Case Quizes

A Case of Anuria

Last modified on August 10th, 2013

Can you solve this case of anuria quiz from Dr. Amarsinha Nikam?

On knowing the diagnosis of the case the first question which will crop up in everyone’s mind is, can such a case be dealt with by Homeopathy? The answer won’t be with yes or no, but in the form of this case.

This is a very interesting case of a boy aged 15 yrs suffering from Anuria since 5 days as an Acute Medical Emergency.

In October 2009, i.e. before 9 months, the patient suffered from anuria. He didn’t pass urine for about 24 hours and other than this, apparently he had no other complaints. He was then taken to a nephrologist and after treatment he passed urine.

After a symptomless phase of about 1½ months the symptoms recurred, for which he was given the same treatment. Such episodes recurred about 3-4 times more, for which he had consulted the top most nephrologists of the city. Along with this he also suffered from slight pain in the bladder region with urinary disturbances since 9 months. Another striking feature of this case is that within 2 months since October 2009, he had suddenly gained 5 kgs. of weight.

Before coming to me, he was suffering from anuria since 5 days and was not responding to the conventional treatment. Even the Nephrologists were not able to judge the exact diagnosis and thought that the symptoms may be due to hormonal imbalance. In the end, the exact diagnosis was not made and still the fact that the patient had not passed urine for 5 days was relevant.

Anuria

Anuria means no passage of urine. In practice it is defined as passage of less than 50 milliliters of urine in a day.

Causes

Failure of kidney function, which can have multiple causes including medications or toxins (e.g., antifreeze); diabetes, high blood pressure. Stones or tumours in the urinary tract can also cause it by creating an obstruction to urinary flow. In males, an enlarged prostate gland is a common cause of obstructive anuria.

Acute anuria, where the decline in urine production occurs quickly, is usually a sign of obstruction or acute renal failure. Acute renal failure can be caused by factors not related to the kidney, such as heart failure, mercury poisoning, infection, and other conditions that cause the kidney to be deprived of blood flow.

 Symptoms

Anuria itself is a symptom, not a disease. It is often associated with other symptoms of kidney failure, such as lack of appetite, weakness, nausea and vomiting. These are mostly the result of buildup of toxins in the blood which would normally be removed by healthy kidneys. As the kidney function decreases:

  • Blood pressure is increased due to fluid overload and production of vasoactive hormones, increasing one’s risk of developing hypertension and/or suffering from congestive heart failure.
  • Urea accumulates, leading to azotemia and ultimately uremia(symptoms ranging from lethargy to pericarditis and encephalopathy).
  • Potassium accumulates in the blood (known as hyperkalemia with a range of symptoms including malaise and potentially fatal cardiac arrhythmias)
  • Erythropoietin synthesis is decreased (potentially leading to anemia, which causes fatigue)
  • Fluid volume overload – symptoms may range from mild edema to life-threatening pulmonary edema
  • Hyperphosphatemia – due to reduced phosphate excretion, associated with hypocalcemia (due to vitamin D3 deficiency). The major sign of hypocalcemia being tetany.
    • Later this progresses to tertiary hyperparathyroidism, with hypercalcaemia, renal osteodystrophy and vascular calcification that further impairs cardiac function.
  • Metabolic acidosis, due to accumulation of sulfates, phosphates, uric acid etc.

Treatment

Treatment is dependent on the underlying cause of this symptom. The most easily treatable cause is obstruction of urine flow, which is often solved by insertion of a urinary catheter into the urinary bladder.

 

THE CASE

  • Investigations :

 

03.12.2009 : Ultrasonography of BUB Region :

Echogenic area 3.8 mm in prostatic urethra is likely to be calculus.

 

17.12.2009 : Sonography Report :

Echogenic shadow in posterior urethra? Impacted tiny calculus in wall of urethra? Inflammatory lesion?

 

27.01.2010 : Ultrasonography of KUB Region :

Chronic Cystitis. Walls thick & edematous.

 

18.06.2010 : Micturating Cysto-Urethrography :

Minimal constriction at prostate -membranous region of the urethra otherwise normal study.

  • C/C :
  1. Difficult micturation with pain in bladder region since 9 mths.

–     H/o Fever before onset of complaints.

–     Continuous spasmodic pain for 15-20 minutes at the bladder region extending up to urethra.

–     H/o Scanty  urination.

–     Burning before urination.

–     Anuria since 5 days.

–     Required straining for micturation.

–     Mild pain before micturation.

–     Pain in xiphisternum region sometimes along with pain in lower abdomen.

–     Sometimes pain extends upward or downward sometimes.

–     Pain :

< Beginning of urination

< Before, during &                > Drinking cold water

after micuturation

< Night                                           > Sitting in knee chest

                                                 position

< Less intake of water                    > Pressure (by hand on

abdomen.)

< Empty stomach                            > Cold milk after.

< Spicy / Pungent                          > Lying on abdomen+++

< Standing                                      > Cold application

< Walking                                       > Rest.

< Exertion                                       > Lying downward

  1. Continuous pain in Lt. inguinal region ∵ 5 days.

Continuous spasmodic pain.

< After defecation                 > Pressure by hand

> Lying down

 

  1. Muddy colored circle around cornea of both eyes; more in Lt. eye since 5 yrs.

–   A/F Jaundice after.

–   Redness of eyes esp. Lt. eye.

–   < After exposure to sun with mild lachrymation sometimes.

< dust+++                               > cold water application

< Sun exposure                     > rubbing by hand.

< day light.                                      > cold air

< summer                              > Night

 

 

  1. Weight gain about 5 kgs within 9 months.

 

  • Past History :

–   Jaundice 5 yrs before

 

  • Family History :

–               Father       : Allergic Rhinitis

–               Mother     : Anaemia

 

  • Physical Generals :
    • Diet                      : Veg.
    • Appetite               : Good. Can tolerate hunger.
    • Desire                   : Pungent, Spicy, Green Veg., Fruits, Oily, Milk & Milk products, Cold things.
    • Aversion              : Sweets, Bitter, Sour.
    • F <                       : Cold things   < Tonsillitis
    • Mouth                  : Foul breath from mouth
    • Tongue                 : Whitish coated, pale, and moist.
    • Thirst                   : Thirstless
      • Bowel                   : Constipation with hard, unsatisfactory++ & blackish++ stool.

–         Passes small quantity at time with straining.

–         Frequency : 3-4 times /day.

  • Urine                    : Anuria since 5 days.
    • Perspiration         : Scanty or absent perspiration since 9-10 months. H/O staining the linen previously.
    • Sleep                    : Unrefreshing. 10 pm – 8 am.

–         Drowsy feeling lunch after.

–         Position : Lies on abdomen+++.

  • Thermally             : CHILLY patient

 

  • Mind :

The patient wass born and brought up in the city of Aurangabad. He has a younger sister. He is a student of std10th.

The information provided by his father is as follows:

 

  1. Tell me something about his nature?

He gets irritable easily, but it lasts for a short period of time. He relieves his anger by talking it out.

He enjoys repairing things here and there. So many times he has tried repairing mobiles and other electronic equipments; but of course at the end, those things never work after that.

Besides this, he is not that interested in studies, so we have sent him in the hostel since 1 year. One incident I would like to mention is that 8-9 months before when he was in the hostel, he had a quarrel with his friend.

He likes to participate in other school activities, like decorating the stage during social gatherings.

He lies very often. Once, he wanted to go for a trip with his friends, so he lied to us that he wants money for some other purpose for which we couldn’t deny.

He is mischievous since childhood. He used to collect empty refills from his friends and then used to get them to me, showing how sincerely he studies! Also he always ends up cheating in his exams.

He is not particular regarding cleanliness.

Besides all this, he gets angry when things go against his will and when his demands are not fulfilled.

He is close to his friends and his mother. But he gets scared of me as I am strict with him. I often scold for his mistakes. But if some day, I’ve misunderstood something about him and have scolded, when it wasn’t his mistake, then he will surely react to it and will make it a point that I realize that, it truly wasn’t his mistake.

He has a very sympathetic and helpful nature. Likes to share his things with others. He mixes very easily with people and is talkative.

 

 

  1. What he is fearful of?

Besides me, he is fearful of ghosts and robbers.

 

Please send your answer and what rubrics you used to:

Mail@hpathy.com     subject : Nikam Quiz

About the author

Amarsinha Nikam

Amarsinha Nikam

Dr. Amarsinha Nikam is a renowned homeopath who runs Aditya Homoeopathic Hospital and Healing Centre in Pune. He started his career as R.M.O. at Lokmanya Hospital Pune, Homoeopathy Division and subsequently practiced as the consultant Homoeopath for 14 years at various places such as Beed, Khopoli, Chakan, Kate – Pimple, Pimple – Gurav and Pimpri Gaon, Pune. Dr. Nikam teaches students to understand the depth of homeopathic treatment and differentiate it from other pathies. He instructs them in his method of practice, but also inspires them to innovate and explore.

2 Comments

  • resp sir,
    we have to consider rubrics— liar, fear of ghost,sleep-position on abd —as the case is psoro–sycotic,
    after repert—chilly–main medisines–caust, lyco,phos —-as he is not intelligent–eliminate-lyco,craving for cold –not menstioned—so think of causticum

  • Dear dr,this case got strong causating modalities,other modalities so i selected bogar method of repertorization.colchicum covers all sym of pt like anuria,scanty urine,burning pain during and after urination,pain shifting downward and upward,burning in urethra,retention of urine,pain in region of kidney,rest,>lying down,<night,unsatisfactory stool,inability to sweat,redness of eyes,so my medicine is colchicum.

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