Homoeopathic Treatment in Pelvi-ureteric Junction (PUJ) Obstruction/Stenosis – A Case Report

Supriya Singh 1 , Abhijit Chattopadhyay 2

1 PG Scholar, Department of Homoeopathic Materia Medica, National Institute of Homoeopathy

2 Former HOD, Department of Homoeopathic Materia Medica, National Institute of Homoeopathy 

Introduction

Pelvi- ureteric junction (PUJ) obstruction/ stenosis is impairment in urine flow from the renal pelvis to proximal ureter due to structural narrowing of the PUJ leading to hydronephrosis and if left uncorrected, leads to progressive renal deterioration and eventually to renal failure. Treatment depends on the underlying cause. However, when there is a definitive structural obstruction, surgical intervention with pyeloplasty or stenting may be required. Here is a case of PUJ obstruction that has been treated successfully with Individualised Homoeopathic Treatment within a timespan of five months without any surgical intervention.

Case Summary

A male patient of 24yrs, visited NIH OPD on 6th October 2021 with the complaint of pain in the right flank since 3yrs with one or two severe episodes per year. The pain typically aggravates during prolong fasting, physical exertion and is ameliorated by lying supine. In USG (W/A), it showed mild hydronephrosis with disproportionately dilated pelvis of right kidney ??PUJ obstruction and mild right perinephric collection. CT Scan (KUB), revealed it to be a right sided PUJO, with associated right sided moderate hydronephrosis. Renogram (99m Tc DTPA), showed reduced parenchymal function of right kidney possibly due to obstruction. Homoeopathic case taking was done and Lycopodium clavatum 200/3Doses was prescribed according to the totality of the symptoms on first visit followed by Rubrum 30/1Drachm on the subsequent visit. On 3rd visit Lycopodium clavatum 200/1Dose was again repeated. On 4th visit, USG (KUB) dated 02/03/2022 suggested features of right sided mild hydronephrosis only with no PUJ obstruction.  

Keywords- Pelvi- ureteric junction (PUJ) obstruction/ stenosis, hydronephrosis, pyeloplasty or stenting, Individualised Homoeopathic Treatment, USG (W/A), CT scan (KUB), Renogram (99m Tc DTPA), Lycopodium clavatum.

Case Study

The Patient:

MRN No. – 14332

Date of Case Taking- 06/10/2021

Name- Mr M S

Age- 24yrs

Sex- Male

Address- Kaliachak, Malda

 

Present Complaint:

1. Pain in the right flank, since 3yrs

Frequency- Once per year

Location- Right flank 

Sensation- Severe cutting pain

Modalities:

Aggravation- Fasting, physical exertion

Amelioration- Supine

Most Probable Cause- Not known to the patient

Treatment Taken- Allopathic Medications

Result- Temporary Relief

 

Past History:

Nothing Significant

 

Family History:

• Paternal Side- N/S
• Maternal Side- Mother has DM
• Own Side- N/S

 

Personal History:

Addiction- Bidi, 5-6 yrs (5-6 /day)

Occupation- Coolie

Accommodation- Pakka House, well ventilated

Diet- Regular, Mixed

Marital Status- Married since 2yrs

No. of Children- 1 daughter, 7months old

Sexual History- N/S

Relationship with others- Cordial at home 

Any medicine taken regularly- NIL

H/O vaccination- Patient do not remember

Developmental Milestone- All at proper age

 

Generalities

Physical General:

Thermal Reaction- Hot Patient

Appetite- Good, cannot tolerate hunger

Desire- Meat (fatty food), sweet (everyday one), fried food

Aversion-N/S

Intolerance-N/S

Thirst- 4-5 L/day, has to drink along with meals

Salivation- Moderate

Tongue- Anteriorly clean, posteriorly dirty coated, moist, b/l pigmentation

Perspiration- Profuse; more on trunk

Stool- 1-2/daily, semi solid 

Urine- Clear

Sleep- Adequate, Sound sleep

Dreams- N/S, earlier he had night falls

 

Mental Generals:

• Likes company (mostly family)
• Gets angry easily, shouts but will not express much
• Weeping easily due to family matters

 

Provisional Diagnosis: Right sided PUJ Obstruction

Investigations Suggested: 

1. USG of W/A - Mild hydronephrosis with disproportionately dilated pelvis of right kidney ? PUJ Obstruction; Mild right perinephric collection (14/06/2021)
2. CT Scan (KUB) – Right sided PUJO, with associated right sided moderate hydronephrosis; Functional kidneys (12/07/2021)
3. Urea – 23 mg/dl; Creatinine- 0.9 mg/dl (12/07/2021)
4. Renogram (99m Tc DTPA)- Normal global renal function; Reduced parenchymal function of right kidney possibly due to obstruction; Normally functioning non obstructed left kidney. (20/08/2021)

 

Totality of Symptoms:

1. Likes company (mostly family)
2. Gets angry easily, shouts but will not express much
3. Weeping easily due to family matters
4. Thermal Reaction- Hot Patient
5. Appetite- Good, cannot tolerate hunger
6. Desire- Meat (fatty food), sweet (everyday one), fried food
7. Thirst-3-4 L/day, has to drink along with meals
8. Tongue- Anteriorly clean, posteriorly dirty coated, moist, b/l pigmentation
9. Perspiration- Profuse; more on trunk
10. Severe cutting pain in the right flank, since 3yrs; once per year

< Fasting, physical exertion, > Supine 

 

Final Selection of Medicine:

After consulting with Materia Medica, Lycopodium clavatum seems to cover the totality of symptoms. That’s why Lycopodium clavatum is finally selected for the case.

 

Preion:

                        Rx

1. LYCOPODIUM CLAVATUM 200/ 3 DOSES

AD× 3 days

1. RUBRUM 200/ 1DRACHM

OD× 27days

 

Follow up:

Date	Observation	Preion
03/11/2021	Patient did not have any episode of pain in the last month. Other Generalities – N/S	BILINOGEN MT/ 30ml                   10 Drops in half cup water                   OD × 30 DAYS RUBRUM 200/ 1 DRACHM OD × 30 DAYS
11/01/2022	No attack of pain in the last month Conjunctivitis of right eye, 2-3 days ago, with pain, lachrymation and redness, discharge sticky glue like pus at night, can’t open eyes in morning. Thirst – decreased Other Generalities – N/S	LYCOPODIUM CLAVATUM 200 1DOSE              OD × 1day RUBRUM 200/ 1 DRACHM OD × 30 DAYS
07/03/2022	No episode of pain Stye right eye Only redness of right eye slight, again since few days Other Generalities – N/S USG (KUB) dated 02/03/2022 suggested features of right sided mild hydronephrosis only.	SULPHUR 30/ 1 DOSE                 OD × 1 DAY RUBRUM 200/ 1 DRACHM OD × 30 DAYS

Conclusion:

The case shared demonstrates that a remedy having strong affinity to a certain organ also has the potential to cure any disease affecting that organ/ location, irrespective of etiology. It also shares the depth and speed of action of Homoeopathic medicine and to demonstrate the role of Homoeopathy in surgical cases.

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