Nephrotic Syndrome Cases.
NATIONAL JOURNAL OF HOMOEOPATHY 1994 May / Jun Vol III No 3.
Mohan Gune.
Cases.
` Apis / Lyc / Syph / Apis / Ars.

Case 1:

Master T N S, a boy of 4 years, had ascites, dyspnoea and oedema of face and legs. There was a history of pyogenic infection 15 days ago. He was brought in a critical condition on 5th August 1992 with the following complaints:

1. Puffiness of face+++
2. Swelling of legs since 2 days
3. Breathlessness +++
4. Fever with cough since eight days
5. H/O Skin infection 15 days ago and haematuria.

General Examination:

Temp- 100F, Pulse-130/min, Resp Rate- 60/min.
JVP-raised;
Abdominal girth- 17.8 inches Weight 14Kg.
Pedal oedema- +++; No clubing or splinter haemorrhage.

Systemic Examination:

Respiratory Sys- Bilateral crepitations.
Abdomen- Liver ++. Minimal fluid, Ascites.

Differential Diagnosis:

1. Acute Glomerular Nephritis
2. Pyelonephritis with Broncho pneumonia.
3. Impending CCF:

He was advised hospitalization and a paeditrician was called for an opinion who advised-

1. Bed rest.
2. Oral liquids or a semisolid diet.
3. IV DLR-P over 24 hrs for maintenance.
4. Inj Ampicillin 500mg IV 6 hourly.
5. Inj Gentamycin 20mg IV stat and remaining doses after Serum Creatinine.
6. Inj Lasix 10mgs IV / IM stat.
7. Strict I / O chart.

FOLLOW-UP

DATE

5/8/92
6/8/92
7/8/92
8/8/92
9/8/92
10/8/92
11/8/92
12/8/92

GENERAL CONDITION

General Condition Poor, Restless++
Oedema+++, Breathlessness+++, 2hrly.
Cough+++ Haematuria
Breathlessness + Crepts ++ Haematuria + Oedema++
Breathlessness decreased, GC improved Crepts + Haematuria + I/O better.
Dyspnoea decreased. No Haematuria.
Crepts+
GC fair. Abdominal girth decreasing.
Weight decreasing
Input output good, GC fair
GC Fair
BP 120/80 mm hg. Weight 12Kgs
Abdominal girth 17 inches

TREATMENT

Ars-alb 200
Lyco 1M stat
Ars-alb 200 2hrly
Lyco 1M stat
Ars-alb 200 2 hrly
Lyco 1M BD
Ars-alb 200 2hrly
Lyco 1M one dose
ct all
ct all
ct all
ct all for 8 days
Lyco 1M one

Rubrics taken:

1. KR 721- Restlessness, nervousness
2. KR 1356- Dropsy
3. KR 766- Respiration difficult
4. KR 681- Urine bloody
5. KR 786- Cough dry
6. KR 340- Nose, motion of wings constant, fan like in pneumonia
7. KR 392- Face swelling
8. KR 393- Face swelling oedematous

Treatment:

The Allopathic medicine was withdrawn and he was given Homoeopathic treatment instead.

Arsenic-alb 200 every two hours was given. Lycopodium 1M single dose was given at 8 p.m., the indication being flapping of alae nasi and difficulty in respiration.

Lab Investigations:

On 6th August 1992:

1. Blood Count- Hb 11.2 gms percent, Total WBC 13400/cmm,
2. Differential WBC- P- 80 percent L 14 percent E- 4 percent M- 2 percent
3. Serum Creatinine- 2.5 mg percent
4. Serum Cholesterol- 250 mg percent
5. Serum Protein- 6.1 gm percent
6. Blood Urea- 48mg percent
7. Urine Routine- Proteins+++ Pus Cells-plenty, RBCs 40-50, Granular casts++
8. X-Ray chest- Bilateral Broncho pneumonia.

The patient is in good health till date. Repeat investigations on 5th September 1992 revealed-

1. Blood Count- Hb- 9.5 gms percent WBC- 9400/cmm
2. Differential WBC- P 66 percent, L 40 percent, E 2 percent, M 2 percent
3. Serum Creatinine- 0.9 mg percent
4. Serum Cholesterol- 190 mg percent

He was continued with the same treatment Lycopodium 1M single dose once a week with Ars-alb 200 1 QID. Oral Calcium and Iron was also suggested.

Case 2:

Master PUA, 15 years of age was brought with complaints of-

1. Puffiness of face especially in the morning
2. Haematuria
3. Dyspnoea on exertion

The complaint had started since two days. There was a history of skin infection 15 days ago. He had also suffered from a past history of urinary tract infection.

General Examination:

Anaemia+
Oedema on face and lower extremities.
Hypo-pigmented patch on the face.
Pulse- 98/min. Regular, normal tension and force. High volume.
BP- 170/90 mm of Hg
Weight- 42 kg

He was advised hospitalization to confirm a diagnosis of Nephrotic Syndrome.

Lab Investigations:

1. Blood Count Hb-10gms percent WBC- 8500/cmm ESR- 52
2. Differential WBC- P 69 percent L 27 percent E 3 percent M 1 percent RBC- Normocytic mild hypochromia
3. Serum Creatinine- 0.4 mgs percent
4. Serum Cholesterol- 216 mg percent
5. Serum Proteins- 5.8 gms percent
6. Blood Urea- 43 mgs percent
7. Blood Sugar- (Random)- 99 mgs percent
8. Urine Routine- Proteins +++ Pus Cells- 4.5 RBCs Nil Granular casts- +

Rubrics:

1. KR 1356- Generalities, dropsy, internal
2. KR 681- Urine bloody
3. KR 766- Respiration difficult
4. KR 392- Face swelling
5. KR 393- Face swelling, oedematous
6. KR 530- Stomach, thirstless

Treatment:

He was prescribed Apis-m 30 every two hours on the basis of oedema, haematuria, and thirstlessness.

Follow-up:

On the third day the patient felt better. His oedema reduced and weight came down to 41 kgs. His blood pressure was still the same 170/90 mm of Hg. An MD physician was called for an opinion and he gave the following-

General Examination:

Anaemia- ++ 
Pulse- 90/mm
BP- 210/100 mm of Hg

Systemic Examination:

CVS- Tachycardia, 1st heart sound loud. SSM at base. Grade II.
RS- Clear. No ronchi or crepitations.
PA- Soft, tenderness at left renal angle. Normal peristaltic sounds. Liver, spleen, kidney- NAD.
CNS- NAD

A dose of Syphilinum 1M for three days was given and Apis -m was raised from 30 to 200 potency, four times daily. His blood pressure started coming down from 210/100 to 160/80 cmm of Hg. On 27/7/82 he was given Syphilinum 10M once daily for four days along with Apis-m 200 one dose four times a day.

On 30/7/92 his blood pressure came down to 134/60mm of Hg. When the MD physician saw the results he was astonished to see his prescription of antibiotics, anti-hypertensive and diuretic withheld.

Date

21/7/92
22/7/92
23/7/92
24/7/92
25/7/92
26/7/92
27/7/92
28/7/92
29/7/92

GENERAL CONDITION

Oedema ++, Haematuria ++ Anaemia++ P-95/min, BP-170/90mm of Hg Wt- 42 kg
I/O 2400/2052cc. Oedema++
I/O 1200/1500 Oedema
Oedema
Wt 41 kg, BP- 250/100 reduced to 190/90mm of Hg.
I/O 1900/2850 cc GC fair BP 180/90 mm Hg
GC fair BP 160/90 mm Hg
BP 160/70 mm of Hg, GCF.
BP 140/70 mm of Hg

TREATMENT

Apis-m 30 2 hourly
ct all
ct all
Syphilinum 1M stat
Apis-m 200 2 hourly
Syph 10M stat
Apis 200 2 hourly
ct all
ct all
ct all
ct all

An Explanation for the schedule and Repetition of Doses used

In the first case, the patient Master TNS was brought in a very bad shape. He was breathless +++ with oedema on face and difficult respiration. It was a case of Nephrotic Syndrome with pneumonia. The baby was already suffering for 6 days at his village. He had been referred to a pediatrician but was brought to me instead. He showed a clear picture of Ars-alb in the clinic itself and was put on 200 potency with repetition every 2 hours. This one may feel as over dosing but in an acute condition, repetition is more beneficial. Borland in his book on pneumonia clearly states the following: "One finds the average length of action of each dose is round about two hours. That is to say, one can give a dose, and in two hours time one will find the patient needs repetition. So in practice what one does is to order six doses of whatever potency one chooses, in the average case probably a 10M and have it repeated every two hours.

The second point is about the use of Lycopodium in BD doses. If you look into the case it matches with the Lycopodium in addition to the flapping of alae nasi at around 8 PM aggravation. Ars-alb had already started acting from 2 p.m. onwards and so Lycopodium was given in 1000 potency. This however continued for 7 more days till the child was in hospital. I was not ready to take any risk what so ever in such a severe case. Later Lycopodium was repeated at the interval of 8 days only.

The second case of Mr PUA was prescribed Apis-m 30 and later 200. On the 4th day the patient was feeling better but clinically his blood pressure remained high which was not acted upon by Apis and so a dose of Syphilinum a great anti-syphilitic drug was given. Both these cases show that the repetition of the remedy in higher potency is useful especially in acute cases.