Multicystic Dysplastic Kidney

Name : Mrs. D. T. with her baby d.

Age : 30 years

Sex : Female

Religion : Hindu

Occupation : Nurse in Dhoot Hospital

Date : 26 / 10 / 2009

 

Chief Complaints : ANC second trimester, with fetal Anomalies.

Location	Sensation	Modalities	Concomitant
Palms & soles	Burning	–	–

Past History :-

LSCS 12-13 months back, Child died after 2-3 days.

LSCS was done due to irregular contractions, os did not open and labor did not progress.

H/O Polyhyramnios.

H/O high BP with swelling over both legs.

H/O fall in FHR i.e 30/min.

Family History : Brother – piles.

Physical General :

Weight – 34 kg.

Appearance :- emaciated, thin, short built dark complexion lady.

Appetite : good

Thirst : Thirsty+

Desires : spicy/pungent, earth, meat, methi (green vegetable).

Aversion : sweet, milk, eggs.

Diet : both

Tongue : Clean

Urine : NAD

Stool : Hard stool

Perspiration : Nil

Bath : Warm water

Fan : Wanting

Coverings : seasonal.

Sleep : unrefreshing. Feels tiredness.

Dreams : God, death of her relatives, running water and snakes are

coming towards her when she is traveling in bus.

Thermals : Hot

 

Menstrual History : Regular. LMP – 08/05/2009

 

Physical examination :

Temp : Afebrile

Pulse : 76 / min

B.P : 130 / 90 mm of hg

 

Systemic examination :

R.S : Clear

CVS : S1 S2 Normal

CNS : NAD

GIT : NAD

Investigations: OB – 2/3 Trimester scan Report ( 23/10/2009)

Impression :- Single gestation corresponding to a gestational age of 24 weeks .

Gestational age assigned as per LMP.

Fetus shows enlarged multicystic dysplastic left kidney.

Fetus right kidney is also echogenic and shows single small cortical cyst at present.

Fetal fl is on lower side, falls at 2^nd percentile for gestational age.

Suggested fetal karyotyping.

Scaned copy is given below

 

 

 

OBST. USG:- (24/10/2009)

Impression:- Single live intrauterine gestation of average age 23 wks 4 days.

Enlarged echogenic left kidney with multiple tiny cysts within replacing the entire renal parenchyma & 2-3 tiny cysts in right kidney.

Scaned copy is given below

Analysis of Mental traits :-

Anger after contradiction. Becomes aggressive and goes into either indignation with guilty feeling that I must not get angry, or throws things which are in hand and remains silent. Wants to beat that person who has contradicted her.

There is history of vexation from her in-laws.

Diagnosis of Disease : ANC with Fetal multicystic Dysplastic left kidney.

Phase of Disease : Chronic Reversible

Diagnosis of miasm : Fundamental – Sycotic

Dominant – sycotic

Diagnosis of susceptibility : Moderate.

Opinion of gynecologist and nephrologists – Suggested to terminate the pregnancy as it could be IUD or it may survive after delivery.

Diagnosis of Remedy : Nat.mur 10M . 1 dose, followed by silicea 3X TDS for 15 days.

 

Follow up Chart :-

Date	Observation	Prescription
11/11/09	Wt – 36kg. H/O one episode of vertigo while walking. H/O Vomiting one episode. Palms & sole burning >+++ Dreams reduced. Sleep sound.	S.L
12/11/ 2007	USG – obst : – Single live intrauterine gestation of average maturity 25 weeks 2 days. Foetal left kidney is enlarged with multiple cysts are seen at periphery. Two tiny cysts are seen in right kidney.	Medorrhinum 200 1 dose.
23/11/ 2009	No any new complaints	Nat. Mur 200 1 dose .
02/12/ 2009	Pain in lumbar region since morning > lying on back. PV – White sticky discharge. Frequency of micturation increased. No /H/O – PV – bleeding. Fetal movement is normal. Cervix is closed. Adv – Obt USG.	Nat. Mur 200 1 dose with water.
03/12/2009	OB – 2/3 Trimester scan report. Single gestation corresponding to a gestational age of 29 weeks 6 days. Breech presentation. Fetus show bilateral echogenic kidneys. Multiple tiny cysts in right kidney F/S/O ? mild degree multicystic renal disease (right) with echogenic left kidney. Sever oligohydramnios, AFI – 4.5	S.L
14/12/2009	No any complaints. USG Obst – Sever oligohydramnios; AFI – 4 H/O PV – white sticky discharge. Gynecologist opinion – e/o some vaginal infection white discharge present.	Nat. Mur – 10M 1 dose.
20/12/2009	Labor pain – irregular. 1 finger dilatation of cervix.	Caullophylum 200 2 dose, Pulsatilla 6 c 6 dose / 4 hrs each.
21/12/2009 9Am	Irregular labor pain. 2 finger dilatation of cervix. Gynecologist Adv – for LSCS. Red discharge +,Thirsty , hungry feeling , weakness +. Direction of pain – weak irregular pain arising in back extending downward going to front & extending upward.	Kali. carb – 200 in water / 10min. Time – 9Am.
21/12/2009 12 MD	Complete regular contraction+++ Full dilatation of cervix. Membrane ruptured	Stop Kali. carb
21/12/2009 2 PM	Normal delivery of male child at 1:45pm. Wt – 1400gms Serum sodium – 121 mmol/L, serum potassium – 4.8 mmol/L, blood group – B positive. CRP – negative. Hb – 17.4 g/dl.	Arnica – 200 1 dose for both mother & child. Child was sent to NICU.
22/12/2009	Child passed urine multiple times And stool 2 times. Sr. bilirubin total – 6.59 mg%.	Aconite 200 1 dose olfaction.
23/12/2009	Child passed urine multiple times No e/o swelling over legs or face of child. Sr. bilirubin total – 8.53 mg%. Sr. creatinine – 1.7 mg/dl morning. Evening : Sr. sodium – 101 mmol/L; Sr. potassium – 8.1 mmol/L	Natrum mur. – 30 1 dose in mother milk.
24/12/2009	Child passed urine multiple times No e/o swelling over legs or face of child. USG of child – Right kidney appear normal except for two tiny cysts. Left kidney show e/o numerous small cysts s/o ? multicystic kidney. Pediatrician and nephrologist suggested to discourage treatment as above all investigation was s/o prerenal failure.	Discharged from NICU. EEL serum 30 with water twice a day for 2 days.
26/12/2009	Child passed urine and stool multiple times. No e/o swelling over legs or face of child.	Urea pura – 30 BD X 3 days.
29/12/2009	Child passed urine and stool multiple times. e/o swelling over both legs +	Natrum mur. 6 c BD X 4 days
1/01/2010	Child passed urine and stool multiple times. Swelling of both legs regressed. e/o swelling below lower eyelids. Tongue reddish, central white.	Natrum mur. 6 c OD X 4 days.
7/01/2010	Child passed urine and stool multiple times. Swelling below lower eyelids regressed. –  Hiccough ++. –  Fever + – Wt. 1500gms	Nat.mur 6 c , 5 dose every alternate day once in day.
19/01/2010	H/O fever for 2 days 10 days back Weight increased by 200 gms. USG Abdomen & pelvis:- scan report given below Blood urea – 17, Sr.creat – 0.9, Na – 140, K – 6.2	Nat.mur – 6c one dose every alternate day 10 dose.
16/02/2010	Crying+ Redness all over body+ Sweating on dorsal region+ Desires to be carried+ Aversion for milk of mother, throws out milk. Weight – 2250 gms.	Silicea 200 1 dose.
30/03/2010	date – 30/03/2010. blood urea – 18 creatinine – 1.1 sodium – 138 potassium – 5.3	S.L
31/03/2010
10/05/2010	Coryza+ Nose obstruction+ Sneezing+ Fever with irritability+ Sweating neck	Calcareaphos – 200 1 dose.
05/10/2010	No any complaints Weight – 6.2kg	S.L

 

Comments :- It was the mother’s second baby ; first baby was expired after 2 – 3 days of birth but during that time no antenatal scan anomaly. Scan was done so its cause of death was undiagnosed. It was LSCS delivery.

This baby was diagnosed as multicystic dysplastic kidneys in fifth month of ANC.

Nephrologist and gynecologists suggested for MTP as baby will never survive. Mother decided on homoeopathic medicine with due consent of risk of baby as well as mother.

After birth baby went into prerenal failure and low birth weight (1400gms) with preterm normal delivery, though her previous was LSCS delivery. It was only due to homoeopathic medicines used during labor pain.

NICU management was discouraged by intensivists, Pediatrician and nephrologist, due to poor prognosis of baby. She decided to take home care for baby with homoeopathic medicine only. Since then baby is only on homoeopathic medicine without any help of NICU.

At present baby is well and gaining weight day by day without any sign of renal impairment,

though there are cysts in both kidneys . His recent weight was 6.2kg. Lastly I only want to say that homoeopathic medicine can not only help in labor, but also in early detected anomaly in ANC.