Nowadays we very frequently encounter Diabetic cases in our day to day practice.
Homoeopathy is considered as one of the very best alternative system for
treating Diabetes Mellitus & its complications. Diabetic nephropathy (also
known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis) is
a progressive kidney disease caused by angiopathy of capillaries in the kidney
glomeruli. It is characterized by nephrotic syndrome and diffuse
glomerulosclerosis, It is due to longstanding diabetes mellitus and is a prime
cause for dialysis in India. Diabetic nephropathy is the most common cause of
chronic kidney failure and end-stage kidney disease in India. People with type
1 and type 2 diabetes are equally at risk to develop this complication. The
risk is even higher if blood-glucose levels are poorly controlled.
Apart from routine investigations like fasting & post
prondial sugar level, HbA1C, Renal Function Test, Complete Urine Analysis &
Lipid Profile, there is an investigation to diagnose the very early damage of
kidneys & heart, in diabetic patients - level of Microalbuminuria. The earliest detectable change in the course of
diabetic nephropathy is a thickening in the glomerulus. At this stage, the
kidney may start allowing more serum albumin (plasma protein) than normal in
the urine (albuminuria), and this can be detected by sensitive medical tests
for albumin. This stage is called "microalbuminuria".
Microalbuminuria occurs when the kidney leaks small
amounts of albumin into the urine, in other words, when
there is an abnormally high permeability for albumin in the renal
glomerulus. Microalbuminuria is probably a misnomer. It is not a
“small” albumin molecule found in the urine, but simply albumin present in low
amounts, below the level of detection of the standard office multi-test urine
dipstick.
ABOUT MICROALBUMINURIA:
Blood contains cells and proteins that we need, as well as
waste products that our body needs to get rid of. Blood is filtered by kidneys
and waste products are removed from body through urine. Usually, cells and proteins
stay in blood, but sometimes a small amount of protein is lost into urine along
with other waste products. Microalbuminuria is when the level of the protein
albumin in urine is always slightly raised. Microalbuminuria is defined as 30 to 300mg of albumin being lost in
urine per day. This is different to proteinuria, which is when the levels
of protein in urine are higher than 300mg a day.
CAUSES OF MICROALBUMINURIA:
The development of Microalbuminuria has been linked to diabetes.
Other than diabetes, risk factors for developing Microalbuminuria include:
Ø
High blood pressure.
Ø
A family history of diabetic kidney disease.
Ø
Smoking.
DIAGNOSIS OF MICROALBUMINURIA:
Normally, most protein stays in the body, and little or no
protein appears in the urine. If albumin is detected in the urine, it signifies
kidneys may be damaged and may not be working properly. Increased levels of
albumin may occur with:.
Ø
Diabetic Nephropathy.
Ø
High blood pressure.
Ø
Certain immune disorders
Ø
Some lipid problems.
The Microalbuminuria Test looks for small quantities of a protein
called albumin in a urine sample. A small sample of urine needs to be
collected. Because the amount of water in urine can vary, it can affect the
concentration of albumin. For this reason, the amount of creatinine is also
measured. The result is reported as the ratio of albumin to creatinine. This is
termed the albumin/creatinine ratio
(ACR) and According to
Gento-Montecatini Microalbuminuria is defined as:
Ø ACR
≥ 3.5 mg/mmol in female.
Ø ACR
≥ 2.5 mg/mmol in male.
Ø Or
an ACR between 30 & 300 µg albumin/mg creatinine.
The ratio of albumin to creatinine
is usually used to classify diabetic nephropathy. A ratio less than 30 micrograms per milligram is normal.
Ø
A ratio of 30-299 in two different 24-hour urine
samples is considered Microalbuminuria.
Ø
A ratio of more than 300 mg is considered Macroalbuminuria.
The American Diabetes Association recommends that people with diabetes receive a Microalbuminuria urine test every year (after 5 years of having the disease in people with type 1 diabetes, and at the time of diagnosis in people with type 2 diabetes).
In type 2 diabetes, having Microalbuminuria is a powerful message, that you have an increased risk of heart disease. Microalbuminuria is the strongest independent risk factor of cardiovascular disease. Screening identifies an increased risk of proliferative retinopathy.
Development of Microalbuminuria
is closely linked to long term blood sugar control. This risk is increased by:
Ø Duration
of diabetes.
Ø High
blood pressure.
MANAGEMENT:
Diet and
exercise play a key role in controlling blood sugar levels and reducing your
weight, blood pressure and cholesterol levels, in turn preventing any further
kidney damage. Steps may include:
Ø Exercising
regularly, if possible for 30 minutes a day.
Ø Eating at
least five portions of fruit and vegetables a day.
Ø Increasing
the amount of starchy carbohydrates in diet.
Ø Choosing
to eat carbohydrates that release energy slowly such as porridge oats, brown rice
and pasta, lentils and beans and avoiding those that release energy quickly
such as white bread and white rice.
Ø Reducing
the amount of sugar, fat and salt in your diet.
Ø Stop smoking.
Ø Cutting
down on alcohol.
Ø Monitoring
and controlling your blood sugar levels if you have diabetes.
Ø Limit the
amount of foods containing high levels of protein, sodium, potassium or
phosphate.
The following measures are advisable in diabetes patients:
Ø
Tighten up your blood sugar control.
Ø
Blood pressure lowering if high.
Ø
Stop smoking.
Ø
Exercise.
Ø
Lipid lowering treatment.
SIGNIFICANCE:
Presence of Microalbuminuria signifies:
Ø Blood vessels involved in filtering waste products in kidneys are damaged.
Ø First sign of kidney damage or kidney disease.
Ø Sign of more widespread damage to blood vessels, including those of heart.
Ø Sign of an increased risk of heart disease, particularly in type 2 diabetes.
Ø An indicator of subclinical cardiovascular disease.
Ø Marker of vascular endothelial dysfunction.
Ø An important prognostic marker for kidney disease, especially in diabetes mellitus & in hypertension.
Ø Increasing Microalbuminuria during the first 48 hours after admission to an intensive care unit predicts elevated risk for acute respiratory failure , multiple organ failure and overall mortality.
Ø A risk factor for venous thrombo embolism.
Ø Healthy people may exceed normal levels after strenuous exercise or with dehydration.
HOMOEOPATHIC MANAGEMENT
Diabetic
nephropathy is supposed to be a constitutional disease, so treatment also
should be constitutional. Normal levels can be absolutely attained and
maintained if Homoeopathic treatment is started earlier. In Homoeopathy,
medicines are highly individualized to the patient and this will help, Following
remedies are quite helpful to treat the symptoms and condition related to
nephropathy
Apis mellifica: Urine suppressed or scanty, high colored, fetid,
containing albumen, blood corpuscles, uriniferous casts & epithelium.
Argentum nitricum: Fatty degeneration of kidneys with haematuria
& epithelial casts in urine.
Arsenicum album: Indicated in primary cases of tubal nephritis.
Urine highly albuminous with waxy & fatty casts.
Arsenicum iodatum: Albuminuria from cardiac disturbances & periodical
effusions, as it reduces the amount of albumen in the urine.
Aurum metallicum:Indicated in interstitial nephritis with
contracted kidneys. Renal troubles secondary to cardiac affections, causing a
decided albuminous crasis. At first the urine is increased in quantity, later
it becomes scanty & albuminous.
Brachyglottis repens: Albuminuria depending on nervous disturbance,
as from over work, gradually causing renal disorganizations.
Berberis vulgaris: Urine of dark, bloody appearance & largely
supplied with albumen.
Bryonia alba: Urine almost dark brown, darker & more scanty
than usual.
Calcarea arsenicosa: Great
sensitiveness to pressure in renal region. Must urinate every hour & urine
full of albumen.
Calcarea carbonica: Albuminuria
following Eruptive diseases, especially variola.
Cannabis indica:Albuminuria as sequelae of pericarditis.
Cantharis vesicatoria: Indicated in Post–Scarlatinal Nephritis
& early stages, especially when occurring from blows on the loins, or
sudden change of temperature & when there is more renal desquamation than
blood. Urine contains an excessive quantity of swollen epithelial cells.
Carbolicum acidum: Post –
Scarlatinal Nephritis with much exhaustion.
Chelidonium majus: Albuminuria
as a result of intercurrent Pneumonia. Urine red & turbid.
Coccus cacti: Indicated in
Acute desquamative nephritis with Pulmonary congestion.
Colchicum autumnale:Urine as black as ink, containing blood, &
loaded with albumen & tube-casts, smoky in appearance. Patient cannot stand
up straight or lie down with stretched out legs without causing pain in renal
region.
Crotalus horridus:Urine dark, smoky from admixture of fluid blood
with renal congestion.
Cuprum metallicum:Urine containing albumen & renal elements with
uremic convulsions.
Digitalis:Post – Scarlatinal nephritis. Granular degeneration of
the kidneys. Scanty urination, urine albuminous, thick, turbid, blackish.
Urinary solids absolutely diminished. Contracted kidney & uremic poisoning.
Glonoinum:Cirrhotic kidney with Albuminuria. Urine high colored,
burning while passing, with red sediment & muddy, reddish – yellow slime.
Helleborus: Post – Scarlatinal or Post – diphtheritic nephritis.
Black urine with a black cloud near the bottom of the chamber or a coffee –
ground sediment.
Helonias:Urine, profuse, clear, light colored, albuminous with
diabetes.
Hepar sulph: Post – Scarlatinal
nephritis. Urine dark red, hot, bloody, burning, or pale, with flocculent,
muddy looking sediment.
Kali bromaticum:Nephritis with a syphilitic background. Urine
loaded with epithelial casts & albumen.
Kalmia latifolia:Albuminuria as a result of heart complication.
Urine scanty, albuminous with fibrinous casts & epithelial cells.
Lachesis:Nephritis after excessive use of alcohol. Urine dark,
turbid or black in spots with full of albumen.
Mercurius corrosivus:Early stages of nephritis, especially when
caused by abuse of alcoholic drinks, by cold or by obstructed portal
circulation. Scanty bloody urine with effusion of fibrin or fat globules in the
urine, or profuse secretion of pale, albuminous urine.
Phosphoricum acidum:Urine contains much phosphate, fibrinous casts
& epithelial cells, fatty corpuscles, rarely carbonate of ammonia with
albumen.
Phosphorus: Kidney present
with great structural changes, granular & fatty degenerations, destruction
of epithelium & finally atrophy. Urine highly albuminous.
Plumbum metallicum:Granular kidney with a urine of low specific
gravity, pale, containing albumen, tube casts, epithelial cells, blood &
pus corpuscles.
Secale cornatum:Post – Scarlatinal nephritis. Urine pale or bloody,
urinary deposits looking like cheese.
Terebinthina: Indicated in
early stages, when blood & albumen abound more than casts & epithelium.
Urine much diminished in quantity & highly charged with decomposed blood.
