Solution to January 2013 Chronic Quiz: A Case of Anuria

nikam answer feb image

Dr. Nikam gives the solution to last month’s chronic quiz case.

  • Totality :

  • Homesickness.

  • Heedless.

  • Restlessness.

  • Aversion to mental work.

  • Concentration difficult.

  • Fear of ghosts.

  • Scanty urination.

  • Straining while urination.

  • Burning before urination.

  • Pain in bladder region < beginning of urination.

  • Photophobia : < day light < Sun.

  • Redness of eyes.

  • Stool hard & unsatisfactory.

  • Patient.

  • Suppressed perspiration complaints from.

  • < Night.

  • Constriction of urethra.

  • Thermal : Chilly.

  • Miasm : Tubercular.

      • Remedy Selected : CLEMATIS ERECTA 30

  • Response :

The level of toxicity that the patient was in could be imagined by fact that he had not passed urine since 5 days.

In such cases, if there is any delay in response to treatment, then the patient may suffer from irreparable damage.

After the selected remedy was given to the patient, I fortunately didn’t have to wait for long; as within 5 minutes of administration of the dose, the patient rushed to urinate. I was very happy as the only immediate sign of the improvement I was expecting in this case, was when the patient passes urine, otherwise the level of toxicity would have worsened further.

Then I asked the patient to get admitted but his father refused to do so. Considering the gravity of the situation, I still insisted, but they were firm on their decision. So the patient left.

After 2 months, when he came back for follow up and a lot of improvement was seen in his health. First and foremost, the episode of anuria did not recur and he did not suffer from any other urinary complaints.

He had reduced in weight. Also his parents observed that his perspiration, which markedly had become scanty since the complaints started, was now normal. His eye troubles are also reduced.

  • D/D :

Opium :

Again a remedy very close to the case. But, in the following points it differs from the case:

  • Opium has a marked dullness, delirious state. It has a strong ailment of fright and also homesickness is not that marked.

  • Opium has very hard stool, which was not the case with this patient. The cause of retention in Opium is more neurological.

  • It is a thirstless remedy.

  • It is a hot remedy and the patient is chilly.

Clematis Erecta has more marked homesickness. The complaint of Photophobia is well covered by it.

Phosphoric Acid :

Although homesickness is marked in Phosphoric Acid, it differs in the following way:

  • It covers all together different ailments, including of loss of body fluids, sexual excesses, disappointment, sorrow, grief which wa not the case with this patient.

  • Activeness followed by debility and exhaustion is a marked feature of the Acid Phosphorus

  • Retention of urine is more marked in Clematis.

Comparatively the patient is more chilly than Phosphoric Acid and this also matches well with Clematis.

Below is the original case of Anuria by Dr. Nikam, followed by analysis of the case sent in by Hpathy readers.

A Case of Anuria by 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:

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 KUB 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 micturation

< 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 was 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.

Readers’s answers to Dr. Nikam’s Jan 2013 Quiz – Anuria

—————————————————–

Clement Desmarty – Answer: Plumbum

This case makes me think PLUMBUM . Moreover he is chilly (PLUMBUM is really chilly) This story of paralysis : mental (maybe doesn’t learn cause he can’t), urinary and stool (constipation with black stool is very caracteristic of PLB with OPIUM and PLATINA)

He enjoys pleasures and cheats (This is the summary of PLUMBUM before he sinks in apathy) He sleeps on abdomen and he rubs his eyes.

=========================================

R.B. Singh – Answer: Pulsatilla

Obesity with inflammation in Urethra is a rare symptom. With these two symptoms we get: Calcarea, Caps., Lyco., Puls, Sep, and Sul.

But most of the rubrics are covered by Pulsatilla It is recommended to give Puls 200 in Split doses

=========================================

Anurag Mittal – Answer : Medorrhinum

The suggested remedy is “Medorrhinum” based on following rubrics:

< After exposure to sun with mild lachrymation sometimes.

< dust+++ > cold water application

< Sun exposure > rubbing by hand.

< day light. > cold air

< summer > Night

And most importantly : > Sitting in knee chest position, lying on abdomen

Following query would further strengthen the remedy if BETTER, at the seashore, lying on stomach, damp weather.

=========================================

Elaine Lewis – Answer: Apis

Dear Dr. Nikam,
Here is my chart. I decided to stick with the symptoms that pertained to the pathology at hand and not mix up acute and constitutional symptoms.
It was hard to choose but Apis, the logical choice here, slightly edges out Causticum and Phosphorus. Basically, we need a remedy that has kidney failure that is better for cold in all ways, better for pressure, has burning pains, pains while urinating (before during and after) and interestingly enough, only one remedy is listed under “cold milk amel” and that’s Apis. It would be hard to ignore Apis in a case of anuria of 5 days.
Sincerely,
Elaine Lewis
=========================================
Vernetta Oberoi – Answer: Opium
For the case of anuria:
I thought there was a theme of spasmodic pain in the bladder, worse after defecating,continuous spasmodic pain in left inguinal region, a need to strain at stool as well as to pass urine.It suggested to me a sluggishness of both intestines as well as bladder.I think that opium could fit this acute state.
Rubrics:Bladder, retention of urine, children, opium-2
Bladder, acute retention after fright, opium-3
Bladder , retention in acute illness, opium-1 H/O fever prior
Bladder, painful retention opium-2
Bladder, retention inactivity opium-2
Bladder sphincter spasm opium-3
Intestines, inactivity opium-2
Intestines, paralysis opium-3
Thank you, Vernetta Oberoi

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.

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