Reflux nephropathy This condition, which was previously known as chronic pyelonephritis, is a specific type of chronic interstitial nephritis (see previous section) associated with vesicoureteric reflux (VUR) in early life and with the appearance of scars in the kidney, as demonstrated by various imaging techniques. About 12% of patients in Europe requiring treatment for ESRD may have this disorder but diagnostic criteria are imprecise.

RISK FACTOR:

Risk factors for reflux nephropathy include:

• Abnormalities of the urinary tract
• Personal or family history of vesicoureteral reflux
• Repeat urinary tract infections

CLINICAL FEATURES:

Usually, the renal scarring and dilatation are asymptomatic and the patient may present at any age with hypertension (sometimes severe), proteinuria or features of CKD.

There may be no history of overt UTI.

 However, symptoms arising from the urinary tract may be present and include frequency of micturition, dysuria and aching lumbar pain.

VUR may occur in children but diminishes as the child grows, and usually has disappeared by adulthood.

Urinalysis often shows the presence of leucocytes and moderate proteinuria (usually < l g/24 hrs) but these are not invariable.

The risk of renal stone formation is increased.

Children and adults with small or unilateral renal scars have a good prognosis, provided renal growth is normal. With significant unilateral scars there is usually compensatory hypertrophy of the contralateral kidney.

PROGNOSIS

In patients with more severe bilateral disease, prognosis is related to the severity of renal dysfunction, hypertension and proteinuria. If the serum creatinine is normal and hypertension and proteinuria are absent, then the long-term prognosis is usually good.

HOMOEOPATHIC TREATMENT

Apis mellifica: This homeopathic medicine is not used in acute forms of CKD. Symptoms of this type include oedematous swelling on the face, paleness, headaches, pain in the back and limb, oedema pulmonum, etc. It is used when there are dull aches in the kidney, reduced urination, and micturition. The urine contains albumen in high levels and blood corpuscles. An eruption of the skin occurs, and the patient feels drowsy.

Arsenicum: This homeopathy medicine is used in all stages of CKD and is one of the best remedies. It is used in later stages of the disease when the patient's skin becomes pale, and he develops a waxen appearance, excess thirst and diarrhoea. The shade of the urine is dark and full of albumen. Dyspnoea attacks are also observed while lying down during the night. Taking aconite produces a mucus and the patient gets relief.

Aurum muriaticum: This homeopathic medicine is used to cure renal diseases such as Morbus bright caused by a gout or from syphilis. Digestive and nervous problems are indicated along with great irritability. Vertigo may also be caused.

Belladonna: Belladonna is the ideal homeopathic remedy for treating inflammation of the kidneys accompanied by piercing or burning pain in the lumbar region of the kidney. The pain reappears repeatedly with increased intensity each time.

Sarsaparilla: Urine scanty, slimy, flaky, sandy, bloody. Gravel. Renal colic. Severe pain at conclusion of urination. Urine dribbles while sitting. Bladder distended and tender. Child screams before and while passing urine. Sand on diaper. Renal colic and dysuria in infants. Pain from right kidney downward. Tenesmus of bladder; urine passes in thin, feeble stream. Pain at meatus.

Cantharis: This homeopathic cure is used in nephritis. There is a cutting pain in the lumbar region, the urine contains blood and the flow is in the form of drops. Cantharis is used in post diphtheric kidney disorders with dropsy. -Intolerable urging and tenesmus. Nephritis with bloody urine. Violent paroxysms of cutting and burning in whole renal region, with painful urging to urinate; bloody urine, by drops. Intolerable tenesmus; cutting before, during, and after urine. Urine scalds him, and is passed drop by drop. Constant desire to urinate. Membranous scales looking like bran in water. Urine jelly-like, shreddy.

Conavallaria: Conavallaria is used in case of nephritis occurring due to heart disorders. It is used when the heart functions irregularly and also in anasarca and ascites because of mitral insufficiency.