Chronic Renal disorders..Homeopathy

This paper was presented by the author at IHMA seminar on Chronic renal disorders at Calicut on 15th Aug 2004

This paper is a compilation of research works conducted by various Homoeopathic institutions in our country. Mainly CCRH (Central Council for Research in Homeopathy), Dr. Rajneesh Kumar Sharma at Suray nature cure Uttaranchal, Pareek Hospital & Research Centre,Agra (India), Dr.Rajesh Sha - a classical Homeopath at Delhi

Instead of elaborating the detailed therapeutics, I would like to present - What should be the approach of Homeopath in renal disorders ? What are the scope and limitations of Homeopathy in kidney disorders ? What we can offer to the community ? etc…

KIDNEYS AND THE HOMOEOPATHIC PERSPECTIVE
Dr.K.R.Mansoor Ali .BHMS,MD(Hom),PGDPC

Homoeopathy does not recognise kidneys as a mere organ of excretion or selective filtration but always recognises it in relation to the individual as a whole. Kidneys have a generalised function--the fluids coming to it and going from it influence every organ, tissue and cell of our body. Kidney function influences the complete vital economy of our body.

It is very important to study the mental picture of patients with primary kidney diseases.
Fear, Anxiety and Shocked State of Acute Renal failure
Depression and Underlying Mental Uneasiness of Chronic Renal failure.
Kidneys are associated with deep emotional life. There are definite 'Renal types' of patients.'Renal type' of patients--They always have an organic fear. They are afraid of having some hidden illness.

ACUTE RENAL FAILURE
Majority of cases of A.R.F. are emergencies, critically ill & hospitalised. Considering the gravity of critical illness, most homoeopaths shy away from treating such cases. Our hospital experience reveals that the indicated homoeopathic remedies backed by accessory medical help act instantaneously in these cases.

Points to remember while managing ARF
(i) Look for the cause of A.R.F. and whether it is Pre-renal, renal or Post-renal.
(ii) Have a full knowledge of emergency handling and to take fullest help of accessory life saving measures. Remember the accessory lives saving measures are no monopoly of any particular medical system.
(iii) We must have a good knowledge of key-notes of well-proved remedies in our Materia Medica. Emergencies like A.R.F. demand Similimum to be picked up at the very first stroke. Observations of objective symptoms are very important.

Some of the remedies which proved to be very helpful in cases of Acute renal failure at CCRH include: Ars. alb, Apis mel., Carbo. veg., Cuprum ars., Digitalis, Helleborus, Opium and Vereterum album.

CHRONIC RENAL FAILURE (C.R.F.)
The state of patient with end stage renal failure or progressive reversible chronic renal disease is very pathetic not only for the patient itself but also for the family and society as a whole.

The individualised homoeopathic therapeutic modality considering the patients psychological presentation is very important. Homoeopathy does wonders here and has prevented a large number of cases progressing to Hemodialysis and Renal Transplant.

The usual presentation of C.R.F. in Homeopathic hospital includes:
1. Patients with just diminished renal reserve.
2. Patient with End Stage Renal Failure pending Hemodialysis and Renal Transplant.
3. Patient already on long term Dialysis pending Renal Transplant.
4. Post Renal Transplant Patients.

1. Patients with just diminished renal reserves:
This is the best field for us to work but unfortunately, the number of cases presenting at this stage are very few. The individualised homoeopathic treatment does wonders here and have prevented a large number of cases progressing to stage of dialysis or renal transplant.

The usual symptomatic presentation at this stage is vague with patients mostly complaining of nausea, anorexia and progressive weakness. The laboratory renal parameters are also not very seriously disturbed. The evolution of individualised totality comprising of the mental sphere, habits, past and family history require lots of patience and labor but the results are marvellous.

Homoeopathy has already done a yoeman service to the society here as hemodialysis and renal transplant are not within easy reach of majority of population in under- developed countries.

2. Patients with end-stage chronic renal failure pending Hemodialysis & Renal Transplant:

This is the group of cases with maximum presentations in the clinics. Majority of these cases come to homoeopathic rescue as a last resort as they can't afford long-term dialysis and transplant.
The other small group of patients want to know the benefits of Homoeopathic treatment over dialysis and if Homoeopathic treatment be carried along with Hemodialysis? The clinical judgment is individualized and varies for every patient. Remember the correlation of uremic symptoms with renal functions varies front patient to patient.

A research conducted by Pareek hospital & research centre at Agra revels that APIS MEL, ARS ALB, CUPRUM ARS, COLCHICUM, EEL SERUM (SERUM ANGUILLAR ICHTHYOTOXIN), GLONOINE, HELLEBORUS, MORPHINUM, OPIUM, PLUMBUM MET were found to be most useful Homoeopathic remedies in these cases.
Apocynum can., SOLIDAGO VIRGA and TRIBULUS TERRESTRIS were found to be most useful organ remedies in drop doses.

3. Patients already on long-term hemodialysis pending renal transplant:

Homeopathy has a great role to play here. Research experiments in various hospitals reveals the following facts :
(a) Indicated homoeopathic remedies reduced the number of dialysis needed over a period of time.
(b) Indicated homoeopathic remedies reduce and overcome the complications associated with chronic dialysis therapy.

Complications of dialysis & its Homeopathic Management
Remember a chronic dialysis patient depends on a machine for his life. These patients develop a variety of psychiatric, neurologic and somatic disorders. A neurologic disorder 'Dialysis dementia' is a characteristic example.
In the mental sphere, these patients become very depressive, their reduced physical abilities make them sad and depressive like AURUM.
They become very irritable like Nat. mur., Nux vomica.
They know that they have to depend on others, they tolerate and do not express the frustration like Staphysagria.
In the physical sphere infections, thrombosis and aneurysm formation occur in the Arterio-venous fistula. There is a high incidence of septic embolisation in these cases. The homoeopathic remedies Arnica, Pyrogenium and Echinacia have immensely helped these cases.
Heparin necessary during the hemodialysis procedures to prevent clotting leads to complications such as subdural hematoma and intracerebral hemorrhage. Arnica and different well-proved snake poisons in our Materia Medica are of great help here. .

4. Post Renal Transplant Patients:
The group of patients coming for homoeopathic advice after Renal Transplant is very limited. Homeopaths have very little experience with these patients and the results are not very encouraging. Most of the symptoms here are marked and distorted by immune-suppressive therapy. Immuno-suppressive therapy suppresses all immune responses and hence Homoeopathic treatment has not much role to play in organ rejection of transplant cases.

From the extensive study conducted at CCRH concluded that Homoeopathy with its individualized therapeutic approach including the psychological aspect of the patients goes a long way not only in a better recovery of Renal Failure but also in minimising the number of cases proceeding to Hemo-Dialysis and Renal Transplant and overcoming effectively the complications of chronic dialysis therepy.

We have observed that those cases with renal failure, being put on Dialysis and if they receive homoeopathy medication simultaneously, they require less frequent dialysis and their quality of life improves.

How and Why Investigations
For patients suffering from renal disorders, investigations become imperative to determine the cause and nature of the renal disease. Early detection ensures proper management of renal dysfunction.
For Homoeopaths too, this understanding will lead to better management and prognosis. The follow-up investigations will allow regulation of dosage. Once cured, a paper presented on these lines will stand the scrutiny of the scientific community.

Nephrotic syndrome - research conducted by Dr.rajesh Shah
Homoeopathy treatment is indicated in all the cases of Nephrotic syndrome. However, children and early developed cases respond very well to homoeopathy. It is possible to avoid steroids in these cases and it is also possible to gradually taper off the dose of steroids in those steroid dependent cases.

Inspite of atrocious nature of the condition, it is possible to treat Nephrotic Syndrome successfully. The treatment of Nephrotic Syndrome has to be planned strategically on a long-term basis. Nephrotic Syndrome being a chronic and deep-seated disease, there is no short cut in the treatment. Homoeopathic treatment is strongly recommended during all stage of Nephrotic Syndrome.

Research at CCRH New Delhi
23 cases of nephrotic syndrome in children under 12 years were treated in CCRH with homeopathic remedies for periods varying from 1 month to 7 years. The clinical pictures during exacerbations and remissions in all the cases are presented.

Apis mellifica and Arsenicum album indicated remedies in most of the cases during exacerbations. No clear-cut indications were found for constitutional remedies in any of the cases. Natrum muriaticum was partially indicated in two cases and Silica in one. Since selection of constitutional remedies was almost impossible in the other cases it was decided to try in all cases.
Natrum muriaticum, Silica and 14 other remedies that covered most of the clinical and pathological symptoms. Calcarea Carbonica, Natrum muriaticum and Silica have been found to act satisfactorily in cases with poor symptomatology and therefore they have been recommended for use in such cases.

Treatment of Nephrotic Syndrome can be planned as under:
1. Dietary and general management
2. Medicinal management

1. Dietary and general management:
The cardinal features of Nephrotic Syndrome being hypoalbuminemia, hypercholesterolemia, and edema. Dietary management plays a vital role in the overall management of Nephrotic Syndrome. The mainstay of dietary management is
o Salt restriction
o Adequate protein intake
o Replace saturated fats with mono or polyunsaturated fats.
o Fibre rich foods and Reduce sugar

In addition to this, prevention of infection and treatment of other disease where Nephrotic Syndrome is secondary to the underlying disease condition is an important step.

2. Medicinal management:
Homoeopathy treatment:
The system of homeopathic medicine has a promising role to offer for the treatment of Nephrotic Syndrome, inclusive of all its variants.

What is to be treated?
When we talk about the treatment of Nephrotic Syndrome, we have to be clear about 'what is to be treated in the case of Nephrotic Syndrome?'

Going back to the causes of Nephrotic Syndrome, let us recall that Nephrotic Syndrome is not just a disease of the kidneys. Nephrotic Syndrome is a multi-factorial, deep level disorder, which is offshoot of wide array of diseases. However the basis of Nephrotic Syndrome and many diseases, which ultimately end up in Nephrotic Syndrome, is imbalance of immunological system in the body, producing functional disturbance at the level of the kidneys.

With this understanding of the disease, it is may be clearly perceived that the any treatment targeted simply at the level of kidney symptoms will have little help. Also treatment directed towards suppressing these expressions of altered immunity will not help the person in along run. . In the same way, Nephrotic Syndrome too upsurges once the suppressive treatment subsides.
The conventional mode of treatment directed towards merely relieving symptoms of edema will prove too superficial an approach, when we are looking at the long-term goal of treating the disease at a root level.

The homeopathic approach to treat Nephrotic Syndrome:
It should be emphasized that homoeopathy treats patient who is diseased and not the disease, which the patient has.The basic approach in homeopathy is to evaluate the disease of Nephrotic Syndrome in its whole extent, whereby a lot of emphasis is given to the patient as a whole besides minutely studying various aspects of the Nephrotic Syndrome.
The homeopathic approach is to enhance body's own healing capacity so that the all deviations of immune system are brought back to normal.

Constitutional approach
As per the classical homeopathy, we believe in constitutional prescribing. Every case of chronic renal disease calls for study of the patient's constitution, which includes various aspects of his physical ailments as well as the in-depth study of the mental sphere, such as emotions, psychosocial background, and behavior and personality pattern.
This calls for individual case study in every case of Nephrotic Syndrome. There is no single specific remedy for all the cases of Nephrotic Syndrome. The exact treatment is determined only on in-depth evaluation of individual case. Furthermore, patient's history of past diseases and that of the family diseases is understood to know the miasmatic background of the patient.

Role of homoeopathic medicines
After putting all the vital information together, and fine evaluation process carried out, an individualist medicine is determined. This constitutional medicine, which when administered in the correct dose treats the patient at an inner level and brings about harmony at the constitutional level. In a situation, where kidney damage has progressed too far, homoeopathy prevents further progress of disease and freezes deterioration of the condition in future.

Important conclusion from these research on nephritic syndrome :
Homoeopathy is very effective in all stages and variants of Nephrotic Syndrome.
It may be taken along with traditional medicines prescribed by physician.
It helps to reduce (and eventually to stop) the dose of conventional medicines for Nephrotic Syndrome, once the improvement sets in. However, withdrawal of the medicine should be done slowly and under supervision of local physician.
It helps arrest further progress of disease and hence deterioration caused by disease.
If administered in early stage it prevents complications like renal failure associated with disease thus minimizing need of dialysis or transplant.
Even if the patient is undergoing dialysis, it will help to reduce frequency and in certain cases abolishes need of dialysis.
It is absolutely safe, harmless, and non-toxic. It does not interfere with other medicines.

Research conducted by Dr. Rajneesh Kumar Sharma at Suray nature cure Uttaranchal

For last two years, his institute was busy with patients suffering from renal failure, both types, acute and chronic. These include RPGN (Rapidly progressing Glomerulonephritis) or Cresentic glomerulonephritis, RPD (Renal medical or renal parenchymal disease), ATN or Acute tubular necrosis, Renal tuberculosis, etc.

Treatment methodology adopted :
Diet low in protein, sodium, potassium, and phosphate, high in calories and calcium and supplemented with essential amino acids; balanced fluid intake and output; monitoring of intake and output, peritoneal dialysis or hemo dialysis to treat end-stage disease; long-term emotional support, counseling for adaptation to chronic, potentially fatal disease.

Total no. of Patients registered 65 (Male- 51, Female- 14)
Effective No. of patients 56
Cured 14 25%
Got Relieved ++++ 14 25%
Got Relieved +++ 14 25%
Got Relieved but left 5 8.92%
First relieved and stable 2 3. 57%
First relieved and died 3 5 .35%
Did not Get relieved 2 3 .57%
Progressively deteriorated and died 1 1.78%
Died 1 1.78%

Total no. of Remedies Employed in 65 Cases 31
Opium is the top rank remedy for CRF. The second one is Apis.
Totaity of the symptoms based on symptoms of CRF, underlying causes and constitutional symptoms of the patients simulates these 31 great remedies rendering their value to top in our repertory for CRF.

Repertorial Rubrics in covering Cardinal Signs and Symptoms of Chronic Renal Failure (CRF)

GENERALS - UREMIA
GENERALS - MEDICINE - allopathic - abuse of
GENERALS - DROPSY - kidney disease, from
GENERALS - DROPSY - albuminuria, with
GENERALS - CONVULSIONS - uremic
GENERALS - HYPERTENSION
KIDNEYS - INFLAMMATION - acute parenchymatous
KIDNEYS - INFLAMMATION - bloody, ink-like, albuminous urine, with
KIDNEYS - INFLAMMATION - cardiac and hepatic affections, with
KIDNEYS - INFLAMMATION - suppurative
KIDNEYS - INFLAMMATION - toxemic
KIDNEYS - SUPPRESSION of urine
KIDNEYS - SUPPRESSION of urine - dropsy,

Apart from these, the constitutional symptoms of the particular individual patient play vital role in deciding the final choice of the remedy. Thus we see that Homoeopathy has a miraculous role in field of Nephrology, especially CRF, where other pathies have only option to transplant a new kidney to support a life.


Important Homeopathic Medicines in CRF

AMMONIUM CARB:
Heaviness in all organs, swelling of glands, acid reactions; prostration; frequent desire to urinate with tenesmus; urine white, scanty, bloody copious turbid and fetid.

ARSENIC ALB:
Urine is scanty, burning involuntary. Bladder as if paralyzed. Albuminuria. Nephritis. Uremia. Atony of bladder in old persons. Epithelial cells cylindrical clots of fibrin and globules of pus and blood. Feeling of weakness in abdomen after urination. Retention of urine, as if the bladder were paralyzed after childbirth. Urine black as if mixed with dung. Dysuria.

AURUM MET:
Painful retention of urine, with urgent inclination to make water, and pressure on the bladder. Frequent emission of watery urine. Urine turbid, like buttermilk, with thick mucus-like sediment.

CICUTA:
Frequent micturition; the urine is propelled with great force. Retention of urine. Convulsions with violent distortion of body.

CUPRUM MET:
Suppression of urine. Passes clear watery urine during or after spasms. Urgent desire to urinate with scanty emission. Frequent emission of fetid, viscid urine, Burning shootings in the urethra, during and subsequent to the emission of urine. Wetting the bed at night.

CUPRUM ARS:
Diabetes. Kidney inefficiency and uremia. Garlic odor of urine. Urine of high specific gravity increased, Contains acetones and diacetic acid.

GLONOINE:
Increased secretion of pale (albuminous) urine; has to rise frequently during the night, and must pass large quantities of albuminous urine. Tubal nephritis, with headache, brought on by walking in the sun; numbness in arms and hands alternating with intense tingling. Inclination to deep respiration.

OPIUM:
Scanty, deep coloured (dark brown) urine, with sediment like brick dust. Retention of urine. Coma. Insomnia. Intermittent respiration.

PHOSPHORUS:
Urine turbid, brown, with red sediment. Uremia with acute atrophy of brain.

PICRIC ACID:
Complete anuria, nephritis with profound weakness.

PLATINA:
Red urine with a white cloud, or else which becomes turbid, and deposits red sediment. Slow but frequent emission of urine.

TEREBINTHINA:
Pressure in the kidneys when sitting, going off during motion. Sensation of heaviness and pain in region of kidneys. Transient movement in region of bladder during stool as if bladder were suddenly distended and bent forward. Frequent desire to urinate. Violent burning drawing pain in region of kidneys. Spasms from any attempt to urinate. Suppressed secretion of urine. Urine smelling strongly of violets; deposit of mucus, or thick, muddy deposit. Thick, slimy, yellowish white sediment in urine. Much blood with very little urine and constant painful Dysuria. Burning sensation, incisive pains, and spasmodic tenesmus of bladder.

Probable miasm:
Sycotic

Side-effects of complementary and alternative medicine
Complementary and alternative medicine are increasingly used to diagnose or treat renal diseases, and numerous studies have reported benefits of this type of medicine. But have its own on risks.The potential sensitizing capacity of numerous herbal remedies may lead to allergic contact dermatitis and more rarely to IgE-mediated clinical symptoms. Organ toxicity has been observed associated with various herbal preparations involving the liver, kidneys, and the heart. Some herbs may have cancerogenic properties.

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Murthy