A Case of Chronic Renal failure Cause: Diabetic Nephropathy

Name of the patient – Verma M. L. Age 77 years
Date of first consultation – 12 – 2 -2004.

Diabetic nephropathy is one of the causes of Chronic Renal Failure, when the glomerular filteration rate (GFR) falls below a certain limit. The excretion of urea depends on the G. F. R., when this drops to about 30% of normal, retention of urea occurs. The raised concentration of urea in the plasma increases the concentration of urea in the filtered fraction and by this an adequate excretion is maintained. In addition to urea, sulphate and phosphate are retained together with potential toxic substances.

The case I am presenting here is a known chronic diabetic. During November 2003 he became quite sick; he was diagnosed as a case of PUC of DM c FBS. He was under the conventional treatment and his condition deteriorated in place of improving. Apart from his physical symptoms his pathology also worsened.

His blood tests on 14 – 1 – 2004 revealed:

Blood urea 104 mg/dl (Normal Values 10 – 50mg/dl)
Serum creatinine 4.9 mg/dl (Normal values 0.5 – 1.4mg/dl)

Now he sought the help of a reputed hospital of the city where his disease was diagnosed as a case of Chronic Renal Failure caused by Diabetic Nephropathy.

Haematology report on 22 – 1 – 2004:

Haemoglobin 8.4 gm% (Normal values, M 14 – 17 gm%)
E. S. R. 40 mm/!st hr. (Normal values, M 0 – 10 mm/!st hr.)

On 22 – 1 – 2004 his Biochemistry Report shows:

S. Alk. Phosphotase 188 U/L (Normal values 38/126 U/L) 100ml
S. Calcium 9.5 mg% (Normal values 8.4 – 11 mg%)
S. Phosphorus 3.2 (Normal values 2.5 – 4.5 mg%)
Sodium 148 (Normal values136 – 145 mmol/L)
Potassium 5.0 mmo l/L (Normal values 3.5 – 5.0 mmol/L).

Ultra-sonography on 22 – 1 – 2004:
Impression – (1) B/L grade I echogenic, borderline size kidneys c maintained CMD.
(2) Enlarge prostate with slightly inhomogenous echotexture.

Empirical treatment by the specialist along with proper diet control suggested by the dietician was given but with no avail.

When his health deteriorated further he called for my help on 12 – 2 – 2004. His symptoms were:

• Extreme weakness.
• Dropsy (+++).
• Very anemic complexion.
• Vertigo on any motion (due to weakness).
• No appetite. Thirst diminished.
• Stools loose. He has tendency of loose and watery stools off and on.
• Despair of recovery.

Apis 200 one dose on alternate days
Serum anguillae 30 tds inter-currently

On 12 – 2 – 2004 when the homoeopathic treatment was commenced no pathological tests were conducted, therefore it can not be said what was the real state of Blood urea and Serum Creatinine. But, when the test were done on 20 – 2 – 2004 i. e. a week later the values of the test were as follows:

Fasting blood sugar 77 mg/dl (Normal values 70 – 110mg/dl)
Blood Urea 191 mg/dl
Serum Creatinine 5.1 mg/dl

I suppose, when the homoeopathic treatment was commenced the Blood Urea and the Serum Creatinine might have been higher than the values found out in test on 20 – 2 – 2004.

By 3 – 3 – 2004 his general condition improved by continuing the above mentioned prescription so much that he came walking to my clinic (a distance of more than half kilometer), but with the help of a stick, whereas on 12th Feb. he was so weak that he used to find it difficult to walk out of his room. He lives on the first floor of his house and at that time he was unable to come down the staircase. And on 8 – 3 – 2004 he visited my clinic without the help of the stick.

The Bio-chemistry Report on 11 – 3 – 2004:

Blood Urea 117 mg/dl
Serum creatinine 4.9 mg/dl

The important aspect of this case is that the patient did not take any allopathic medicine since 12th February 2004.

Same prescription was continued and the Bio – chemistry Report on 31 – 3 – 2004 was:

Fasting Blood Sugar 75 mg/dl
Blood Urea 91 mg/dl
Serum Creatinine 2.8 mg/dl

Occasionally he did get attacks of loose stools with urging to stool after eating or drinking anything. He had such tendency for a long time. So, occasional dose of Sulphur 200 and later Sulphur 1M was given which did not help much in the tendency of the attacks of loose stools.

Serum anguillae 30 was continued as stated above.
The patient is a man who looses courage easily. Therefore whenever he get an attack of diarrhea/loose stools he becomes prostrated. Sometimes he feels so much weakness that when he is moving or after walking a short distance feels tired and his breathing becomes laborious.

Same prescription was continued. The last report of Bio – chemistry conducted on 13 – 5 – 2004 was as given hereunder:
Serum creatinie 1.4 mg/dl (Normal values O.5 to 1.4 mg/dl)
Serum potassium 3.90 mEq/L

As far as the Blood Urea Serum creatinine and Serum potassium are concerned the values have come down within normal limits. Now treatment for the tendency of urging to stool with loose watery stools is after eating and drinking is continued intermittently.

I have selected the remedies on the basis of the pathogenesis as given hereunder: –

Apis Mellifica

Encyclopedia of Pure Materia Medica – Allen T. F.
Stool and anus
– Urging to stool.
– Urging to stool, with rumbling in the abdomen.
– Passage of flatus before stool.
– Copious, watery diarrhea.
– Several loose stools daily.
– Increasing prostration during diarrhea.

Generalities
– Actual swelling, or “puffing up”, of the whole body, without any noticeable change of color, except in the face.

Pocket Manual of Homoeopathic Materia Medica – W. Boericke

– Acts on cellular tissues causing edema of skin and mucous membranes.
– Swelling or puffing up of various parts, edema, red rosy hue, stinging pains, soreness, intolerance of heat, and slightest touch, and afternoon aggravation are some of the general guiding symptoms.

Guiding Symptoms of Our Materia Medica – C. Hering

Stool and rectum
– ¤¤ Watery diarrhoea. ð Catarrh of stomach.
– ¤ Stools : watery; yellow, watery, with griping; watery and foul smelling; watery, copious, black; thin yellow with extreme weakness; greenish-yellowish mucus; agg mornings, slimy, mucus and blood; frequent, bloody, painless, olive green, slimy, profuse; full of bright red lumps.
– ¤ Edema of limbs. ð Albuminuria.
– ¤ Dropsy of limbs. ð Organic disease of heart.
Serum aguillae

Pocket Manual of Homoeopathic Materia Medica – W. Boericke

– We should bear in mind that the elective action of the eel’s serum is on the kidney, and I believe we can well assert that if digitalis is a cardiac, the eel’s serum is a renal remedy.
– In the presence of acute nephritis with threatening uraemia we should always think of this serum.

Some Ramdom Notes on Homoeo – Remdies – Chatterjee T. P.

– Very effective in lowering blood urea. Use potencies 6 and 30, twice daily, till it is near normal (Dr. Harish Chand). The normal range is 15-40 mg/100 ml.

Murphy R. Homoeopathic Medical Repertory

Kidneys
– INACTIVE
– NEPHRITIS, infection, – parenchymous, acute
– UREMIA

Homoeopathic Remedy Guide – Murphy R.

– The Eel’s serum eminently efficacious to re-establish diuresis and in rapidly arresting albuminuria. Kidney failure.
– Eel has put an end to the kidney obstruction and produced an abundant diuresis.
– But its really specific indication seems to be for acute nephritis, (Jousset). Sub-acute nephritis.
– In the presence of acute nephritis with threatening uremia we should always think of this serum. Very efficacious in functional heart diseases.