My experience with end stage renal disease: An Observational Study

Human life starts with a very simple cell and then gradually it becomes complex. Similarly, there is evolution of man. Primitive man life was very simple and were less civilized. They ate raw food and wore animal skin but as the time went primitive man also evolved himself and his lifestyle also changed. Lifestyle is defined as the typical way a person/individual, group or a culture live.

It constitutes both mental and physical make up of a man. Along with the civilization the lifestyle of human being has also changed which has affected both the mental and physical make-up. Our ancestors lived a much calmer life and had less worries but along with the civilization the stress has changed and now life becoming target oriented and completing the deadlines has mentioned the levels of stress.

With the advancement in science and technology we are gifted by gadgets and means which has made our lives much easier. Now we can communicate with each other in fraction of seconds, can search anything around the corner of the world in seconds through internet. All this civilization and advancement has made our life comfortable and easier but as said that every coin has two sides and so goes with the civilization. Although civilization has made our lives easier but with this comfort, we have invited many diseases such as diabetes mellitus, thyroid, obesity, hypertension etc. and this is the reason these diseases are known as diseases of civilization or lifestyle diseases. Human body is gifted with various organs each given its unique feature to perform. Similarly, kidneys in our body are very important and has excretory, biosynthetic and regulatory functions to play. Kidneys help in excretion of waste material and any abnormal function of kidney can lead to accumulation of these waste material in the body which can lead to increased levels of blood urea nitrogen and creatinine and the condition is known as azotaemia. Kidney still have an adaptive response until 3/4^th kidney is damaged. When there is further destruction it leads to uraemia and there occur imbalances in fluid, electrolytes, hormones, along with metabolic abnormalities. If this condition persists for many days then it leads to Chronic kidney failure and finally causing end stage kidney disorders.

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दिल्ली बाढ़: स्वास्थ्य चुनौतियाँ और उनका होम्योपैथिक इलाज और रोकथाम

Chronic kidney failure is defined as –

1. Kidney damage for more than 3months in respect to structural and functional abnormality of the kidney with/without decreased GFR manifest either by-

• Pathological abnormality
• Markers of kidney damage, including abnormality in the composition of the blood/urine or abnormality in imaging tests.

2. GFR < 60ml/min/1.73m² for>3months, with or without kidney damage.

Causes of Chronic Kidney Failure

Cause of the CRF can be differentiated into following types-

IATROGENIC

Prolonged use of—-

• Antibiotics
• Painkillers
• Others

LIFESTYLE

• Smoking
• Diet
• Diabetes mellitus
• Hypertension
• Older age

MIASMATIC

Familial

• F/H/O Diabetes
• F/H/O CKD
• F/H/O Hypertension

Renal

• Renal artery stenosis
• Glomerular diseases
• Interstitial diseases

Congenital and inherited

Stages of CRF

Each patient is classified into one of the following 5 stages of CKD because management and prognosis varies according to the progression of damage.

• Stage 1: Kidney damage with normal or increased GFR(>90 mL/min/1.73 m²)
• Stage 2: Mild reductionin GFR (60-89 mL/min/1.73 m²)
• Stage 3: Moderate reductionin GFR (30-59 mL/min/1.73 m²)
• Stage 4: Severe reductionin GFR (15-29 mL/min/1.73 m²)
• Stage 5: Kidney failure(GFR <15 mL/min/1.73 m² or dialysis)

According to homoeopathy stages of CKD can be divided as mentioned below –

Stage 1 & Stage 2 – Homoeopathy can very well help in bringing cure by treating the patient as a person and thus slowing the further progression of destruction and thus restoring the function of kidney.

Stage 3, 4 & 5 – Homoeopathy can only help by palliating the disease along with auxillary treatment.

GFR – CALCULATION METHOD

Cockcroft-Gault Method (Adult)
GFR for male – (140 – age) x wt (kg) / [72 x Serum Creatinine]
GFR for female – GFR (females) = GFR (males) x 0.85

For e. g:

Kidney consist of around 1million nephrons in the glomeruli and the number of nephrons is calculated by the surrogate of glomerular number. The relationship between glomeruli number and number of nephrons is considered as compensatory enlargement of the remaining glomeruli in situations of nephron deficiency or a process in order to restore the normal functioning of kidney back to normal. Hence the increased glomerular volume might be an important marker for nephron deficiency. Nephrons decreases with increasing age. GFR is the best measurement of overall kidney function and for the identification of kidney function in clinical practice GFR can be estimated from the creatinine clearance or creatinine level which helps in knowing that how much creatinine is cleared out from the body. The normal level of GFR in young adults is approx.-125ml/min & declines by approximately 1ml/min/year thereafter. Although serum creatinine is considered as a poor predictor of GFR as it is influenced by factors such as age, sex, body weight, muscle mass, diet, drugs etc.

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Symptoms of CRF

The early symptoms of chronic kidney disease are also symptoms of other illnesses. These symptoms may be the only signs of kidney disease until the condition is more advanced.

Symptoms may include:

• Appetite loss
• General ill feeling and fatigue
• Headache
• Itching (pruritus) and dry skin
• Nausea
• Weight loss without trying to lose weight

Other symptoms that may develop, especially when kidney function has gotten worse, include:

• Abnormally dark or light skin
• Bone pain
• Brain and nervous system symptoms:
  • Drowsiness and confusion
  • Problems concentrating or thinking
  • Numbness in the hands, feet, or other areas
  • Muscle twitching or cramps
• Breath odor
• Easy bruising, bleeding, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)
• Shortness of breath
• Sleep problems, such as insomnia, restless leg syndrome, and obstructive sleep apnea
• Swelling of the feet and hands (edema)
• Vomiting, typically in the morning

Methodology

Let us create a standard plan of treatment for Chronic Kidney Failure keeping Organon of Medicine by Master Samuel Hahnemann as our basis.

Master Hahnemann has very beautifully explained about the aim of the physician from Aphorism 1-Aphorism 4 which can be classified as-

• Cure in Curable Cases-In Stage 1 &Stage 2 homoeopathic physician can help a patient of CRF easily by prescribing him with a similimum homoeopathic medicine.
• Palliation in Incurable Cases- palliation can be done in Stage 3, Stage 4 & Stage 5 cases of CRF
• Prevention in who are Liable- Certain cases of CRF can be prevented by following certain steps such as-

1. No Iatrogenic causes
2. Improved lifestyle
3. Thorough case taking & screening test repeating periodically
4. Preventive wholistic treatment for patients as a person
5. Homoeopathic prescription

What should be done in order to achieve our aim?

There should be certain plans made in order to complete the objective. Following steps can be taken-

• Standardization in prescription-case taking procedure (Aphorism 5-Aphorism7, Aphorism 82-Aphorism 104).
• Easy, Quick selection of medicine (Aphorism 153)
• Easy, Quick selection of potency (Aphorism 279)
• Easy, Quick selection of Quantum & Repetition (PQR-Aphorism 246 F.N.)
• Correct selection at the earliest (Aphorism 2, Aphorism 149)

In Homoeopathy the physician has to understand wholism in two respects. These 2 aspects are mentioned as below-

Understanding the patient who has chronic kidney failure .CRF is diagnosed with various constitutional signs & symptoms which must cover up the wholistic approach upto terminal stage (Aphorism 5).

Must be covering stage of CRF in vogue and in time to come (changing pattern of diseases)

Understanding the medicine – which cover the symptoms of CRF.These medicines include both the well-known i.e. Well known medicines (extensively proved) and lesser known medicines (need extensively proving) and then medicine is used on patient considering the following points-

• Patient as a person
• As an intercurrent
• To set in reaction

Selection of remedy-Remedy should be selected on the following basis-

• To the patient as a person
• Seeing through the hole (regional remedies)
• Selection of medicine must have in-built concept of miasm (homoeopathic etiology) by understanding presenting complaints with encapsulated past of the patient.

Miasm analysis

Miasm analysis should be done of the patient who has the disease and not of the disease.

Selection of Dose-PQR

Selection of the dose should be done according to the potency (P), Quantity (Q) &Repetition (R) as mentioned in Aphorism 246 FN.

Potency should be decided according to the understanding of pathology & susceptibility

Quantity of the medicine & repetition of the medicine should be decided keeping the below mentioned things-

• Nature of medicinal substances
• Physical constitution of patient
• Magnitude of his disease

Management

Homoeopathic management of chronic kidney failure should be to remove the obstacles or causes. Master Hahnemann has been described about the various factors which act as obstacles while treating the patient.

A homoeopathic physician should carefully notice these obstacles & treat accordingly. The obstacles are mentioned as below-

Fundamental cause

• Master Hahnemann in aphorism 5 described about miasm which he considered as the fundamental cause of any disease.

Causa occassionalis

• Master Hahnemann in aphorism described about causa occassionalis which consist of either an exciting cause (aphorism 5) or maintaining cause (aphorism 7).

Diet & lifestyle

Since we can see that all the lifestyle diseases are caused by the adoption of incorrect lifestyle thereby it is high time that we should now correct out lifestyle which includes both our diet and our mode of living.

Lifestyle – Avoid stress, Regular exercise

Diet

• Restrict protein consumption- Protein breakdown is cleaned by kidney and intake of proteins will burden the functioning of proteins. Total protein required by an adult man is 56 grams a day and that by an adult woman is 46 grams a day or it is = 0.60 mg protein/kg/day
  • Decrease potassium level-
  • Decrease sodium food content-sodium causes fluid retention
  • Cut down milk, coconut water and citrus fruits
  • Eliminate high phosphorous foods-increased phosphorous levels will cause decrease calcium and thus causing bone diseases
  • Stay away from saturated fats and trans fatty acid- as they cause increased cholesterol level leading to heart diseases

Follow up of case

Follow up includes either the selection of next suitable medicine or from the relationship of remedies. During a follow up of a case either the patient presents with improvement or with no improvement or is worse than before. It is mentioned as below –

If the case shows improvement then the follow up should be

• General to Particular –In this case either follow HERING’S LAW or if there is no progressive improvement then follow relationship of medicine.

If the case is not improving or is worse than before then check the whole case and then act accordingly

• At the Patient level
• At the Doctor level
• At the Quality/Dispensing of medicine.

Cases

Case 1

Mr. A, 47yrs/M diagnosed case of diabetic nephropathy came to our clinic with the following complaints-

• Pain left foot with difficulty walking.
• B/L pitting knees & pedal edema
• Swelling face.
• Increased frequency of urination.
• Itching in genitals. (for 1 year).
• Husky and Hoarse Voice

Past History

• Fracture Radius (15 yrs. back)
• Head Injury (10 yrs. back)
• Operated for subdural hemorrhage (9 yrs. back)

Life Situation

• Separated from wife and children 10 yrs. back. Still misses his family.
• Tensed due to younger brother’s career.
• Under financial constraint.

Family History-Not significant.

Physical Generals

• Thirst: Increased.
• Desire: Fried food, chilled water.
• Dreams: Nightmares as if legs were cut while crossing the road, flying in air
• T/R: Hot.

Mental General – VERY SYMPATHETIC.

Habit and Addictions – Chronic smoker and alcoholic (left since 1 yr).

Remedy – Causticum LM 1/ BD – LM 14/BD, 1 tsp.

Follow Up

• C. Better.
• Voice better.
• Pain foot better.
• Swellings better.

Biochemical Marker/ Dialysis (BEFORE) CASE NOT ON DIALYSIS

1. Hb: 11.4gm%
2. Urea: 119 mg %
3. Uric Acid: 16.4 mg %
4. Creatinine: 10.0 mg %

My Experience with End Stage Renal Disease – Limitation of Homoeopathy

Dr.Pankaj Aggarwal (M.D.)

Dr.Nidhi Navin Sharma (B.H.M.S)

Human life starts with a very simple cell and then gradually it becomes complex. Similarly, there is evolution of man. Primitive man life was very simple and were less civilized. They ate raw food and wore animal skin but as the time went primitive man also evolved himself and his lifestyle also changed. Lifestyle is defined as the typical way a person/individual, group or a culture live.

It constitutes both mental and physical make up of a man. Along with the civilization the lifestyle of human being has also changed which has affected both the mental and physical make-up. Our ancestors lived a much calmer life and had less worries but along with the civilization the stress has changed and now life becoming target oriented and completing the deadlines has mentioned the levels of stress.

With the advancement in science and technology we are gifted by gadgets and means which has made our lives much easier. Now we can communicate with each other in fraction of seconds, can search anything around the corner of the world in seconds through internet. All this civilization and advancement has made our life comfortable and easier but as said that every coin has two sides and so goes with the civilization. Although civilization has made our lives easier but with this comfort, we have invited many diseases such as diabetes mellitus, thyroid, obesity, hypertension etc. and this is the reason these diseases are known as diseases of civilization or lifestyle diseases. Human body is gifted with various organs each given its unique feature to perform. Similarly, kidneys in our body are very important and has excretory, biosynthetic and regulatory functions to play. Kidneys help in excretion of waste material and any abnormal function of kidney can lead to accumulation of these waste material in the body which can lead to increased levels of blood urea nitrogen and creatinine and the condition is known as azotaemia. Kidney still have an adaptive response until 3/4^th kidney is damaged. When there is further destruction it leads to uraemia and there occur imbalances in fluid, electrolytes, hormones, along with metabolic abnormalities. If this condition persists for many days then it leads to Chronic kidney failure and finally causing end stage kidney disorders.

Chronic kidney failure is defined as –

1. Kidney damage for more than 3months in respect to structural and functional abnormality of the kidney with/without decreased GFR manifest either by-

• Pathological abnormality
• Markers of kidney damage, including abnormality in the composition of the blood/urine or abnormality in imaging tests.

2. GFR < 60ml/min/1.73m² for>3months, with or without kidney damage.

Causes of Chronic Kidney Failure

Cause of the CRF can be differentiated into following types-

IATROGENIC

Prolonged use of—-

• Antibiotics
• Painkillers
• Others

LIFESTYLE

• Smoking
• Diet
• Diabetes mellitus
• Hypertension
• Older age

MIASMATIC

Familial

• F/H/O Diabetes
• F/H/O CKD
• F/H/O Hypertension

Renal

• Renal artery stenosis
• Glomerular diseases
• Interstitial diseases

Congenital and inherited

Stages of CRF

Each patient is classified into one of the following 5 stages of CKD because management and prognosis varies according to the progression of damage.

• Stage 1: Kidney damage with normal or increased GFR(>90 mL/min/1.73 m²)
• Stage 2: Mild reductionin GFR (60-89 mL/min/1.73 m²)
• Stage 3: Moderate reductionin GFR (30-59 mL/min/1.73 m²)
• Stage 4: Severe reductionin GFR (15-29 mL/min/1.73 m²)
• Stage 5: Kidney failure(GFR <15 mL/min/1.73 m² or dialysis)

According to homoeopathy stages of CKD can be divided as mentioned below –

Stage 1 & Stage 2 – Homoeopathy can very well help in bringing cure by treating the patient as a person and thus slowing the further progression of destruction and thus restoring the function of kidney.

Stage 3, 4 & 5 – Homoeopathy can only help by palliating the disease along with auxillary treatment.

GFR – CALCULATION METHOD

Cockcroft-Gault Method (Adult)
GFR for male – (140 – age) x wt (kg) / [72 x Serum Creatinine]
GFR for female – GFR (females) = GFR (males) x 0.85

For e. g:

Kidney consist of around 1million nephrons in the glomeruli and the number of nephrons is calculated by the surrogate of glomerular number. The relationship between glomeruli number and number of nephrons is considered as compensatory enlargement of the remaining glomeruli in situations of nephron deficiency or a process in order to restore the normal functioning of kidney back to normal. Hence the increased glomerular volume might be an important marker for nephron deficiency. Nephrons decreases with increasing age. GFR is the best measurement of overall kidney function and for the identification of kidney function in clinical practice GFR can be estimated from the creatinine clearance or creatinine level which helps in knowing that how much creatinine is cleared out from the body. The normal level of GFR in young adults is approx.-125ml/min & declines by approximately 1ml/min/year thereafter. Although serum creatinine is considered as a poor predictor of GFR as it is influenced by factors such as age, sex, body weight, muscle mass, diet, drugs etc.

Symptoms of CRF

The early symptoms of chronic kidney disease are also symptoms of other illnesses. These symptoms may be the only signs of kidney disease until the condition is more advanced.

Symptoms may include:

• Appetite loss
• General ill feeling and fatigue
• Headaches
• Itching (pruritus) and dry skin
• Nausea
• Weight loss without trying to lose weight

Other symptoms that may develop, especially when kidney function has gotten worse, include:

• Abnormally dark or light skin
• Bone pain
• Brain and nervous system symptoms:
  • Drowsiness and confusion
  • Problems concentrating or thinking
  • Numbness in the hands, feet, or other areas
  • Muscle twitching or cramps
• Breath odor
• Easy bruising, bleeding, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)
• Shortness of breath
• Sleep problems, such as insomnia, restless leg syndrome, and obstructive sleep apnea
• Swelling of the feet and hands (edema)
• Vomiting, typically in the morning

Methodology

Let us create a standard plan of treatment for Chronic Kidney Failure keeping Organon of Medicine by Master Samuel Hahnemann as our basis.

Master Hahnemann has very beautifully explained about the aim of the physician from Aphorism 1-Aphorism 4 which can be classified as-

• Cure in Curable Cases-In Stage 1 &Stage 2 homoeopathic physician can help a patient of CRF easily by prescribing him with a similimum homoeopathic medicine.
• Palliation in Incurable Cases- palliation can be done in Stage 3, Stage 4 & Stage 5 cases of CRF
• Prevention in who are Liable- Certain cases of CRF can be prevented by following certain steps such as-

1. No Iatrogenic causes
2. Improved lifestyle
3. Thorough case taking & screening test repeating periodically
4. Preventive wholistic treatment for patients as a person
5. Homoeopathic prescription

What should be done in order to achieve our aim?

There should be certain plans made in order to complete the objective. Following steps can be taken-

• Standardization in prescription-case taking procedure (Aphorism 5-Aphorism7, Aphorism 82-Aphorism 104).
• Easy, Quick selection of medicine (Aphorism 153)
• Easy, Quick selection of potency (Aphorism 279)
• Easy, Quick selection of Quantum & Repetition (PQR-Aphorism 246 F.N.)
• Correct selection at the earliest (Aphorism 2, Aphorism 149)

In Homoeopathy the physician has to understand wholism in two respects. These 2 aspects are mentioned as below-

Understanding the patient who has chronic kidney failure .CRF is diagnosed with various constitutional signs & symptoms which must cover up the wholistic approach upto terminal stage (Aphorism 5).

Must be covering stage of CRF in vogue and in time to come (changing pattern of diseases)

Understanding the medicine – which cover the symptoms of CRF.These medicines include both the well-known i.e. Well known medicines (extensively proved) and lesser known medicines (need extensively proving) and then medicine is used on patient considering the following points-

• Patient as a person
• As an intercurrent
• To set in reaction

Selection of remedy-Remedy should be selected on the following basis-

• To the patient as a person
• Seeing through the hole (regional remedies)
• Selection of medicine must have in-built concept of miasm (homoeopathic etiology) by understanding presenting complaints with encapsulated past of the patient.

Miasm analysis

Miasm analysis should be done of the patient who has the disease and not of the disease.

Selection of Dose-PQR

Selection of the dose should be done according to the potency (P), Quantity (Q) &Repetition (R) as mentioned in Aphorism 246 FN.

Potency should be decided according to the understanding of pathology & susceptibility

Quantity of the medicine & repetition of the medicine should be decided keeping the below mentioned things-

• Nature of medicinal substances
• Physical constitution of patient
• Magnitude of his disease

Management

Homoeopathic management of chronic kidney failure should be to remove the obstacles or causes. Master Hahnemann has been described about the various factors which act as obstacles while treating the patient.

A homoeopathic physician should carefully notice these obstacles & treat accordingly. The obstacles are mentioned as below-

Fundamental cause

• Master Hahnemann in aphorism 5 described about miasm which he considered as the fundamental cause of any disease.

Causa occassionalis

• Master Hahnemann in aphorism described about causa occassionalis which consist of either an exciting cause (aphorism 5) or maintaining cause (aphorism 7).

Diet & lifestyle

Since we can see that all the lifestyle diseases are caused by the adoption of incorrect lifestyle thereby it is high time that we should now correct out lifestyle which includes both our diet and our mode of living.

Lifestyle – Avoid stress, Regular exercise

Diet

• Restrict protein consumption- Protein breakdown is cleaned by kidney and intake of proteins will burden the functioning of proteins. Total protein required by an adult man is 56 grams a day and that by an adult woman is 46 grams a day or it is = 0.60 mg protein/kg/day
  • Decrease potassium level-
  • Decrease sodium food content-sodium causes fluid retention
  • Cut down milk, coconut water and citrus fruits
  • Eliminate high phosphorous foods-increased phosphorous levels will cause decrease calcium and thus causing bone diseases
  • Stay away from saturated fats and trans fatty acid- as they cause increased cholesterol level leading to heart diseases

Follow up of case

Follow up includes either the selection of next suitable medicine or from the relationship of remedies. During a follow up of a case either the patient presents with improvement or with no improvement or is worse than before. It is mentioned as below –

If the case shows improvement then the follow up should be

• General to Particular –In this case either follow HERING’S LAW or if there is no progressive improvement then follow relationship of medicine.

If the case is not improving or is worse than before then check the whole case and then act accordingly

• At the Patient level
• At the Doctor level
• At the Quality/Dispensing of medicine.

Cases

Case 1

Mr. A, 47yrs/M diagnosed case of diabetic nephropathy came to our clinic with the following complaints-

• Pain left foot with difficulty walking.
• B/L pitting knees & pedal edema
• Swelling face.
• Increased frequency of urination.
• Itching in genitals. (for 1 year).

• Husky and Hoarse Voice

Past History

• Fracture Radius (15 yrs. back)
• Head Injury (10 yrs. back)
• Operated for subdural hemorrhage (9 yrs. back)

Life Situation

• Separated from wife and children 10 yrs. back. Still misses his family.
• Tensed due to younger brother’s career.
• Under financial constraint.

Family History-Not significant.

Physical Generals

• Thirst: Increased.
• Desire: Fried food, chilled water.
• Dreams: Nightmares as if legs were cut while crossing the road, flying in air
• T/R: Hot.

Mental General – VERY SYMPATHETIC.

Habit and Addictions – Chronic smoker and alcoholic (left since 1 yr).

Remedy – Causticum LM 1/ BD – LM 14/BD, 1 tsp.

Follow Up

• C. Better.
• Voice better.
• Pain foot better.
• Swellings better.

Biochemical Marker/ Dialysis (BEFORE) CASE NOT ON DIALYSIS

1. Hb: 11.4gm%
2. Urea: 119 mg %
3. Uric Acid: 16.4 mg %
4. Creatinine: 10.0 mg %