Clinical Cases

Hydronephrosis in a 3.5 Month Old Boy

Written by Petr Hoffman

Homeopath Petr Hoffman presents a case of hydronephrosis in a 3.5-month-old boy. Cold perspiration on feet, milk crust, and gonorrhea-like discharge were among the symptoms leading to two curative remedies.

This 3.5 month old boy was diagnosed with hydronephrosis (swelling of a kidney due to a build-up of urine. He had an enlarged pelvis and ureter right after birth. During pregnancy, his mother was told that one of the child’s ureters was enlarged.

The enlargement is on the right side only (right kidney and right ureter). (3) The dilation is grade 4 (the highest). The doctors assume that it is a congenital defect. One of the ureters connects to the kidney at a higher position than usual.

The boy is taking low doses of antibiotics in the long term which is a common protocol in this diagnosis.

He has milk crust on scalp and between the eyebrows. (3) Skin peels off at the same places.(2)

He is breast-fed. When his mother drinks cow‘s milk, he develops pains in the abdomen, distention and green diarrhea. (2) However, it used to be more frequent in the past and now it seems to be a bit better.

When his feet get cold, he has clammy sweat on them. (3)

His nails are soft. (2)

His stool smells sourish. (2)

He gets startled easily, mainly in his sleep. He jerks in his sleep as if startled, but falls asleep instantly. (2) During daytime, he gets startled from sudden noises and  starts crying. (2)

He has had some diaper rash (1), but not excessive. The only acute disease he has had so far was a coryza which he got last week after getting cold.  He has not been vaccinated yet.

Family anamnesis:

Mother: hypothyroidism, mononucleosis, chronic coryza

Maternal grandmother: chronic coryza

Father: poliomyelitis in childhood

Paternal grandfather: kidney cancer at the age of 55

Analysis of the case:

The prognosis:

Medical professionals say that this condition resolves by itself with age in about 50% of cases. This is a favourable factor for the prognosis. However, we will try to help the boy with homeopathy in order to increase the chances for success.

In cases of such young children, we always struggle with scarcity of symptoms. In this case, we have a few solid and usable symptoms which makes the prognosis better.

It is interesting that we find kidney cancer in the family anamnesis, a pathology of the same organ as the boy. This is an unfavourable factor for the prognosis. On the other hand, there is nothing else in the family anamnesis which would significantly worsen the prognosis.

Pathology is on the physical level only, but it is quite serious.

The prophylactic administration of antibiotics is necessary due to the fact that there is high incidence of urinary tract infections in children with this diagnosis. We will have to adjust dosing of homeopathic remedies accordingly.

Congenital defects have a genetic background and they are therefore always more difficult to cure. Overall prognosis is not ideal, but there may be a chance for improvement as the child is very young and the organism is very vital.

Selection of symptoms:

  • dilation of kidney, pelvis and ureter (3)
  • milk crust on scalp and between eyebrows (3)
  • peeling of skin on scalp and between eyebrows (2)
  • green diarrhoea when the mother eats cow’s milk (2)
  • abdomen pains and distention when the mother eats cow’s milk (2)
  • sour smell of stool (2)
  • clammy perspiration of feet when they get cold (3)
  • soft nails (2)
  • startling in sleep (2)
  • startling from noise (2)

Relevant rubrics: (using The Essential Synthesis repertory)[1]
KIDNEYS – HYDRONEPHROSIS
KIDNEYS – SWELLING
KIDNEYS – COMPLAINTS of kidneys – Ureters
HEAD – ERUPTIONS – milk crust
HEAD – ERUPTIONS – milk crust – children; in
HEAD – ERUPTIONS – milk crust – children; in – newborns
FACE – ERUPTIONS – Eyebrows
FACE – ERUPTIONS – crusty, scabby – Eyebrows
HEAD – ERUPTIONS – desquamating
RECTUM – DIARRHEA – milk – agg.
GENERALS – FOOD and DRINKS – milk – agg.
STOOL – GREEN
ABDOMEN – PAIN – milk – agg.
ABDOMEN – DISTENSION – milk agg.
ABDOMEN – FLATULENCE – milk agg.
ABDOMEN – MILK – agg.
STOOL – ODOR – sour
EXTREMITIES – PERSPIRATION – Foot – clammy
EXTREMITIES – COLDNESS – Feet – cold – perspiration; with
EXTREMITIES – NAILS; complaints of – brittle nails
MIND – STARTING – sleep – during
MIND – STARTING – noise, from
RECTUM – ERUPTIONS – Anus; about – rash – children; in – newborns
RECTUM – ERUPTIONS – Perineum – children; in – newborns

This is not the actual repertorisation, but a full list of any possible rubrics. In my practice, I do not rely on repertorisation as a main tool, but use it rather to get a clue about other possible remedies when I am short of ideas.

Apart from one small insignificant rubric (pustules between eyebrows), there are no rubrics for eruptions between eyebrows. However, I included the closest rubrics I could find.

Differential diagnosis of the most probable remedies:

Calcarea carbonica is one of the main remedies for milk crust in newborns.[2] Scaly eruptions in general can be well confirmed in this remedy. It has intolerance of milk, sour discharges, clammy sweating of feet and brittle nails as keynotes. Green diarrhoea and tendency to get startled easily can be confirmed in several books of Materia medica, for example Hering’s guiding symptoms of our Materia medica.[3]

Sulphur covers sour odour of stool, green stool, perspiration of feet, brittle nails and intolerance of milk, but not as keynotes. Startling from noise and from sleep can be well confirmed in Kent’s materia medica.[4] Sulphur is the king of eruptions and it covers different types eruptions including eruptions of scalp.

Silicea has aggravation from milk and perspiration of feet as keynotes. Silicea has affections nails including softness of nails. Eruptions of scalp and seborrhoea can be confirmed in the remedy. Silicea has anxiety from noise so it is not surprising that it also covers startling from noise.

Natrum carbonicum belongs to one of the main remedies for intolerance of milk. Easy startling and sensitivity to noise can be confirmed for example in Kent’s materia medica.4 Confirmation for sour smelling stools can be found in C. Hering’s Guiding symptoms.[5]

Natrum phosphoricum also covers intolerance of milk. It is known for acidity of stomach, sour eructations and it also has sour odour of stool. Green stool was confirmed by C. Hering and Margaret Tyler.2 Hering even specifically states green and sour stool in children with colics and vomiting of milk.[6] Because of its Phosphoric element, it gets startled easily, especially from noise.

Medorrhinum is the main remedy for recurrent diaper rash in newborns. It can be found in the rubrics for diarrhoea from milk and general aggravation from milk (additions from Dr. Geukens) and for soft fingernails. It cannot be confirmed otherwise.

Magnesia carbonica and Magnesia muriatica both have strong intolerance of milk as a keynote. They both cover green stool, but cannot be confirmed otherwise.

Choice of the remedy:

It is obvious that I gravitated towards remedies which cover intolerance of cow’s milk in children as this was an objective and valuable symptom in the case. I did not differentiate any of the remedies from the rubric Kidneys – Hydronephrosis, because none of these remedies cover important aspects of the case like intolerance of milk, clammy perspiration of feet, sour smelling stool or soft nails. On top of that, this is a clinical rubric expressing a diagnosis and these rubrics tend to be very incomplete.

The remedy which covers the highest number of keynotes in the case is Calcarea carbonica.  There is no other remedy in our Materia medica which would cover the combination of intolerance to milk, clammy cold perspiration of feet, sour smelling stool and soft nails as keynotes. I am sure the reader knows that it is the most frequently indicated remedy in young children.

Prescription: Calcarea carbonica 30C once a day until a reaction

Outcome of the treatment:

Update after 6 days of taking the remedy:

The boy has been taking the remedy for 6 days. On the 2nd and 3rd day he was angry when nursed and he refused to be nursed. During nursing he was arching his back and crying. On the 2nd day, he slept unusually long. When he woke up, he was very weepy and cross. This is unusual for him. The same evening he had a cold sweaty head during nursing, which is also new for him. On the 3rd day, he had frequent stools. On the 4th day, he developed a diaper rash.

The mother says she remembered that he used to have these rashes quite a lot, more than I understood in the initial consultation. The coryza reappeared on the 4th day, but subsided the same day. For the past 2 days, he has not been angry or weepy and has not had any apparent complaints.

Evaluation of the reaction:

An initial aggravation already took place from the 2nd day of dosing. As the boy has been taking the remedy for 6 days, I suggest withdrawing it and waiting. The cold perspiration of head when nursing is probably a proving symptom of Calcarea carbonica. I advise the reader to check the rubric HEAD – PERSPIRATION of scalp – eating – while – agg. in Synthesis repertory.1

Recommendation: withdraw Calcarea carbonica and wait

Follow-up 1: 1 month after beginning of treatment

The milk crust has disappeared, but they have also been applying some kind of natural hydrating ointment. The mother tried to eat some milk products and it did not seem to produce any problems.

The boy was calmer during nursing. Before treatment, he used to wriggle a lot when being nursed. The feet perspired less. The boy has been recently checked by a nephrologist who said the dilation of the renal pelvis is the same or maybe a bit smaller. He could not tell for sure. However, during the previous check-up they found dilation of the kidney calyces, whereas now, they are not dilated. They also visit a urologist regularly, who leans towards surgical solution of the problem. The nephrologist would rather wait.

For the past week, the boy has been getting worse again.  He again wriggles a lot during nursing, has started sweating on hands (2) and yesterday he developed another diaper rash. He has not been tolerating milk (when mother eats it) again for the past few days.(2)

He has developed a new symptom – yellow stains at his diaper at the places where he urinates.(2)

Evaluation of the reaction:

Considering that there was an initial aggravation followed by improvement of intolerance of milk and (probable) improvement of the dilation of renal calyces and maybe even pelvis, the remedy might have been correct.

However, we would expect the improvement to last longer. The long-term antibiotic prophylaxis could explain the relapse, but I am still not confident enough about the reaction. What concerns me is the appearance of the stains on the diaper. It is probably a sign of some inflammatory discharge from the urethra.

The reaction is, in my opinion, not perfectly convincing, but as we can confirm yellow discharge (and also gonorrhea) in Calcarea carbonica, the first thing we need to do, is to repeat it. It is interesting that the boy has developed diaper rash together with the urethral discharge. This could point to a possibility of Medorrhinum, which I already discussed in the differential diagnosis, but there are no other strong symptoms to confirm it.

Prescription: Calcarea carbonica 30C once a day until a reaction

Acute disease: 5 days after the last follow up

After 5 days of taking Calcarea carbonica, the boy has developed an acute disease.

This morning, he got a fever 38°C.

He has a hot head and cold extremities. (3)

He is irritable (2) and arches his back (3).

There are no other symptoms.

They brought a urine sample to the paediatrician and they are waiting for results.

Evaluation of the situation:

As the boy is too young for me to evaluate his level of health, we cannot use the occurrence of fever to assess the reaction to our remedy. Because of the yellow discharge from the urethra, I am assuming the boy might be having some kind of inflammation of the urinary tract, despite taking the prophylactic antibiotics. I therefore decided to treat it.

The only remedy which I could think of for the combination of current symptoms is Belladonna. The situation, however, makes me doubt more about Calcarea carbonica. We also do not know the boy’s level of health as he is too young and we do not have enough data for it, so I cannot include the occurrence of the acute condition and the fever in the evaluation of the reaction.[7]

Prescription: Belladonna 30C single dose

Follow-up 2:  2 months after beginning of the treatment (one month after the last follow up)

Although the fever subsided within a few hours after Belladonna, they got the urine test results later which revealed the presence of klebsiella, so the mother decided to treat the boy with a course of stronger antibiotics.

For the past 2 days, he has had the yellow discharge in the diaper again, but only after morning urination. (2)

Milk crust has not reappeared.  He does not seem to have any problems when the mother drinks milk. He has the cold sweating of feet again. (2) He has started sweating in the cervical region after the course of stronger antibiotics. (2)

His nails are still very soft (2) and thumbnails are split (2).

Evaluation of the follow-up:

I understand that there is a danger of kidney damage in case of a urinary tract infection, but I still think it was worth waiting at least a few more hours because the reaction to Belladonna seemed to be favourable.

In any case, the discharge from the urethra has reappeared and that is why I opt for giving a remedy. It is interesting that the boy developed another new symptom of Calcarea carbonica – perspiration of the cervical region (although not specifically in sleep). Together with the other remaining symptoms, it is a solid justification for repeating the same remedy.

Prescription: Calcarea carbonica 30C once a day until a reaction

Follow up 3:   4 months after beginning of the treatment (2 months after the last follow up)

After 3 days of taking Calcarea carbonica the boy got cross and weepy and developed mild coryza. I advised the mother to stop dosing and wait.

After about one week the discharge from the urethra (staining the diaper) got better – it got lighter and the stains were smaller, but it has never really disappeared completely. It has been worse again for the past 2 weeks.  His stool does not smell sour anymore. Perspiration on the cervical region, hands and feet disappeared in about 3 weeks after the remedy. His nails are still soft.(2)

Because of the ongoing urethral discharge, I asked the mother whether there was any gonorrhoea in the family medical history. She confirmed that her husband – father of the boy, had gonorrhoea at the age of 18.

Evaluation of the follow-up:

I am sure that any homeopath who has decent knowledge of Materia medica knows which remedy I am about to prescribe at this point because of the ongoing urethral discharge, history of diaper rash and the boy’s father’s history of gonorrhoea.

The information about gonorrhoea was missing in the beginning and there were solid indications for Calcarea carbonica so it is a question to what extent it was a correct remedy or not. I would tend to consider it a correct remedy to begin the treatment with, because an improvement of the dilation of renal calyces occurred after it and intolerance of milk disappeared.

But what is also important, it forced the organism to bring out the sycotic predisposition – the gonorrhoea-like discharge, which we can now address with another remedy. After all, swelling and enlargement is a sycotic characteristic.

Prescription: Medorrhinum 200C split dose (I opt for a split dose in spite of the boy taking the antibiotics because I wanted to give a higher potency of the remedy and giving 200C daily might be too much stimulation for the organism. If there is no reaction, I can always try repeating it.)

Follow up 4:    6 months after beginning of the treatment (2 months after the last follow up)

After administration of Medorrhinum, the discharge from urethra stopped completely in 2 days and there has been no staining of diapers since then.

His nails have become stronger.

He still has no problems when the mother drinks milk.

3 weeks ago, he developed mouth thrush which he still has. (3)

Since the thrush, he has been cross and irritable (3) and his sleep has been interrupted (3). He has also cried in sleep for the past few days. (2)

Evaluation of the follow-up:

The reaction to Medorrhinum might be correct, but we should be cautious because there was no initial aggravation. Quick disappearance of the urethral discharge is a good sign though.

Because the thrush has not been resolving by itself, we should help the organism to overcome it with a suitable remedy. There are not many specific symptoms regarding the thrush, but in my opinion, Borax could do the job if we consider that it is one of the main remedies for ulcers in mouth (e.g. aphthae) and it also covers irritability and night crying in children.

Prescription: Borax 30C once a day until a reaction

Follow up 5:    11 months after beginning of the treatment (5 months after the last follow up)

Borax was stopped after 4 days of dosing because an improvement started taking place. The thrush disappeared completely in the next 3 days.

2 months ago, they visited the nephrologist for a regular check-up. Ultrasound examination revealed clear improvement. The kidney pelvis has gotten significantly smaller. The mother stopped giving the boy antibiotics without consulting anyone.Apart from two acute colds, he did not have any troubles.

However, for the past month, he has had difficulties falling asleep. It takes him about one hour to fall asleep and he is restless and tosses in bed instead of sleeping. (3) Once he falls asleep, he sleeps well for the rest of the night.

One of the acute colds was a gastroenteritis which all members of the family had. It only took one day, but before and after it, he had slight urethral discharge in the diaper. Then it disappeared and has not come back since.

He likes to pinch his mother, pull her nose etc. (2) He also torments their cat – he lies on her, pulls her tail etc. (2)

He has slept on his knees and chest for the past 1,5 months. (3)

He uncovers in sleep. (3)

As he is older now, we can detect some food preferences. He likes sweets (2), ice (3) and soft-boiled eggs (1). He has an aversion to legumes. (1)

He has still not been vaccinated yet.

Evaluation of the follow-up:

We have a clearly confirmed improvement of the hydronephrosis and the discharge from urethra got better too. This means Medorrhinum was a correct remedy. The withdrawal of antibiotics is the mother’s decision, but as long as there has not been any signs of a urinary tract infection, I am not going to force her to go back to them. However, we need to be careful and observant.

The question is whether we should intervene now or not. This is one of the situations where is it difficult to decide. There has been a good reaction so I would not like to spoil it, but on the other hand, the boy has been having some sleep problems.

What will help me decide here is the fact that the organism has produced some new symptoms, which, interestingly enough, belong to Medorrhinum. Namely, the desire for ice and sweets, aversion to legumes, sleep in the knee-chest position, tormenting the cat, restless sleep, and finally, the difficulty falling asleep (because of excessive energy in the evening). Because of the fact that the picture of the remedy is now even more clear, I decide to repeat Medorrhinum.

Prescription: Medorrhinum 200C split dose

Follow up 5:   20 months after beginning the treatment (9 months after the last follow up)

There was an initial aggravation (irritability and even more difficulty falling asleep) for a few days. Sleep problems then improved.

They visited a nephrologist two months ago and a urologist one month ago. They both found clear improvement and said that the affected kidney is growing normally. There is no dilation of the pelvis or ureter and neither of the specialists recommends a surgery.

He has not had any discharge from the urethra.

They finally got the boy vaccinated 6 months ago. He has had 2 doses of hexavaccine so far, and should get the 3rd dose soon.  He has had a cold with high fever twice since the last follow-up.  Neither of them needed treatment and they both resolved on their own.

His sleep has worsened again. For the past 2 months, it takes him long to fall asleep. (3) He gets full of energy in the evening and tosses around. (3) He again torments his cat.(3) It was already better after the last remedy.

His mother has noticed that he has been touching his genitals a lot recently. (2) He also has mild constipation.(2).  He has developed a rash about anus (something like a diaper rash, but he does not wear diapers anymore).(2)

Evaluation of the follow-up:

The improvement of the hydronephrosis was confirmed by two independent specialists. It is also a very good sign that he has not developed any urinary tract infection in spite of not receiving any antibiotics.

There has been a partial relapse though. The boy again developed some new symptoms belonging to Medorrhinum (handling genitals, constipation, rash about anus). The relapse might have been caused by the vaccination, as we often see in our practice. Because there are still clear symptoms of Medorrhinum, the obvious course of action is to repeat it.

However, as the boy is going to get the 3rd dose of his hexavaccine soon, we must wait until he gets the vaccine and if there are no complications or new symptoms within 2 or 3 weeks after it, we can repeat Medorrhinum. I would also prefer raising the potency of the remedy as the boy has already had it twice.

The fact that the boy gets high fevers with his acute diseases is very positive and it means that his level of health is good.

Prescription: Medorrhinum 1M split dose at least 2 weeks after the vaccination (unless there are some changes after the vaccine).

Reaction to the remedy (1 month after the remedy):

There was an aggravation on the psychological level after the remedy. From the fourth day, he was more irritable and rude. It lasted for about 4 days and then it improved. His sleep improved about 3 weeks after the remedy.

Rash about anus has disappeared. Handling of genitals still persists. Constipation is a bit better.

Discussion:

The improvement of such a serious pathology under homeopathic treatment is always very rewarding, especially when it is confirmed by objective medical examination. In this case, two remedies were needed to completely cure the pathology and they both brought an improvement.

It is common in chronic cases that a series of correct remedies in the right order is needed to cure the case, while each of the remedies produces some improvement and pushes the case forward. It is interesting how the first remedy (Calcarea carbonica) brought the sycotic genetic predisposition to the surface so it could then be addressed with a more appropriate remedy, which I was already considering in the initial differential diagnosis. The follow-up of the case is now 4 years and the kidney problems have never come back. Neither has the discharge from the urethra.

[1] SCHROYENS, F. The Essential Synthesis 9.2E. London: Homeopathic Book Publishers, 2007. ISBN: 978-0-9557151-0-5
[2] TYLER, M.L., Homeopathic drug pictures. New Delhi: B Jain Publishers, 2004. ISBN 978-8131903063
[3] HERING, C. Guiding Symptoms of Our Materia Medica. Calcarea carbonica (online). http://www.homeoint.org/hering/c/calc-ostr.htm
[4] KENT, J.T. Lectures on homoeopathic materia medica. New Delhi: B. Jain Publishers, 2011. ISBN 978-81-319-0259-2
[5] HERING, C. Guiding Symptoms of Our Materia Medica. Natrum carbonicum (online). http://www.homeoint.org/hering/n/nat-c.htm
[6] HERING, C. Guiding Symptoms of Our Materia Medica. Natrum phosphoricum (online). http://www.homeoint.org/hering/n/nat-p.htm
[7] VITHOULKAS, G., Levels of Health: The Second Volume of The Science of Homeopathy. Athens, Greece: International Academy of Classical Homeopathy, Center of Homeopathic Medicine, S.A., 2017. ISBN: 978-6188331204

About the author

Petr Hoffman

Petr Hoffmann is a graduate of the International Academy of Classical Homeopathy in Greece where he studied with Prof. George Vithoulkas. He lives and works in the Czech Republic. Email: [email protected], web: www.hpph.cz Petr runs his own practice, but he also gives lectures at the Prague College of Classical Homeopathy in the Czech Republic (www.pcch.cz), and he occasionally translates homeopathic literature.
Petr also runs a Facebook study group which the readers can join. The group link is https://www.facebook.com/groups/1727619584199693/

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