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Kidney




Kidney play a central role in excretion of many metabolic breakdown products, including ammonia, urea and creatinine from protein, and uric acid from nucleic acids, drugs and toxins. They also regulate fluid and electrolyte balance.

Kidney also regulates acid-base homeostasis, calcium and phosphate homeostasis, Vit.-D metabolism and production of RBC. They are important in regulating blood pressure .To maintain homeostasis and a normal plasma Na+ concentration

Three steps required for kidney to excrete a water load : 1. Filtration or delivery of water to the diluting sites of nephron
2. Active reabsorption of Na+ and Cl- without water in thick ascending limb of loop of Henle ( TALH) to a lesser extent in distal nephron
3. Maintenance of dilute urine due to impermeability of collecting ducts to H2O in absence of AUP.
Any abnormalities of any of these steps can result impaired free water excretion and eventually causes different kidney problems.

1.Hypovolemia – True volume depletion or hypovolemia generally refers to a combined salt and water loss exceeding intake, leading to ECF volume contraction. Many condition are associated with excessive urinary tract NaCl and water losses, including diuretics. Many tubular and interstitial renal disorders are associated with NA+ wasting.

COMMON SYMPTOMS: History of recurrent vomiting, diarrhoea, polyuria, diaphoresis.
• Fatigue, weakness, muscle cramps, thirst and postural dizziness are some secondary to electrolytes imbalance.
• Severe degree leads to end-organ ischaemia manifest as oliguria, cyanosis, abdominal and chest pain
• Confusion and obtundation
• Diminished skin turgor and dry oral mucous membrane

2.HYPONATREMIA. A plasma Na+ concentration <135m mol/L usually reflects a hypotonic state. However , plasma osmolarity may be normal or increased in some cases of hyponatremia.
Isotonic or slightly hypotonic hyponatremia may complicate transurethral resection of prostate or bladder because large volumes of iso-osmotic or hypo-osmotic bladder irrigation solution can be absorbed or result in dilution hyponatremia. Hypotonic hyponatremia is usually due to hypoglycemia or occasionally intra-venous administration of mannitol. During poorly controlled Diabetic mellitus, glucose is an effective osmole and draws water from muscle cells resulting in hyponatremia.

COMMON SYMPTOMS : Hyponatremia related to osmotic water shift leading to increased ICF vol.
CAUSES :-
• Brain cell swelling or oedema symptoms are primarily neurologic.
• Asymptomatic or complaint of nausea and malaise.
• Headache, lethargy, confusion and obtundation.

3. HYPERNATREMIA – When plasma Na+ concentration >145m mol/L.
Majority of cases of hypernatremia result from loss of water. The two causes of hypernatremia are
• Increase water intake stimulated by thirst.
• Excretion of the minimum vol of maximally concentrated urine reflecting AVP section in response to osmotic stimulus.

The degree of hyperosmolarity is typically mild unless the thirst mechanism is abnormal or access water is limited later occurs in infants, physical handicapped and patient with impaired mental status ,in postoperative state.

COMMON SYMPTOMS :- Subarachnoid or intracerebral hemorrhage
• Neurologic or altered mental status
• Weakness, neuromuscular irritability
• Focal neurologic deficits, coma or seizures.
• Patient also complain of polyuria or thirst .
• Patient with polydipsia from CDI tend to prefer Ice- cold water.
• History of excessive sweating, diarrhoea or an osmotic diuresis

4.HYPOKALEMIA – When plasma K+ concentration <3.5m mol/L may result from once (or more) of the following decreased net intake, shift into cells, increased net loss. Diminished intake of is seldom the sole cause of K+ depletion. With the exception of urban poor and certain cultural groups, the amount of K+ in the diet almost always exceeds that excreted in urine. However dietry K+ restriction may exacerbate the hypokalemia secondary to increased gastrointestinal or renal loss.

LIDDLE SYNDROME :- Rare familial disease characterized by hypertension, hypokalemia, metabolic alkalosis, renal K+ wasting & suppressed rennin and aldosterone secretion.

BARTTER’S SYNDROME:- Is a disorder characterized by hypokalemia, metabolic alkalosis, hyperreninemic and juxtaglomerular apparatus hyperplasia.


COMMON SYMPTOMS:- Depends on individual patients and their severity depend on degree of hypokalemia
• Fatigue, Malaise, Myalgia and muscular weakness of lower extremities are common complaints.
• Severe form lead to weakness, hypoventilation(due to respiratory muscle involvement) and eventually complete paralysis.
• Smooth muscle function may also be affected and manifest as paralytic ileus.
• Severe hypokalemia increased risk of ventricular arrhythmias especially in patient with myocardial ischaemia or ventricular hypertrophy
• Glucose intolerance may also occur.

5. HYPERKALEMIA:- Defined as plasma K+ concentration >5.0m mol/L occurs as a result of either K+ release from cells or decreased renal loss. Increase K+ intake is rarely sole cause of hyperkalemia.
CAUSES:-
• Renal failure
• Decreased distal flow (i.e decreased effective circulating arterial volume)
• Decreased K+ secretion.

A. IMPAIRED Na+ REABSORPTION:
Primary hypoaldosteronism – Adrenal insufficiency adrenal enzyme deficiency
Secondary hypoaldosteronism – Hyporeninemia, drugs (NSAID’S, Heparin, Ace inhibitors)
Resistance to aldosteron- Pseudohypoaldosteronism, Tubulointerstitial disease, drug (trimethoprin,pentamidines)

B.ENHANCED Cl- :
* Reabsorption ( chloride shunt)
* Gordon’s syndrome
*Cyclosporine


COMMON SYMPTOMS:- Weakness due to prolonged depolarization.
• May also causes flaccid paralysis and hypoventilation if respiratory muscles involved.
• Metabolic acidosis occur’s due to impaired acid excretion
• Most serious effect of hyperkalemia is cardiac toxicity.

6. HYPERCALCEMIA:- Excess PTH productions, which is not appropriately suppressed by increased Serum Calcium Concentration and occur in primarily neoplastic disorders of Parathyroid Glands (Parathyroid adenomas, hyperplasia or rarely, Carcinoma) that are associated with increased parathyroid cell mass and impaired feedback inhibition by calcium.
Disorders that directly increase calcium mobilization from bone, such as hyperthyroidism or osteolytic metastasis also lead to hypercalcemia with suppressed PTH secretions, as does exogenous calcium overload as in milk-alkali syndrome,or total parenteral nutrition with excessive calcium supplementation.


COMMON SYMPTOMS:- Mild Calcemia (11-1105mg/dl) is usually asymptomatic.
• Some patients complaint of vague neuropsychiatric symptoms, including trouble concentrating, personality changes, or depression.
• Peptic Ulcer or nephrolithiasis and fracture risk maybe increased.
• More severe Hypercalcemia (>12-13mg/dl) develops acutely may results lethargy, stupor or coma as well as GIT symptoms (anorexia, coma, constipation or pancreatitis).
• Hypercalcemia decrease renal concentrating ability, which may cause polyuria and polydipsia.
• With long standing Hyperparathyroidism, patient may present with bone pain or pathologic fractures.

7. HYPOCALCEMIA:- Causes of Hypocalcemia can be differentiated according to whether Serum PTH levels are low (Hypothyroidism) or high (Secondary Hyperparathyroidism). Although there are many potential causes of Hypocalcemia, impaired PTH or VITAMIN D production are most common etiologies. Hypocalcemia may also occur in conclusion associated with severe tissue injury such as Burns, rhabdomyolysis, tumourlysis or pancreatitis. The cause of hypocalcemia in these settings may include a combination of low albumin, hyperphosphatemia, tissue deposition of calcium and impaired PTH secretion.

COMMON SYMPTOMS:- Mostly asymptomatic but, if decrease in Serum Clcium are relatively mild and chronic, there maybe life threatening complications.
• Moderrate to severe associated with paresthesias, usually of fingers, toes and circumoral regions and caused by neuro-muscular irritability.
• Severe hypocalcemia induce seizures, carpopedal spasm, brochospasm, laryngospasm and prolongation of QT-interval.
NEPHROTIC SYNDROME :- Nephrotic syndrome characterized by following abnormalities :
• Proteinuria ( >3.5g in 24 hrs)
• Generalized oedema
• Hyperlipidaemia
• Hypoalbuminaemia

In nephritic syndrome, permeability of glomerular wall increased due to glomerular inflammation,
• Change in surface electrical charge and
• Alteration in pore size

All these result in excessive leakage of plasma protein into the urine leading hypoalbuminaemia

Increased concentration of albumin in blood decreased plasma oncotic pressure which disturb starling force acting across peripheral capillaries due to this intravascular fluid migrate into interstitial tissue cause oedema.

Low plasma oncotic pressure also stimulate hepatic lipoprotein synthesis. Hence , hyperlipidaemia also associated with nephritic syndrome.

It also increased risk of artherosclerosis and cardiovascular disease.

CAUSES: -
i.PRIMARY (IDIOPATHIC) – i. Minimal lesion glomerulonephritis (80% in children)
ii. Membranous nephropathy (male predominance)
iii. Focal & segmental glomerulosclerosis( 1/3 of cases in adult)
iv. Mesangial proliferation glomerulonephritis.

2.SECONDARY-
I. INFECTION- Malaria, syphilis, bacterial endocarditis, hepatitis-B,leprosy, HIV-infection.
2. Connective tissue disease – SLE, Rheumatoid arthritis
3. Neoplasms – Hodgkin’s lumphoma, carcinomas, leukaemias
4. Drugs & toxins- Pencillamine, captopril,gold,mercury contaminated heroin.
5. Metabolic –Diabetes mellitus, Amylodosis.

CLINICAL FEATURES :-

i.Gradual swelling of whole body started from face to lower limbs so called descending type of oedema. ii.Breathlessness
iii. Abdominal discomfort & tightness
iv. Weakness & susceptibility to infection are very common.

HOMOEOPATHIC MEDICINES FOR NEPHROTIC SYNDROME


1.APIS MELLIFICA: BAD EFFECTS FROM – Acute exanthema imperfectly developed or suppressed. After Measles. After Scarlatina. Suppressed urticaria. In Bright’s disease.

CHARACTERISTICS –Oedema ; bag like, puffy swelling under the eyes ; of hands and feet, dropsy, withoutthirst.Acute inflammation of kidney and other parenchymatous tissues are characteristic pathological state corresponds to Apis. Anasarca. Ascites. Incontinence of urine, with great irritation of the part. Can scarcely retain the urine a moment, when passed scaled severely.
WORSE- Night. After sleep especially warm & heated room are intolerable; lying down. BETTER- open air, cold bathing, uncovering.
Associated features. Thirtslessnessin Anasarca, ascites. Burning, stinging and sore. General soreness: “every hair is painful to touch.”
2.CALCAREA ARSENICA: Nephritis in Alcoholic persons, especially after abstaining. Nephritis with great sensitiveness in kidney region. Albuminuria, passes urine every hour. Dropsy. In fleshy individuals with palpitation on slightest emotions with history of recurrent malaria.
General dropsical swelling, temples,face,back of hands, with albuminaria. Frequent micturition ; burning with scanty urine.
Night sweat after 3 a.m. Slightest emotions causes palpitation of heart.
Worse – in cold weather; when out of doors, slight exertion.
Associated features.Children with enlarged liver and spleen. Chilliness is marked, originates inwardly, with a sensation as if skin and adjoining parts were hot. Dyspnoea with feeble heart. Leucophlegmatic constitution.
3.EEL SERUM; Sudden nephritis after from cold , infectionor intoxication, and the attack is characterised by oliguria , anuria and albuminuria . the presence of albumin and renal elements in the urine , the haemoglobinuria, the prolonged anuria ( 24-26 hours ), together with the results of the autopsy, plainly demonstrate its elective action on the kidneys.Indicated when dyspnea and scanty urine. But its really specific indication seems to be for acute nephritis a frigori.
The serum of the eel seems better adapted to cases of hypertension and oliguria without oede
4.FERRUM METALLICUM: Dropsy: after loss of vital fluids; abuse of quinine; suppressed intermittent.
Constant desire to urinate with pain in kidneys, liver and chest. Urine blood red, contain blood corpuscles. Albuminuria, hot urine. Incontinence of urine. Extreme paleness of the face, lips and mucous membranes which become red and flushed on the least pain, emotion or exertion.Red parts become white.Always feels better by walking slowly about,although weakness obliges the patient to lie down.
Worse- At night; at rest, especially while sitting still.
Better- walking slowly about; in summer.
5.NATRUM MURIATICUM- After prolonged use of excessive salt causes profound nutritive changes in the system, resulting in salt retention, evidenced by dropsies, oedemas and in alteration in the blood causing the condition of anaemia and leucocytosis.
Pain just after micturating. Increased involuntary when walking, coughing, etc.
Has to wait for a long time for it to pass if others are present.Clear urine with red sediment, resembling brick-dust. During micturition stitches in bladder, smarting ,burning in urethra. Urine dark like coffee, or black.
Mapped, tongue with red insular patches; like ringworm on side.
Worse –at the seashore or from sea air; heat of sun or stove; mental exertion,talking,writing, reading; lying down
Better - in open air; cold bathing; going without regular meals ; lying on right side.
CRF also defined as irreversible deterioration in renal function over 3 months with GFR <15MIN/1.73m2
A reduced GFR leads to retention of nitrogenous waste products (azotemia) such as urea & creatinine. Azotemia result from reduced renal perfusion, intrinsic renal disease pr post renal processes (ureteral obstruction)
Precise determination of GFR is problematic as both commonly measured indices (urea&creatinine) have characteristic that affect their accuracy as markers of clearance.
• Urea clearance significantlyunderestimate GFR because of tubule urea reabsorption.
• Creatinine derived from muscle metabolism of creatinine & its generation varies little from day to day.
Creatinine is useful in estimating GFR becoz it is small, freely filtrated solute. However serum creatinine level increased acutely from dietary ingestion of cooked meat & creatinine can be secreted into proximal tubule through an organic cation pathway, leading to overestimation of GFR.

CAUSES OF CRF:-


i.Primary & secondary glomerulonephritis
ii.Diabetic nephropathy
iii.Hypertensive nephrosclerosis
iv.Polycystic kidney disease
v.Chronic pyelonephritis
vi.Analgesic nephropathy
vii.Vesicoureteric reflux
viii.Renal tuberculosis
ix. Nephrocalcinosis
x.Obstructive nephropathy
xi. Tubulo-interstitial diseases.

CLINICAL FEATURES:-

IN GENERAL- Patient with chronic renal failure look unwell.
• Their skin pallid, complexion yellow & slightly yellowish hue is often evident.
1.Mucous membrane pale, reflecting associated normochromic, normocytic anaemia.
2.Their may be bruises, purpura & scratch marks due to uraemic pruritus
3. Nails often appear pale & opaque (leuconychia) in nephrotic syndrome & sometimes in CRF.
4.When blood urea high uraemic frost may seen on part of body & appears as white powder
5.causes severe bone deformity & VIT-D deficiency.Advanced uraemic also associated with metabolic flap, a corse tremor which best seen at wrists when in dorsiflexed position.
6.Metabolic acidosis common accompaniment of CRF.
7.Hypertension develop in approx. 80% of patients.
1.ARSENIC ALBUM: It clear cut characteristic symptoms and correspondence to several severe types of disease make its homoeopathic employment constant and certain.Alcoholism, ptomaine poisoning,stings, dissecting wounds,chewing tobacco and ill effects from decayed food.

Swollen,pale,yellow,cachectic, sunken, cold and covered with sweat.Albuminous . Urine scanty, burning, involuntary. Bladder feels as if paralyzed.After micturating,feeling of weakness in the abdomen.Bright’s disease.Burning relieved by heat.

Worse – AFTER MIDNIGHT (1 to 2 a.m or p.m); from cold, cold drinks or foods; when lying on affected side or with the head low.

Better – From heat in general(reverse of sec.) except headache, which is temporarily > by cold bathing ; burning pain > by heat.

2.LYCOPODIUM –In nearly all the cases where Lyco. is indicated, evidence of urinary or digestive disturbance will be found.Pain in back before micturating; ceases after flow; slow in coming ,must strain. Retention.Polyuria at night. heavy red sediment.Renal colic, right side.

Craves everything warm. Deep seated, progressive, chronic diseases.Symptoms characteristically run from right to left, act especially on the right side of the body and are worse from about 4 to 8 p.m.

Worse – Nearly all diseases from 4 to 8 p.m. from above downward , hot air.

Better – by motion, after midnight, from warm food and drink, on getting cold, from being uncovered .

3.HELONIAS DIOICA – Menses are often suppressed and kidney congested.It seems as if monthly congestion (menses), instead of venting itself as it should, through the uterine vessels, vents itself via the kidneys.Constant aching and tenderness over the kidney region.

Albuminous, phosphatic ; profuse and clear, saccharine.Pain and weight in the back; tired and weakAching and burning across the lumbar region ;can trace the outlines of the kidneys by constant burning.Patient is better when kept busy, when mind is engaged, when doing something.

Worse - Motion , touch

Better –When doing something (mental diversion)

3.EEL SERUM; Sudden nephritis after from cold , infectionor intoxication, and the attack is characterised by oliguria , anuria and albuminuria . the presence of albumin and renal elements in the urine , the haemoglobinuria, the prolonged anuria ( 24-26 hours ), together with the results of the autopsy, plainly demonstrate its elective action on the kidneys.Indicated when dyspnea and scanty urine. But its really specific indication seems to be for acute nephritis a frigori.

The serum of the eel seems better adapted to cases of hypertension and oliguria without oedema.

5.PHOSPHORUS-Produces a picture of destructive metabolism.Bad effectof iodine and excessive use of table salt.Hematuria, especially in acute Bright’s disease.Turbid , brown, with red sediment.A weak, empty, all gone sensation in head, chest, stomach and entire abdomen.Suddenness of symptoms,sudden prostration, faints, sweats, shooting pains, etc.

Worse - Evening , before midnight ; lying on left or painful side ; during a thunderstorm; weather changes, either hot or cold.

Better - In dark, lying on the right side, cold food ; cold; open air ; washing with cold water

ACUTE RENAL FAILURE


ARF is abrupt onset of declining renal function occurring over a period of hours or days, usually (but not always’s) accompanied by a marked reduction or cessation of urinary flow rate.

Rapid decline in GFR, leading to nitrogen retention and usually to sodium & water retention as well.
• An increase in serum creatinine of >0.3mg/dl within 48 hours
• An increase in serum creatinine of >1.5 times baseline
• Urine Vol <0.5ml/kg per hours for more than six hours.
An except in patient in whom decline of GFR not accompanied by reduction of urine flow so called non-oliguric acute renal failure.
RIFLE : Criteria used to classify severity of AFR
R- RISK
I-INJURY CLASSE
F-FAILURE
L-LOSS
E-END-STAGE KIDNEY
AETIOPATHOGENESIS- Kidney receive approx. 25% of cardiac output at rest.
In pre-renal ARF kidney are inadequately perfused (due to diminished cardiac output) & GFR is greatly diminishing resulting in oliguria (urine output <400ml/day)
Post-renal failure caused by obstruction of urinary tract at any point in its course.

Renal causes of ARF from intrinsic disease of kidney themselves, like glomerular tubulo-interstitial or vascular disease.

In ATN (acute tubular necrosis), a diminution in supply of O2 & nutrients to tubular cells fortunately tubular cell regenerate when causative factors are removed.

CAUSES:-
1.Pre-renal – i..Hypovolaemia
ii.Reduced cardiac output
iii.Renal vessels diseases
iv.Drugs
2.Renal – i.Glomerular disease
ii.Vascular disease
iii. Acute tubular necrosis
iv. Acute tubule-interstitial nephritis.
3.Post-renal – i.Extra-renal obstruction prostatic enlargement, urethral stenosis, tumors, calculi.
ii. Intra-renal obstruction- Uric acid crystals, sloughed papillae.

CLINICAL FEATURES –
Pre-renal disorder – Rapidly develop uraemia
• Low-blood pressure
• Poor peripheral perfusion & a falling of urine output.
Renal (ARF) – Pedal odema
• Ascites
• Pulmonary oedema
• Hyperkalaemia commonly occur
Last for 10-14 day’s or vary few hrs to long as 4 weeks.
• Last for 4 days to week
• GFR low
• Urine output remains low
• Urine output increased
• Polyuria in few days
• Dehydration , hyponatremia
• Hypertension, proteinuria & haematuria.
• Fever, skin rash and arthralgias

Post-renal – Commonly causes Anuria with h/o loinpain, haematuria, renal colic or difficulty in micturition.
GENERAL SYMPTOMS – Anorexia
• Nausea & vomiting
• Pruritus
• Mental state changes seizures
• Dyspnoea due to fluid overload

GENERAL SIGNS OFARF PATIENTS


• Myoclonus
• Pericardial rub
• Oedema
• Crepitations
• Visual blurring
1.APIS MELLIFICA: BAD EFFECTS FROM – Acute exanthema imperfectly developed or suppressed. After Measles. After Scarlatina. Suppressed urticaria. In Bright’s disease.

CHARACTERISTICS –Oedema ; bag like, puffy swelling under the eyes ; of hands and feet, dropsy, withoutthirst.Acute inflammation of kidney and other parenchymatous tissues are characteristic pathological state corresponds to Apis. Anasarca. Ascites. Incontinence of urine, with great irritation of the part. Can scarcely retain the urine a moment, when passed scaled severely.
WORSE- Night. After sleep especially warm & heated room are intolerable; lying down. BETTER- open air, cold bathing, uncovering.

Associated features. Thirtslessnessin Anasarca, ascites. Burning, stinging and sore. General soreness: “every hair is painful to touch.

2. ARSENIC ALBUM : It clear cut characteristic symptoms and correspondence to several severe types of disease make its homoeopathic employment constant and certain.Ailments from Alcoholism, ptomaine poisoning,stings, dissecting wounds,chewing tobacco and ill effects from decayed food.Swollen,pale,yellow,cachectic, sunken, cold and covered with sweat.Albuminous. Urine scanty, burning, involuntary. Bladder feels as if paralyzed.After micturating, feeling of weakness in the abdomen.Bright’s disease.

Associated complaints - Burning relieved by heat Great anguish and restlessness. Changes place continuously. Cannot bear the sight or smell of food. Great thirst; drinks much, but little at a time.
Worse -AFTER MIDNIGHT (1 to 2 a.m or p.m); from cold;cold drinks or foods; when lying on affected side or with the head low.

Better –From heat in general(reverse of sec.) except headache, which is temporarily > by cold bathing ; burning pain > by heat.

3.CANTHARIDES - The burning pain and intolerable urging to urinate,is the red strand of cantharis in all inflammatory affection Constant urging to urinate, passing but a few drops at a time , mixed with blood Intolerable urging before, during and after of urination Violent pain in bladder. Burning, cutting pains in urethra during micturition . Violent tenesmus and strangury
Associated complaints -Burning thirst but averse to liquids, Drinking even small quantities of water increases pain in bladder
Worse- Urinating, drinking, sound of water
Better- Warmth, rest

4. NATRUM MURIATICUM- After prolonged use of excessive salt causes profound nutritive changes in the system, resulting in salt retention, evidenced by dropsies, oedemas and in alteration in the blood causing the condition of anaemia and leucocytosis. Pain just after micturating. Increased involuntary when walking, coughing, etc.Has to wait for a long time for it to pass if others are present.Clear urine with red sediment, resembling brick-dust. During micturition stitches in bladder, smarting ,burning in urethra.Urine dark like coffee, or black.

Associated complaints -Great emaciation ;losing flesh while living well. Mapped, tongue with red insular patches; like ringworm on side.

Worse -at the seashore or from sea air; heat of sun or stove; mental exertion,talking,writing, reading; lying down
Better - in open air; cold bathing; going without regular meals ; lying on right side.

5.THYREOIDINUM – In myxoedema and cretinism its effects are striking.Increased flow ; polyuria ; with albumen and sugar.Enuresis in children who are nervous and irritable. Urine of violets, burning along the urethra, increase of uric acid in urine. Albuminuria.Has a powerful diuretic action in myxoedema and various types of oedemas.

Worse - by least exertion ; by stooping, by lying down, cold.
Better -by rest

URINARY TRACT INFECTION:- UTI may be anatomically sub-divided into lower tract infection ( urethritis , prostatitis , cystitis) and upper tract infections ( pyelonephritis & perinephric abscess)
DEFINITION– The pressure of more than 10 organism/ml in the midstream sample of urine (MSU).
This is donated as “significant bacteriuria”

UTI associated with multiplication of organisms in the urinary tract.

AETIOLOGY – Common micro-organisms involved in UTI’S are Escherichia coli (80% cases), proteus, klebsiella , enterobacter , pseudomonas , serratia, Chlamydia trachomatis and neisseria gonorrhea.

• About one-third of females with dysuria & frequency have either insignificant no. of bacteria in mid-stream cultures or completely sterile cultures.
• This subset of patient has been defined as having acute urethral syndrome.

PATHOGENESIS – i. Bacteria gain access to the bladder via. The urethra in the vast majority of cases. Ascent of bacteria from the bladder may then follow, which results in parenchymal infections.
ii. Female are more prone to the development of cystitis due to several reasons :
• Short urethra (4cm)
• Gram ( -)ve enteric organisms residing near the anal region colonise the peri-urethral region.
• Absence of bactericidal prostatic secreations.
• Sexual intercourse facilitates entry of introital bacteria into the bladder.

iii. Pregnancy is associated with an increased incidence of UTI due to decreased in ureteral tone & ureteral peristalsis and there is transcient incompetence of vesicoureteral valves.all these factor’s favour the development of UTI.
iv. Instrumentation of urinary tract like catheterization urethral dilatation & cystoscopy.
v. Associated disorders that impair defence mechanism like diabetic mellitus favour the development of UTI.
vi. Neurogenic bladder dysfunction that occurs with spinal cord injuries, tabes dorsalis and multiple sclerosis also pre-dispose to UTI.

CLINICAL FEATURES


I .Fever with chills & rigors.
ii. frequency of micturation
iii. Dysuria or scalding micturation
iv. Urgency
v. Haematuria
vi. Suprapubic pain resulting from cystitis.
vii. Bladder irritation.
viii. Urine is cloudy with an unpleasant odour.
ix. Sequelae like sepsis, metastatic abscesses and renal failure are common in complicated UTI.
1. CANTHARIDES – The burning pain and intolerable urging to urinate,is the red strand of cantharis in all inflammatory affection.Constant urging to urinate, passing but a few drops at a time , mixed with blood.Intolerable urging before, during and after of urination .Violent pain in bladder .Burning, cutting pains in urethra during micturition . Violent tenesmus and strangury
Associated complaints -Burning thirst but averse to liquids, Drinking even small quantities of water increases pain in bladder
worse - Urinating, drinking, sound of water
Better - Warmth, rest
2. Equisetum Hyemale - Frequent and intolerable urging to urinate, with severe pain at close of urination . Large quantity of clear, watery urine, Constant desire to urinate.Sharp, burning, cutting pain in urethra while urinating . Severe dull pain in the bladder, as from distention, not α urinating.Profuse watery urine where habit is the only ascertainable cause (enuresis) .Dribbling urine . Mucus in urine
Worse - at closure of urination Pressure , touch, movement.
Better– in afternoon from lying down.
3.EUPATORIUM PERFOLIATUM –i. Excellent in renal dropsy, ii
ii. Albuminuria.Irritable bladder, enlarged prostrate are special field for this remedy.Deep, dull pain in kidneys.burning in bladder and urethra on urinating.Insufficient flow; milky. Strangury. Haematuria.Bladder feels dull. Vesical irritability in women.
Associated complaints -Bruised feeling, as if broken, all over the body. Bone pains, before and during chill. Insatiable thirst before and during chill abd fever ; knows chill is coming because he cannot drink enough.
Worse -inopen air ; after being in ice-house.
Better - in house
4.SARSAPARILLA – Bright’s disease, bladder, affections of. Dysuria.
a. CHARACTERISTICS- i. Renal colic
ii. Stone in bladder- bloody urine
iii. Passage of gravel or small calculi
iv. Severe, almost unbearable pain at conclusion of urination
v. Urine – bright and clear bit irritating, scanty, slimy, flaky, sandy, copious, passed without sensation, deposit white sand (child screams before and after passing it)
vi. Painful distension and tenderness in bladder
vii. Urine dribbles while sitting, standing, passes freely
viii. Air passes from urethra
b. MODALITIES-
Worse – on moving , cold diet, dim sight ,bread.
Better – standing
5.UVA URSI – Cystitis. Dysuria. Heamaturia. Urinary affections.
a.CHARACTERISTICS – Its traditional reputation as an “astringent used to check excessive secretion of mucous, as in urinary and bronchial affections, and even in calculus.” ii. The keynote indications are : painful micturition with burning sensation. Burning after discharge of slimy urine. Slime passes with blood
iii. Painful dysuria. Green urine
iv.Urine contains blood, pus and much tenacious mucus, with clots in large masses.