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: niil2007@yahoo.co.inCorrespondence: niil2007@yahoo.co.in

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