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Polycystic kidneys ( synonym: Congenital polycystic kidneys ) -- A Rare Disease

Dr. Nilanjana Basu Lecturer, Department of Surgery, Bakson Homoeopathic Medical College, Greater Noida Correspondence:

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 2 nd and 3 rd decades of life and does not usually manifest itself clinically before the age of 30 years. It is almost always bilateral.

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: 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: 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: Irregular upper quadrant abdominal mass Loin pain Haematuria Infection Hypertension Uraemia

Uraemia: Chronic renal failure develops as functioning renal tissue is replaced progressively by cysts. The patient complains of anorexia, headache and vague abdominal discomfort. As the symptoms are non-specific, the diagnosis maybe missed until drowsiness and vomiting result from the biochemical derangement. Severe anaemia is common. Signs of end-stage renal failure often begin suddenly during middle life, and the patient is unlikely to survive without renal replacement by dialysis or renal transplantation.

Case report: Chief complaints: Pain in right loin since 4 years Pain in left loin since 11 days

History of presenting 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- He had jaundice 10 years ago. Chicken pox 4 years ago

Family history- Mother-alive -Hypertension Father-died-Polycystic kidney disease Grandfather-died-Polycystic kidney disease Uncle-died-Polycystic kidney disease Brother -died-Polycystic kidney disease Brother-alive-Polycystic kidney disease Brother-alive-Renal mass Sister-died-Polycystic kidney disease hernia Son-alive-Bilateral inguinal hernia

General physical examinations 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 examination Inspection: No fullness in the lumbar region. Palpation: No palpable mass

Systemic examination: Gastro Intestinal Tract – normal CNS – normal CVS -- normal

Diagnosis: USG report and family history suggested POLYCYSTIC KIDNEY DISEASE.

Generalities: Appetite: Good, can’t wait for food when hungry. Flatulence if he not eat for long Desire: Salty food, eggs, very warm food Thirst: Profuse, large quantities at a time Tongue: Coated, moist Sleep: Wakes due to slightest noise and lies on back Stool: Regular, twice a day with flatulence Urine: Comes in drops

Mental generals: Irritable Consolation aggravates Desire to travel MISER Does not work.

Characteristic symptoms Complaint started from right side to left Burning pain in loin Pain associated with flatulence >ed by flatus Can’t wait for food when hungry. H/o jaundice Desire for very warm food MISER Desire to travel

Evaluation of symptoms MISER Desire for very warm food Pain associated with flatulence >ed by flatus Complaint started from right side to left

Totality of symptoms MISER Desire for very warm food Pain associated with flatulence >ed by flatus Complaint started from right side to left

Prescription: Lycopodium was the medicine selected and was given in fifty millesimal potency three times daily on Patient was asked to take a low protein diet. And avoid strenuous exercise.

Follow up: – 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

Analysis: Date Right kidneyLeft kidney mm194mm mm175mm

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: 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: Bailey & Love’s Short Practice of Surgery, 24 th ed., International Student’s Edition,2004 S.Das, A Manual on Clinical Surgery, 6 th edition,reprinted,2006 S.Das, Textbook of Surgery, 4 th edition,2006 Hompath M.D. version