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Missing You SirMissing You Sir
Polycystic kidneysPolycystic kidneys ((synonym: Congenital polycystic synonym: Congenital polycystic
kidneyskidneys))
-- A Rare Disease -- A Rare Disease
Dr. Nilanjana BasuDr. Nilanjana Basu
Lecturer, Department of Surgery,Lecturer, Department of Surgery,Bakson Homoeopathic Medical College, Bakson Homoeopathic Medical College, Greater NoidaGreater Noida
Correspondence: [email protected]: [email protected]
Introduction:Introduction:
Polycystic kidneys are hereditary and can be transmitted by either parent as an autosomal dominant trait. The disease is usually not detectable on standard imaging until the 2nd and 3rd decades of life and does not usually manifest itself clinically before the age of 30 years.
It is almost always bilateral.
Aetiology:Aetiology:
This condition occurs due to defect in the mechanism of joining between the uriniferous (secretory) tubules and the collecting tubules.
The blind secretory tubules which are connected to functioning glomeruli becomes cystic. As these cysts enlarges, they compress adjacent tissues and gradually occlude normal tubules.
Pathology:Pathology:
The kidneys become enormously enlarged, the cysts giving the appearance of a collection of bubbles below the renal capsule. On histological section, the renal parenchyma is riddled with cysts of varying size containing clear fluid, thick brown material or coagulated blood.
In 18% of cases there is a congenital cystic liver disease. The pancreas and lungs are occasionally affected as well. The etiology of all renal cysts is uncertain although theories abound.
Prognosis:Prognosis:
These patients do not live longer than 5-10 years after the diagnosis is made, unless dialysis or renal transplantation is made available.
Clinical features: Clinical features:
Irregular upper quadrant abdominal mass
Loin painHaematuriaInfectionHypertensionUraemia
Case report:Case report:
Chief complaints:Pain in right loin since 4 yearsPain in left loin since 11 days
History of presenting History of presenting illness: illness: A 35 years old male presented with
pain in both loins. His pain first appeared on the right side 4 years ago which was treated with some allopathic medicines and the pain subsided. There was burning in the part since then and no diagnosis was made. He had pain in left loin 11 days ago associated with flatulence which was > ed by passing flatus. There is no h/o haematuria.
Past history-Past history-
He had jaundice 10 years ago.Chicken pox 4 years ago
Family history-Family history-Mother-alive -HypertensionFather-died-Polycystic kidney diseaseGrandfather-died-Polycystic kidney
diseaseUncle-died-Polycystic kidney diseaseBrother -died-Polycystic kidney diseaseBrother-alive-Polycystic kidney diseaseBrother-alive-Renal massSister-died-Polycystic kidney disease
herniaSon-alive-Bilateral inguinal hernia
General physical General physical examinationsexaminations Mental state & conciousness-Well oriented &
fully conscious Built & Nutrition – well built Facies – normal Pallor – absent Icterus – absent Cyanosis – absent Oedema – absent Clubbing – absent Temperature – normal Pulse – 80/min Respiration – 14/min B.P. – 130/80 mm hg
Local examinationLocal examination
Inspection: No fullness in the lumbar region.
Palpation:No palpable mass
Systemic examination:Systemic examination:
Gastro Intestinal Tract – normalCNS – normalCVS -- normal
Diagnosis:Diagnosis:
USG report and family history suggested
POLYCYSTIC KIDNEY DISEASE.
Generalities:Generalities:Appetite: Good, can’t wait for food when
hungry. Flatulence if he not eat for longDesire: Salty food, eggs, very warm foodThirst: Profuse, large quantities at a timeTongue: Coated, moistSleep: Wakes due to slightest noise and
lies on backStool: Regular, twice a day with
flatulenceUrine: Comes in drops
Mental generals:Mental generals:
IrritableConsolation aggravatesDesire to travelMISERDoes not work.
Characteristic symptomsCharacteristic symptomsComplaint started from right side to leftBurning pain in loinPain associated with flatulence >ed
by flatusCan’t wait for food when hungry.H/o jaundiceDesire for very warm foodMISERDesire to travel
Evaluation of symptomsEvaluation of symptoms
MISERDesire for very warm foodPain associated with flatulence >ed by flatus
Complaint started from right side to left
Totality of symptomsTotality of symptoms
MISERDesire for very warm foodPain associated with flatulence >ed
by flatusComplaint started from right side to
left
11.10.09
Prescription:Prescription:
Lycopodium was the medicine selected and was given in fifty millesimal potency three times daily on 11.10.09
Patient was asked to take a low protein diet. And avoid strenuous exercise.
Follow upFollow up::
19.10.09 – Burning in loin was relieved. Urine now comes in proper flow and quantity increased. Distension of abdomen was relieved.
Lycopodium was continued from 0/2 to 0/9 and another USG was done on 24.2.10
Analysis:Analysis:
Date Right kidney Left kidney
5.10.09 191mm 194mm
24.2.10 195mm 175mm
There was marked reduction in size of left kidney and complaints of the patient i.e. pain and burning in loin, scanty urination, distension and flatulence of abdomen subsided.
The patient feels healthy, has a good appetite and further rapid progression of cyst formation is restricted with only homeopathic treatment, which is always evident otherwise.
Case followed the Hering’s law of cure.This case also proves the fact that the
treatment on totality gives good result in rare diseases like POLYCYSTIC KIDNEY DISEASE.
Discussion:Discussion:Lycopodium was prescribed according
to the totality of symptom.Fifty millesimal potency was used for
frequent repetition in ever increasing doses.
It was also given to avoid aggravations.
Complications such as Bleeding and Infection was prevented.
It can prevent the end-stage renal failure if formation of cysts is prolonged.
References:References:Bailey & Love’s Short Practice of Surgery,
24th ed., International Student’s Edition,2004S.Das, A Manual on Clinical Surgery, 6th
edition,reprinted,2006S.Das, Textbook of Surgery, 4th edition,2006Hompath M.D. version