such as, Burning micturition, during and after act of urination. Flow of urination was difficult, slow and painful. Pain stitching type during urination. Pain stitching type during urination as well as sorness, tenderness and irritation near urethra. Throbbing type of pain in right renal region. Urine offensine, hot, scanty, passes drop by drop and bloody urine. Whereas, patient had some other complaints which was renal Caliculi (Kidney Stone) left side, pain in lumbar region. Aggravated lying on left side. No other specific complaints and no treatment adopted previously. USG of whole abdomen was advised which shows a calculus left kidney. Renal calculi, right side, (USG Investigation Done).
The patient’s personal history which includes as follows
Appetite — Moderate
Thirst — Thirstlessnes
Bowel- Urging for stool during urination
Urine- Hot, scanty, Bloody, Yellow urine
Sweat- Moderate
Sleep — Sound
Mind — Fear of disease
Weeping Tendancy
Emotionaly Sensitive
Anger
Irritable
Conclusion
Homeopathic treatment can remove renal stones without surgery and can provide an alternative option for non-invasive treatment and economical way which is not popularized. Homeopathic is best alternative for those people who are afraid of surgeries. In this narrative review, the above-mentioned treatments are the first line of treatments for bigger stones globally, especially for the class patients who still do not prefer surgical intervention for the disease for many reasons.
The presence of kidney stones is an important and challenging clinical problem. Medical therapy, when used judiciously in conjunction with dietary measures, can help in preventing stones. Hence, awareness of the advantages and limitations of different modalities of medical therapy is necessary in order to provide the correct treatment to patients presenting with this common complaint.
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