Individualised Homeopathic Management, 2 Case Reports – Hpathy.com

We present two cases of individualised homoeopathic management of steroid-sensitive nephrotic syndrome (SSNS). The benefit from individualised homoeopathy in reducing acute as well as long-term complications of steroid toxicity is demonstrated here. Importance of the theory of “levels of health” and the “continuum theory” are also emphasised through these cases.

Keywords: Steroid-sensitive nephrotic syndrome; SSNS; Frequently relapsing nephrotic syndrome; Steroid-dependent nephrotic syndrome; Steroid toxicity;Theory of Levels of health (LOH); The continuum of a unified theory of diseases.

Introduction:

Nephrotic Syndrome (NS) is characterised by mblockive protein loss from urine and varying degree of hypoalbuminemia, oedema and hyperlipidaemia.

The cause is yet unknown, but immune cell dysregulation and the creation of circulating substances that harm the glomerular filtration barrier have been reported. On the other hand, monogenic origins account for up to one-third of instances of steroid-resistant NS.

NS with multiple medication resistance, frequently results in renal failure and can trigger relapse following kidney transplantation. While renal function is unaffected in steroid-sensitive nephrotic syndrome (SSNS), most affected children experience relapses that necessitate recurrent steroid cycles with severe side effects.

Certain patients require steroid-sparing immunosuppressive drugs, such as cyclophosphamide, levamisole, mycophenolate mofetil, calcineurin inhibitors, and anti-CD20 monoclonal antibodies, in order to reduce morbidity.

To avoid acute consequences, close observation and preventative actions are necessary at the beginning and during recurrence (e.g., hypovolemia, acute renal damage, infections, and thrombosis), while minimizing treatment-related side effects is necessary for long-term care.

A portion of individuals continue to have active illnesses throughout adulthood.⁴ NS affects 7 to 16 out of every 100000 children under the age of 16, and is the most prevalent glomerular disease in children worldwide. Steroid therapy is effective for the majority of children with NS.

Nevertheless, 40 and 60 percent of affected children experience relapses frequently or develop steroid dependence. In order to sustain extended periods of remission, this group of children needs to take steroids on a regular or extended basis, along with other immunosuppressants.^{5, 6}

In clblockical homoeopathy, after strict individualisation based on blockysis of symptoms from three areas viz mental, emotional and physical, a single remedy is given to stimulate the defence mechanism of the individual under treatment, resulting in complete remission of the condition ^{3, 7, 8}

 Case 1:

On March 27, 2021, a 4-year-old female child presented with nephrotic syndrome, for which she was hospitalised in December 2020. At hospital she received IV-20% of Human Albumin for over 12 hours on the first day and 8 hrs the next day, then Syrup Omnacortil 9 ml orally twice daily, Rantac 2.5 ml orally 12 hourly. Injection Lasix 20mg Thrice daily.

On Discharge, on12.12.20 she was advised- to continue Omnacortil (15mg/5ml)- 9ml BD- orally and syrup Rantac75mg/5ml- 2.5ml BD orally till further advice. Past medical history: all scheduled vaccinations were done without any adverse reaction.

Family History: Paternal grandfather- diabetes mellitus, paternal grandmother- general anxiety disorder, uncle – juvenile diabetes,

Maternal grandmother – Psoriasis, maternal grandfather- diabetes mellitus, uncle- sarcoidosis.

Homoeopathic consultation on 27.3.21: She had stopped taking conventional treatment 2 week ago.

Symptoms available for prescription:

Irresistible yawning without sleepiness++.

Masturbation in children +++

Haughty and puts a show of herself in whatever she does.  (++).

Intense symptoms – leg pain++, and protein in urine++ (dip stick method).

Details of the follow-up are mentioned in Table 1.

Fig. 1. Urticarial rashes during treatment of nephrotic syndrome

Fig. 2. Urticarial rashes during treatment of nephrotic syndrome

Outcome: There were 2 relapses of proteinuria in 2021 and 3 relapses in 2022 and one in 2023 and none in 2024. All relapses happened with acute fever with either respiratory tract infections or urinary tract infections. Recently, the protein in urine is trace amount, cholesterol is normal, and total albumin is normal. The leg pain has reduced completely. A shift may be appreciated in disease from deeper organ to skin^{3, 7} .

 Case 2

A 3-year-old male child presented with Cushingoid’s feature post Omnacortil. H/O of first episode of nephrotic syndrome diagnosed on 4/7/2022, was hospitalised with swelling of face, abdomen, legs, scrotum and ***.

Treatment at hospital: – IV-20% of Human Albumin over 12hr on first day and 8hrs the next day, then Syrup Omnacortil 12.5 ml  twice daily, Pan 20 junior once a day, Rantac -3ml twice a day orally. Injection Lasix 40mg twice a day.

On Discharge (12.12.20) – was advised to continue Omnacortil  – 14ml once a day- orally and syrup Rantac 3ml twice a day till further advise, Lasix 40mg ½ tablet twice a day for 2 days.

 Homoeopathic consultation on 27/3/21

The child presented with cushingoid features, behaviour issues, and excessive hair growth on upper arm and back.

Mental/emotional symptoms: He was Disobedient 3+, Malicious2+, Restless 3+,

Generalities: perspiration copious 2+, craving for banana2+,

Past Medical history- From the age of one year, he had recurrent lower respiratory tract infections, for which he was given repeated antibiotics and  nebulization.

Family Medical History: Mother- Tuberculosis, Father- Asthma. Both side Grandparents were Diabetic.

Details of the follow-up are mentioned in Table 2

Outcome: In case 2, there were two relapses. During the first, the patient’s parents were not willing to continue with homoeopathy during exacerbation of proteinuria and resorted to omnacortil, and in second relapse they persisted with homoeopathic treatment. During that, there was initial aggravation in both fever and proteinuria and then amelioration. Further, his bronchitis came back and improved under individualised homeopathy^3,7.

Discussion

Mainstay of treatment of SSNS is corticosteroids. If there are frequent relapses, then they resort to immunosuppressants. The long-term adverse effect of both is very well known. In the above cases the children were benefited from clblockical individualised homeopathy and nephrotic syndrome resolved as evident clinically and on laboratory investigations.

Further, both cases demonstrated shift of pathology. One showed appearance of urticarial rashes while the other demonstrated return of suppressed bronchitis. The prescription as always is based on the specific picture of the symptomatology as and when required, using the strategies to prescribe as taught by George Vithoulkas⁹.

The MONARCH criteria for causality score in both the cases is provided in Table 3 and the score was 11/13 for both the cases.

 Conclusion: The two cases of children with nephrotic syndrome presented here benefited greatly with individualised clblockical homeopathy. The kidney function and clinical symptoms improved and stayed that way on long follow ups. This gives ground to plan scientific studies to establish the role of clblockical homeopathy in nephrotic syndrome.

 References:

1. Kang HG, Seo H, Lim JH, et al. Markers of disease and steroid responsiveness in paediatric idiopathic nephrotic syndrome: Whole-transcriptome sequencing of peripheral blood mononuclear cells. Journal of International Medical Research. 2017;45(3):948-963. doi:10.1177/0300060516652762
2. Vithoulkas G. Levels of Health. 3^rd Revised Edition. International Academy of Clblockical Homeopathy. Alonissos. 2019
3. Vithoulkas G, Carlino S. The “Continuum” of a Unified Theory of Diseases Medical science Monitor.SR7 Special Report. 2010.
4. Vivarelli M, Gibson K, Sinha A, Boyer O. Childhood nephrotic syndrome. The Lancet. 2023;402(10404):809-824. doi:10.1016/S0140-6736(23)01051-6
5. Esezobor CI, Solarin AU, Olagunju AT. Significant Burden and Psychological Distress Among Caregivers of Children With Nephrotic Syndrome: A Cross-Sectional Study. Can J Kidney Health Dis. 2020;7. doi:10.1177/2054358119898016
6. Sanjad SA, Ulinski T, Aoun B. Editorial: Nephrotic Syndrome in Children. Front Pediatr. 2021;9. doi:10.3389/fped.2021.803923
7. Oberbaum M, Singer SR, Vithoulkas G. The colour of the homeopathic improvement: The multidimensional nature of the response to homeopathic therapy. Homeopathy. 2005;94(3):196-199. doi:10.1016/j.homp.2005.05.004
8. George Vithoulkas. The Science of Homoeopathy. 7th edition. International academy of clblockical homoeopathy, Alonissos 37005; 2014.
9. George Vithoulkas. E-Learning programme by IACH.