Haematuria Health Dictionary

Saraca asoca

Caesalpiniaceae

San:Asoka, Gatasokah;

Hin:Asok, Asoka; Ben:Ashok; Mal:Asokam;

Tam: Asogam;

Kan:Asokada, Aksunkara;

Tel: Asokamu, Vanjalamu

Importance: Ashoka, the sacred tree of Hindus and Buddhists, possesses varied medicinal uses. The bark is useful in dyspepsia, fever, dipsia, burning sensation, visceromegaly, colic, ulcers, menorrhagia, metropathy, leucorrhoea and pimples. The leaf juice mixed with cumin seeds is used for treating stomachalagia. The floweres are considered to be uterine tonic and are used in vitiated conditions of pitta, syphilis, cervical adinitis, hyperdipsia, burning sensation, haemorrhoids, dysentery, scabies in children and inflammation. The well-known Ayurvedic preparations are ”Ashokarishta” and “Ashokaghrita”. Ashokarishta is prescribed in leucorrhoea, haematuria, menorrhagia and other diseases of genitourinary system of females.

Distribution: Ashoka is found almost throughout India, except North-Western India, upto 750m. It is also found in the Andaman Islands.

Botany: Saraca asoca (Roxb.) de Wilde. syn. S. indica auct. non Linn. is a medium sized evergreen tree growing upto 9m height with numerous spreading and drooping glabrous branches. Leaves are pinnate, 30-60cm long having 2-3 pairs of lanceolate leaflets. Flowers are orange or orange yellow, arranged in dense corymbs and very fragrant. Fruits are flat black pods, leathery and compressed with 4-8 seeds/pod. Seeds are ellipsoid oblong and compressed. The bark is dark brown to grey or black with a warty surface. The thickness varies from 5mm to 10mm. The entire cut surface turns reddish on exposure to air. Polyalthia longifolia (Annonaceae) is equated with the name Asoka by some (Kapoor & Mitra, 1979; Chunekar, 1982) and is often used as an adulterant of the genuine Asoka bark or as a substitute (Warrier et al,1996).

Agrotechnology: Asoka grows well in areas with well distributed rainfall and in slightly shady areas. Asoka requires soil rich in organic mater and moisture. The best season of planting is June-July. It is also grown in summer, if irrigation facilities are available. The plant is seed propagated. Seeds are formed usually during February-April. Seeds are collected when they are ripen and fall down and are sown after soaking in water for 12 hours on the prepared beds. Seeds germinate within 20 days. The seeds are then planted in polybags. 2-month-old seedlings from the polybags are used for transplanting. Square shaped pits of 60cm depth are taken at 3m spacing and filled with topsoil, sand and dried cowdung. On this the seedlings are planted. Application of FYM at 10kg/tree/year is highly beneficial. Chemical fertilisers are not usually applied. Irrigation during summer months is essential. No serious pests or diseases are generally noted in this crop. If properly cultivated, Asoka can be cut after 20 years and the bark collected. It is cut at a height of 15cm from the soil level. If given irrigation and fertilisers, the cut wood will sprout again and harvested again after 5 years. This can be continued. When it is difficult to cut the tree, the bark can be peeled off from one side first. When the bark grows and cover that part, the other side can be peeled off. This is also continued (Prasad et al, 1997; Karshakasree, 1998).

Properties and activity: Flowers give -sitosterol, flavonoids and flavone glycosides-quercetin, kaempferol-3-O- -D- glucoside, quercetin-3-O- -D-glucoside. The anthocyanins present are pelargonidin-3, 5-diglucoside and cyanadin-3, 5-diglucoside. Bark yields catechol and sterols-(24)-24-methyl cholest-5-en-3 -ol, (22E, 24)-24-ethylcholesta-5, 22-dien-3 -ol and (24)-24-ethyl cholest-5-en-3 -ol, a wax containing n-alkanes, esters and free primary alcohols. Alcoholic extract and glycoside P2 from stem bark is oxytoxic. Aerial part is CNS active, hypothermic, CNS depressant and diuretic. Stem bark is anticancerous, has spasmodic action on rabbit intestine and cardiotonic action in frog and dog. Seed is antifungal. Stem bark is astringent, antileucorrhoeic, antibilious and uterine sedative. Flower is uterine tonic, antidiabetic and antisyphilitic. Stem bark and flower is antibilious (Husain et al, 1992).... ashoka

The escape of blood from any of the blood vessels, normally in response to some trauma, or as a result of a clotting disorder such as HAEMOPHILIA. The bleeding may be external – for example, following a skin laceration; or it may be internal – for example, haematemesis (bleeding into the stomach), haemoptysis (bleeding from the lungs), or haematuria (bleeding from the kidneys or urinary tract). For more information about these conditions, see separate entries.

Bleeding into or around the brain is a major concern following serious head injuries, or in newborn infants following a di?cult labour. Haemorrhage is classi?ed as arterial – the most serious type, in which the blood is bright red and appears in spurts (in severe cases the patient may bleed to death within a few minutes); venous – less serious (unless from torn varicose veins) and easily checked, in which the blood is dark and wells up gradually into the wound; and capillary, in which the blood slowly oozes out of the surface of the wound and soon stops spontaneously. Haemorrhage is also classi?ed as primary, reactionary, and secondary (see WOUNDS). Severe haemorrhage causes SHOCK and ANAEMIA, and blood TRANSFUSION is often required.

When a small artery is cut across, the bleeding stops in consequence of changes in the wall of the artery on the one hand, and in the constitution of the blood on the other. Every artery is surrounded by a ?brous sheath, and when cut, the vessel retracts some little distance within this sheath and a blood clot forms, blocking the open end (see COAGULATION). When a major blood vessel is torn, such spontaneous closure may be impossible and surgery is required to stop the bleeding.

Three main principles are applicable in the control of a severe external haemorrhage: (a) direct pressure on the bleeding point or points;

(b) elevation of the wounded part; (c) pressure on the main artery of supply to the part.

Control of internal haemorrhage is more dif?cult than that of external bleeding. First-aid measures should be taken while professional help is sought. The patient should be laid down with legs raised, and he or she should be reassured and kept warm. The mouth may be kept moist but no ?uids should be given. (See APPENDIX 1: BASIC FIRST AID.)... haemorrhage

Linn.

Adansonia digitata Linn.

Family: Bombacaceae.

Habitat: Native to tropical Africa; common along the west coast of India.

English: Baobab, Monkey Bread tree, African calabash.

Ayurvedic: Sheet-phala, Ravanaam- likaa, Gorakshi, Panchparni.

Unani: Gorakh Imli.

Siddha/Tamil: Papparapuli.

Folk: Gorakh Imli; Gorakh Chinchaa.

Action: Cooling, refrigerant (allays burning sensation). Leaves— diaphoretic (used as a prophylactic against fevers). Fruit—antidysen- teric, antiseptic, antihistaminic.

The fruit pulp is a source of vitamin C (175.0-445.4 mg/100 g); dried pulp contains calcium and vitamin B1. Furfural (9.6%) is obtained after distillation of the fruit. In Africa, dried leaves provide much of the dietary calcium. Aqueous extract of the bark is used for treating sickle cell anaemia.

An infusion of the leaves and flowers is given in respiratory disorders. (Powdered leaves prevented crisis in asthma induced by histamine in guinea pigs.) Dried fruit pulp also gives relief in bronchial asthma, allergic dermatitis and urticaria.

Family: Leguminosae; Mimosaceae.

Habitat: The western Ghats, the Andamans and sub-Himalayan tract; also cultivated.

English: Coral Wood, Red Wood.

Ayurvedic: Rakta Kanchana, Rakta Kambala.

Siddha/Tamil: Anai-gundumani.

Folk: Ghumchi (bigger var.).

Action: Astringent and styptic (used in diarrhoea, haemorrhage from the stomach, haematuria), anti-inflammatory (in rheumatic affections, gout). Seeds— anticephalgic; also used for the treatment of paralysis. A decoction is given in pulmonary affections.

The seed contains an anti-inflammatory active principle, O-acetyletha- nolamine. The leaves contain octa- cosanol, dulcitol, glucosides of beta- sitosterol and stigmasterol. The bark contains sitgmasterol glucoside.... adenanthera pavonina

A metalloid with industrial use in glass, wood preservative, herbicide, semiconductor manufacture, and as an alloy additive. It may be a component in alternative or traditional remedies both intentionally and as a contaminant. Common in the environment and in food, especially seafood, arsenic is odourless and tasteless and highly toxic by ingestion, inhalation and skin contact. It binds to sulphydryl groups inhibiting the action of many enzymes (see ENZYME) and also disrupts oxidative phosphorylation by substituting for PHOSPHORUS. Clinical effects of acute poisoning range from severe gastrointestinal effects to renal impairment or failure characterised by OLIGURIA, HAEMATURIA, PROTEINURIA and renal tubular necrosis. SHOCK, COMA and CONVULSIONS are reported, as are JAUNDICE and peripheral NEUROPATHY. Chronic exposures are harder to diagnose as effects are non-speci?c: they include gastrointestinal disturbances, hyperpigmentation and HYPERKERATOSIS of skin, localised OEDEMA, ALOPECIA, neuropathy, PARAESTHESIA, HEPATOMEGALY and jaundice. Management is largely supportive, particularly ensuring adequate renal function. Concentrations of arsenic in urine and blood can be measured and therapy instituted if needed. Several CHELATING AGENTS are e?ective: these include DMPS (2, 3-dimercapto-1-propanesulphonate), penicillamine and dimercaprol; DMPS is now agent of choice.... arsenic

willd.

Family: Asparagaceae.

Habitat: Native to Europe and West Asia.

English: Asparagus, Sparrow grass.

Ayurvedic: Shataavari, Vari, Shatviryaa, Shatmuuli, Shatpadi, Bhiru, Naaraayani, Bahusutaa, Atirasaa.

Unani: Haliyun.

Family: Asparagaceae.

Habitat: Found wild in tropical and subtropical parts of India, including the Andamans and ascending in the Himalayas to 1,500 m.

English: Indian asparagus.

Ayurvedic: Shataavari, Shatmuuli, Atirasaa, Bahusutaa, Shatpadi, Shatviryaa, Bhiru, Indivari, Vari. (Substitute for Medaa, Mahaamedaa.)

Unani: Sataavar.

Siddha/Tamil: Thanneervittan kizhangu, Sataavari Kizhangu.

Action: Used as a galactagogue and for disorders of female genitourinary tract; as a styptic and ulcer-healing agent; as an intestinal disinfectant and astringent in diarrhoea; as a nervine tonic, and in sexual debility for spermatogenesis.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the tuberous root in gout, puerperal diseases, lactic disorders, haematuria, bleeding disorders and also recommends it for hyperacidity.

The plant contains saponins—sha- tavarins I-IV. Shatavarin IV is a glycoside of sarsasapogenin. The saponin in doses of 20-500 mcg/ml produces a special blockade of syntocinon (oxy- tocin)-induced contraction of rat, guinea-pig and rabbit uteri in vitro and in situ. It also blocks the uterine spontaneous motility.

The dried root yields sitosterol; 4,6- dihydroxy-2-O-(2' hydroxyisobutyl) benzaldehyde and undecanyl cetano- ate, and contains a large amount of saccharine matter, mucilage and miner- als—Ca (0.172), Cu (0.033), Na (14.60), K (8.32), Mg (0.169), Mn (0.0074), Ni (0.105) and Zn (0.072) mg/g(dry weight).

The root was found to reduce gastric emptying time comparable to that of metoclopramide. (J Postgrad Med, 1990, 36(2), 91-94).

The root extracts exhibited antiallergic activity in animal studies.

The root, when fed orally, acted as immunomodulator against induced sepsis and peritonitis in rats and mice.... asparagus racemosus

Now named renal cell carcinoma, this is a malignant tumour resembling the tissue of the suprarenal gland and occurring in the KIDNEYS. Fever, loin pain, HAEMATURIA and swelling are among the presenting symptoms, but the tumour may be symptomless for many years. Surgical removal is the initial treatment; hypernephromas are fairly insensitive to CYTOTOXIC drugs and RADIOTHERAPY – although hormone treatment may help – and are prone to spread via the bloodstream, for example, to the lungs.... hypernephroma

Linn.

Synonym: B. candida Roxb.

Family: Caesalpiniaceae.

Habitat: Punjab, Western Peninsula and Assam. Also cultivated in gardens.

English: Mountain Ebony, Buddhist Bauhinia.

Ayurvedic: Kaanchanaara, Kaan- chanaaraka, Kanchanak, Kaan- chana, Gandhaari, Sonapushpaka, Ashmantaka.

Siddha/Tamil: Sivappumanchori.

Action: Buds—a decoction is given in piles (also used against tumours), haematuria, menorrhagia. Dried buds are used in diarrhoea, dysentery, worm infestation, piles and tumours. Root— carminative, used in dyspepsia and flatulence (a decoction is reported to prevent obesity). Bark—astringent, anthelmintic; used externally in scrofula and skin diseases. Seeds—possess human blood agglutinating activity. Leaf— antifungal.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicated the use of the stem bark in lymphadenitis and goitre. (Ka- anchnaar Guggulu is prescribed for glandular swellings and goitre.)

Water-soluble portion of alcoholic extract of the plant showed preventive effect against goitre in rats.

Flowers gave flavonoids, kaempfe- rol-3-galactoside and kaempferol-3- rhamnoglucoside. The stem bark yields hentriacontane, octacosanol and stigmasterol. Stem contains beta-sitos- terol, lupeol and a flavanone glyco- side.

Dosage: Stem bark—20-30 g for decoction. (API Vol. I.)... bauhinia variegata

Diseases affecting the kidneys can be broadly classi?ed into congenital and genetic disorders; autoimmune disorders; malfunctions caused by impaired blood supply; infections; metabolic disorders; and tumours of the kidney. Outside factors may cause functional disturbances – for example, obstruction in the urinary tract preventing normal urinary ?ow may result in hydronephrosis (see below), and the CRUSH SYNDROME, which releases proteins into the blood as a result of seriously damaged muscles (rhabdomyolosis), can result in impaired kidney function. Another outside factor, medicinal drugs, can also be hazardous to the kidney. Large quantities of ANALGESICS taken over a long time damage the kidneys and acute tubular NECROSIS can result from certain antibiotics.

K

Diagram of glomerulus (Malpighian corpuscle).

Fortunately the body has two kidneys and, as most people can survive on one, there is a good ‘functional reserve’ of kidney tissue.

Symptoms Many patients with kidney disorders do not have any symptoms, even when the condition is quite advanced. However,

others experience loin pain associated with obstruction (renal colic) or due to infection; fevers; swelling (oedema), usually of the legs but occasionally including the face and arms; blood in the urine (haematuria); and excess quantities of urine (polyuria), including at night (nocturia), due to failure of normal mechanisms in the kidney for concentrating urine. Patients with chronic renal failure often have very di?use symptoms including nausea and vomiting, tiredness due to ANAEMIA, shortness of breath, skin irritation, pins and needles (paraesthesia) due to damage of the peripheral nerves (peripheral neuropathy), and eventually (rarely seen nowadays) clouding of consciousness and death.

Signs of kidney disease include loin tenderness, enlarged kidneys, signs of ?uid retention, high blood pressure and, in patients with end-stage renal failure, pallor, pigmentation and a variety of neurological signs including absent re?exes, reduced sensation, and a coarse ?apping tremor (asterixis) due to severe disturbance of the body’s normal metabolism.

Renal failure Serious kidney disease may lead to impairment or failure of the kidney’s ability to ?lter waste products from the blood and excrete them in the urine – a process that controls the body’s water and salt balance and helps to maintain a stable blood pressure. Failure of this process causes URAEMIA – an increase in urea and other metabolic waste products – as well as other metabolic upsets in the blood and tissues, all of which produce varying symptoms. Failure can be sudden or develop more slowly (chronic). In the former, function usually returns to normal once the underlying cause has been treated. Chronic failure, however, usually irreparably reduces or stops normal function.

Acute failure commonly results from physiological shock following a bad injury or major illness. Serious bleeding or burns can reduce blood volume and pressure to the point where blood-supply to the kidney is greatly reduced. Acute myocardial infarction (see HEART, DISEASES OF) or pancreatitis (see PANCREAS, DISORDERS OF) may produce a similar result. A mismatched blood transfusion can produce acute failure. Obstruction to the urine-?ow by a stone (calculus) in the urinary tract, a bladder tumour or an enlarged prostate can also cause acute renal failure, as can glomerulonephritis (see below) and the haemolytic-uraemia syndrome.

HYPERTENSION, DIABETES MELLITUS, polycystic kidney disease (see below) or AMYLOIDOSIS are among conditions that cause chronic renal failure. Others include stone, tumour, prostatic enlargement and overuse of analgesic drugs. Chronic failure may eventually lead to end-stage renal failure, a life-threatening situation that will need DIALYSIS or a renal transplant (see TRANSPLANTATION).

Familial renal disorders include autosomal dominant inherited polycystic kidney disease and sex-linked familial nephropathy. Polycystic kidney disease is an important cause of renal failure in the UK. Patients, usually aged 30–50, present with HAEMATURIA, loin or abdominal discomfort or, rarely, urinary-tract infection, hypertension and enlarged kidneys. Diagnosis is based on ultrasound examination of the abdomen. Complications include renal failure, hepatic cysts and, rarely, SUBARACHNOID HAEMORRHAGE. No speci?c treatment is available. Familial nephropathy occurs more often in boys than in girls and commonly presents as Alport’s syndrome (familial nephritis with nerve DEAFNESS) with PROTEINURIA, haematuria, progressing to renal failure and deafness. The cause of the disease lies in an absence of a speci?c ANTIGEN in a part of the glomerulus. The treatment is conservative, with most patients eventually requiring dialysis or transplantation.

Acute glomerulonephritis is an immune-complex disorder due to entrapment within glomerular capillaries of ANTIGEN (usually derived from B haemolytic streptococci – see STREPTOCOCCUS) antibody complexes initiating an acute in?ammatory response (see IMMUNITY). The disease affects children and young adults, and classically presents with a sore throat followed two weeks later by a fall in urine output (oliguria), haematuria, hypertension and mildly abnormal renal function. The disease is self-limiting with 90 per cent of patients spontaneously recovering. Treatment consists of control of blood pressure, reduced ?uid and salt intake, and occasional DIURETICS and ANTIBIOTICS.

Chronic glomerulonephritis is also due to immunological renal problems and is also classi?ed by taking a renal biopsy. It may be subdivided into various histological varieties as determined by renal biospy. Proteinuria of various degrees is present in all these conditions but the clinical presentations vary, as do their treatments. Some resolve spontaneously; others are treated with steroids or even the cytotoxic drug CYCLOPHOSPHAMIDE or the immunosuppressant cyclosporin. Prognoses are generally satisfactory but some patients may require renal dialysis or kidney transplantation – an operation with a good success rate.

Hydronephrosis A chronic disease in which the kidney becomes greatly distended with ?uid. It is caused by obstruction to the ?ow of urine at the pelvi-ureteric junction (see KIDNEYS – Structure). If the ureter is obstructed, the ureter proximal to the obstruction will dilate and pressure will be transmitted back to the kidney to cause hydronephrosis. Obstruction may occur at the bladder neck or in the urethra itself. Enlargement of the prostate is a common cause of bladder-neck obstruction; this would give rise to hypertrophy of the bladder muscle and both dilatation of the ureter and hydronephrosis. If the obstruction is not relieved, progressive destruction of renal tissue will occur. As a result of the stagnation of the urine, infection is probable and CYSTITIS and PYELONEPHRITIS may occur.

Impaired blood supply may be the outcome of diabetes mellitus and physiological shock, which lowers the blood pressure, also affecting the blood supply. The result can be acute tubular necrosis. POLYARTERITIS NODOSA and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) may damage the large blood vessels in the kidney. Treatment is of the underlying condition.

Infection of the kidney is called pyelonephritis, a key predisposing factor being obstruction of urine ?ow through the urinary tract. This causes stagnation and provides a fertile ground for bacterial growth. Acute pyelonephritis is more common in women, especially during pregnancy when bladder infection (CYSTITIS) spreads up the ureters to the kidney. Symptoms are fever, malaise and backache. Antibiotics and high ?uid intake are the most e?ective treatment. Chronic pyelonephritis may start in childhood as a result of congenital deformities that permit urine to ?ow up from the bladder to the kidney (re?ux). Persistent re?ux leads to recurrent infections causing permanent damage to the kidney. Specialist investigations are usually required as possible complications include hypertension and kidney failure.

Tumours of the kidney are fortunately rare. Non-malignant ones commonly do not cause symptoms, and even malignant tumours (renal cell carcinoma) may be asymptomatic for many years. As soon as symptoms appear – haematuria, back pain, nausea, malaise, sometimes secondary growths in the lungs, bones or liver, and weight loss – urgent treatment including surgery, radiotherapy and chemotherapy is necessary. This cancer occurs mostly in adults over 40 and has a hereditary element. The prognosis is not good unless diagnosed early. In young children a rare cancer called nephroblastoma (Wilm’s tumour) can occur; treatment is with surgery, radiotherapy and chemotherapy. It may grow to a substantial size before being diagnosed.

Cystinuria is an inherited metabolic defect in the renal tubular reabsorption of cystine, ornithine, lysine and arginine. Cystine precipitates in an alkaline urine to form cystine stones. Triple phosphate stones are associated with infection and may develop into a very large branching calculi (staghorn calculi). Stones present as renal or ureteric pain, or as an infection. Treatment has undergone considerable change with the introduction of MINIMALLY INVASIVE SURGERY (MIS) and the destruction of stone by sound waves (LITHOTRIPSY).... kidneys, diseases of

Proliferation of epidermis or epithelium (see SKIN) to form a tumour. Benign papillomas are common in the skin and are sometimes viral in origin. Papilloma of the urinary bladder may cause HAEMATURIA.... papilloma

The bladder is a hollow muscular organ with a wall of smooth muscle. It stores urine received from the kidneys which is released via the urethra in an action known as micturition. Common disorders, see: ENEURESIS. FREQUENCY OF URINE. GRAVEL. HAEMATURIA. INCONTINENCE. STONE IN THE BLADDER. STRANGURY. STRICTURE. URETHRITIS. URINE – PAIN ON PASSING. ... bladder disorders

human immunodeficiency virus-associated nephropathy: a condition associated with HIV infection. The patient usually presents with nephrotic-range proteinuria (see nephrotic syndrome) with microscopic haematuria, without oedema but with a rapid decline in renal function. Enlargement of the kidneys on ultrasound examination is a common finding, and HIVAN may precede other manifestations of HIV infection. Typical renal pathological findings are of a collapsing form of *focal segmental glomerulosclerosis. The clinical course is usually one of rapid decline in renal function.... hivan

(Lam.) Taub.

Synonym: B. frondosa Koenig ex Roxb.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout India, up to 1,200 m except in very arid regions.

English: Flame of the Forest, Butea Gum, Bengal Kino.

Ayurvedic: Paalasha, Kimshuka, Raktapushpaka, Kshaarshreshtha, Brahmavriksha, Samidvar.

Unani: Dhaak, Samagh Dhaak, Kamarkas.

Siddha/Tamil: Palasam, Purasus.

Folk: Tesu.

Action: Bark—astringent, styptic (prescribed in bleeding piles, ulcers, haemorrhages, menstrual disorders), anthelmintic. Flowers— astringent, diuretic, emmenagogue (also given for leucorrhoea). A decoction of flowers is given in diarrhoea and haematuria, also to puerperal women. Seeds—clinical use of seeds as an anthelmintic drug is not considered safe in humans.

Leaves—antibacterial. Stem bark— antifungal.

An aqueous extract of flowers has shown hepatoprotective activity against CCl4-induced liver injury in albino rats.

Extracts of flowers have exhibited significant anti-oestrogenic activity in mice. The seed suspension, on oral administration to albino rats (175 and 350 mg/kg body weight), showed 38.46 and 68.75% cases, respectively, where pregnancy was not interrupted but foetus was malformed.

Alcoholic extract of the whole plant produced persistent vasodepression in cats.

The plant contains flavonoids and glucosides—butin, butrin, isobutrin and palastrin. Flowers contain butrin, coreopsin, monospermoside and their derivatives and sulphurein; also chal- cones.

Dosage: Stem bark—5-10 g powder (API Vol. II); flower—3-6 g powder; seed—3 g powder; gum—0.5-1.5 g (API Vol. IV.)... butea monosperma

Linn.

Family: Euphorbiaceae.

Habitat: Native to South-East Asia. Now cultivated in Assam, Bengal and South India.

English: Purging Croton.

Ayurvedic: Jayapaala, Dravanti, Dantibija, Tintidiphala.

Unani: Habb-us-Salaateen, Jamaal- gotaa, Hubb-ul-Malook.

Siddha/Tamil: Nervaalam.

Action: Cathartic, rubefacient, irritant. Used in ascites, anasarca, dropsy and enlargement of abdominal viscera.

The seed oil is purgative. It produces severe symptoms of toxicity when taken internally or applied externally to the skin.

Croton oil showed tumour-promoting activity on mouse skin. The skin irritant and tumour promoting diterpene esters of the tigliane type (phorbol esters) and toxins have been isolated from the seeds. (In China, where the herb is employed for the treatment of gastro-intestinal disturbances, the highest incidence of naso- pharyngeal cancer has been reported.) 1 ml oil is usually fatal. Phorbols (terpenoids) from nonvolatile oil are toxic. Crotin, a toxic albuminous substance, is not extracted in the oil. The plant caused haematuria and swelling of lymph glands in animals.

Dosage: Seed—6-12 mg powder. (API Vol. IV.)... croton tiglium

Pers.

Family: Gramineae; Poaceae.

Habitat: Throughout India up to 3,000 m.

English: Bermuda Grass, Bahama Grass, Couch Grass.

Ayurvedic: Duurvaa, Bhaargavi, Shatvalli, Shatparvaa, Tiktaparvaa, Shatviryaa, Sahastravirya, Shitaa, Anantaa, Golomi.

Unani: Duub.

Siddha/Tamil: Arugampallu.

Action: The grass is a reputed as a remedy in epitaxis, haematuria, inflammed tumours, whitlows fleshy excrescences, cuts, wounds, bleeding piles, cystitis, nephritis and in scabies and other skin diseases. It is credited with astringent, diuretic, antidiarrhoeal, anticatarrhal, styptic and antiseptic properties. The Ayurvedic Pharmacopoeia ofIn- dia recommended the dried fibrous root in menorrhagia, metrorrhagia and burning micturation.

Phenolic phytotoxins—ferulic, sy- ringic, p-coumaric, vanillic, p-hydro- xybenzoic and O-hydroxyphenyl acetic acids, are reported from the plant. The leaves contain tricin, flavone C- glycosides and a flavonoid sulphate.

Dosage: Whole plant—10-20 ml juice (API Vol. IV.); root—5-10 ml juice (API Vol. III.)... cynodon dactylon

generalized inflammation of the glomeruli of the kidneys resulting in a reduction in *glomerular filtration rate, with mild oedema and hypertension resulting from renal salt and water retention. Urine analysis shows the presence of proteinuria and microscopic haematuria with red cell casts. Common and usually self-limiting causes are *Berger’s nephropathy and poststreptococcal glomerulonephritis. Less common but more serious causes of the nephritic syndrome are the vasculitides (see vasculitis) and *Goodpasture’s disease, which, untreated, usually prove fatal.... nephritic syndrome

nephritis associated with infected indwelling shunts. The infection is usually with staphylococci (S. epidermidis) and patients present with anorexia, malaise, arthralgia, and low-grade fever. Purpura, anaemia, and hepatosplenomegaly may be found and urine analysis shows heavy proteinuria, often with a *nephrotic syndrome and haematuria. Treatment usually involves removal of the infected shunt as well as antibiotics.... shunt nephritis

progressive renal disease developing in 5–8% of patients with *sickle-cell disease. Infarcts in the cortex can occur with sickle-cell crises and present with pain and haematuria. Acute or more insidious damage to the medulla will lead to a urinary concentrating defect and later to papillary necrosis and/or fibrosis. Occlusion of vessels within the glomerular capillary tuft leads to a secondary form of *focal segmental glomerulosclerosis and can present with the *nephrotic syndrome.... sickle-cell nephropathy

In?ammation of the URINARY BLADDER. The presenting symptom is usually dysuria – that is, a feeling of discomfort when urine is passed and frequently a stinging or burning pain in the URETHRA. There is also a feeling of wanting to pass water much more often than usual, even though there is very little urine present when the act is performed. The condition may be associated with a dragging ache in the lower abdomen, and the urine usually looks dark or stronger than normal. It is frequently associated with haematuria, which means blood in the urine and is the result of the in?ammation.

Cystitis is a common problem; more than half the women in Britain suffer from it at some time in their lives. The cause of the disease is a bacterial infection of the bladder, the germs having entered the urethra and ascended into the bladder. The most common organism responsible is called Escherichia coli. This organism normally lives in the bowel where it causes no harm. It is therefore likely to be present on the skin around the anus so that there is always a potential for infection. The disease is much more common in women because the urethra, vagina and anus are very close together and the urethra is much shorter in the female than it is in the male. It also explains why women commonly suffer cystitis after sexual intercourse and honeymoon cystitis is a very common presentation of bladder in?ammation. In most cases the in?ammation is more of a nuisance than a danger but the infection can spread up to the kidneys and cause PYELITIS which is a much more serious disorder.

In cases of cystitis the urine should be cultured to grow the responsible organism. The relevant antibiotic can then be prescribed. Fluids should be taken freely not only for an acute attack of cystitis but also to prevent further attacks, because if the urine is dilute the organism is less likely to grow. Bicarbonate of soda is also helpful as this reduces the acidity of the urine and helps to relieve the burning pain, and inhibits the growth of the bacteria. Careful hygiene, in order to keep the PERINEUM clean, is also important. (See URINARY BLADDER, DISEASES OF.)... cystitis

Linn.

Family: Euphorbiaceae.

Habitat: Smaller var., equated with E. thymifolia, is found in tropical plains and low hills of India, ascending to 1,750 m. Bigger var., E. pilulifera/E. hirta Linn. is found in warmer parts of India from Punjab eastwards, and southwards to Kanyakumari.

Ayurvedic: Dudhi (smaller var.), Dugdhikaa, Naagaarjuni, Swaaduparni.

Siddha/Tamil: Sittrapaladi.

Action: Plant—antispasmodic, bronchodilator, antiasthmat- ic (used in bronchial asthma), galactagogue (also used for spermatorrhoea). Root—used in amenorrhoea. Latex—used in ringworm, dandruff. Leaf, seed and latex—purgative. A decoction of the plant, with honey, is given to treat haematuria.

Aerial parts gave epitaraxerol, n- hexacosanol, euphorbol, two derivatives of deoxyphorbol-OAC, 24-meth- ylene cycloartenol and quercetin galactoside. Co-carcinogenic activity is due to phorbol derivatives. The plant exhibits antimicrobial activity due to alkaloids.

Dosage: Whole plant—10-20 g paste. (CCRAS.)

Family: Euphorbiaceae.

Habitat: Native to Africa; naturalized in the warmer parts of India.

English: Milk-Bush, Milk Hedge, Indian tree Spurge, Aveloz, Petroleum Plant

Ayurvedic: Saptalaa, Saatalaa.

Siddha/Tamil: Tirukalli.

Folk: Angulia-thuuhar.

Action: Purgative, emetic, antiasthmatic, bechic. Used for whooping cough, asthma, dyspepsia, biliousness, jaundice, enlargement of spleen, leucorrhoea. Latex—applied externally on warts.

Used as a purgative and for rheumatism and neuralgia. Stem bark—used for gastralgia, colic, asthma.

The latex contains an ingol ester besides triterpenoids, euphorbinol and cycloeuphordenol.

Presence of a number of ingenol and phorbol esters (diterpenoids), and tri- terpenoids are reported from the plant. The stem gave hentriacontane, hentri- acontanol, beta-sitosterol, Me-ellagic and ellagic acids and kaempferol glu- coside.

The latex is a weak tumour promoter.... euphorbia thymifolia

an inherited disease of the kidneys in which the glomerular basement membrane, which filters waste material from the blood, is too thin, allowing small amounts of blood to pass across it. This can be a cause of benign familial haematuria and thin membrane disease is a common finding in renal biopsy series where the procedure has been carried out as part of the investigation of *haematuria. Thin membranes are also found in other conditions, e.g. in some cases of *Alport’s syndrome and *Berger’s nephropathy.... thin membrane disease

combining form denoting 1. a condition of urine or urination. Example: polyuria (passage of excess urine). 2. the presence of a specified substance in the urine. Example: haematuria (blood in).... uria

Linn.

Family: Moraceae.

Habitat: Sub-Himalayan tracts, West Bengal, Central and South India; planted throughout India as an avenue tree.

English: Peepal, Bot-tree.

Ayurvedic: Ashvattha, Bodhidru, Bodhivrkisha, Sebya, Chalapa- tra, Gajabhaksha, Kshiradruma, Peeppal.

Unani: Peepal.

Siddha/Tamil: Arasu, Ashvatham.

Action: Bark—astringent, antiseptic, alterative, laxative, haemostatic, vaginal disinfectant (used in diabetes, diarrhoea, leucorrhoea, menorrhagia, nervous disorders; also in skin diseases.) Applied externally on unhealthy ulcers and wounds. Leaves and twigs— laxative.

The bark contains beta-sitosteryl-D- glucoside. Vitamin K, n-octacosanol, methyl oleanolate, lanosterol, stigmas- terol, lupen-3-one are reported from the stem bark.

A hypoglycaemic response is reported for beta-sitosterol-D-glucoside obtained from the bark.

Aerial roots are given to women, also used in prescriptions, for inducing conception. The dried fruits are used as a uterine tonic.

The fruits contain 4.9% protein having the essential amino acids, isoleu- cine and phenylalanine. The chloroform extract of fruits exhibited anti- tumour and antibacterial activities in bioassays.

Various plant parts are included in formulations used for menorrha- gia, metrorrhagia, blood dysentery, bleeding piles, haematuria and haemorrhages.

Dosage: Bark, fruit—50-100 ml decoction. (CCRAS.)... ficus religiosa

Linn.

Synonym: O. caryophyllatum Roxb. O. minimum Linn. O. pilosum Willd.

Family: Labiatae; Lamiaceae.

Habitat: Lower hills of Punjab; cultivated throughout India.

English: Sweet Basil, Basil Herb.

Ayurvedic: Barbari, Tuvari, Tungi, Kharpushpa, Ajgandhikaa, Baabui Tulasi.

Unani: Faranjmishk. (also equated with Dracocephalum moldavica Linn. by National Formulary of Unani Medicine.), Raihan (also equated with O. sanctum). (used as a substitute for Phanijjaka.)

Siddha/Tamil: Tiruneetruppachhilai.

Folk: Bana-Tulasi. Sabzaa (Maharashtra).

Action: Flower—stimulant, carminative, antispasmodic, diuretic, demulcent. Seed—antidysenteric. Juice of the plant—antibacterial. Essential oil—antibacterial, antifungal, insecticidal.

(Because of high estragole content of the essential oil, the herb should not be taken during pregnancy, nursing or over extended periods of time.) (German Commission E.) Included among unapproved herbs by German Commission E.

The herb contains an essential oil; major constituents are linalool (up to 55%) methyl ether (estragole) up to 70% and eugenol; caffeic acid derivatives; flavonoids. Thymol and xan- thomicrol were isolated from the leaves. Aesculetin, p-coumaric acid, eriodic- tyol, its 7-glucoside and vicenin-2 from leaves have been isolated.

The essential oil at concentration of 0.15% completely inhibited mycelial growth of twenty two species of fungi, including mycotoxin-producing strains of Aspergillus flavus and A. par- asiticus. Leaves act as an insect repellent externally; bring relief to insect bites and stings.

In homoeopathy, the fresh mature leaves are used to treat haematuria, inflammation and congestion of kidney.

Dosage: Whole plant—50-100 ml decoction; seed—1-3 g powder. (CCRAS.)... ocimum basilicum

Linn.

Family: Plantaginaceae.

Habitat: The temperate and alpine Himalayas from Kashmir to Bhutan at altitudes of 600-3,500 m.

English: Broadleaf Plantain.

Ayurvedic: Ashvagola (var.).

Folk: Isabgol.

Action: Plant—haemostatic, antihistaminic, antibacterial, wound-healing in burns and inflammation of tissues. Leaves— cooling, astringent, diuretic, vulnerary, febrifuge. Used for diarrhoea, bacillary dysentery, hepatitis, urinary diseases, piles, ulcers and skin diseases. Leaves are used for cystitis with blood, haematuria and other bladder disorders.

The aqueous extract of the leaves showed anti-inflammatory activity in mice.

The aerial parts contain an iridoid glucoside, majoroside. The leaves contain a phenylpropanoid glycoside, plantamajoside, exhibiting antibacterial activity against several pathogenic bacteria including E. coli and Staphy- lococcus aureus. (The glycoside is less inhibitory than the free acids, caffeic, ferulic, and rosmarinic and esculetin.)... plantago major

Willd.

Family: Sterculiaceae.

Habitat: Maharashtra, Manipur, North Bengal, Bihar and Assam, Western Ghats and Andaman Islands.

English: Hathipaila.

Ayurvedic: Muchukun- da, Muchakunda, Kshatra- vriksha, Chivuka, Prativishnuka, Muchukunda Champaa. Karnikaara (also equated with Cassia fistula).

Unani: Gul-e-Muchkun.

Siddha/Tamil: Vennangu.

Action: Flower—anti-inflammatory, styptic (used for bleeding piles, haematuria, ulcers). Charred flowers and bark, mixed with the powder of Mallotus philippinensis, are applied to smallpox eruptions.

The fresh flowers yielded kaempfe- rol- 3 - O -beta - D -galactoside, along with luteolin and its 7-O-glucoside. The leaves also contain betulin, lu- peol, bauerenol, friedelin and beta- sitosterol.

Dosage: Flower—3-6 g powder. (CCRAS.)... pterospermum acerifolium

DC.

Synonym: Frangulapurshiana (DC) A. Grey.

Family: Rhamnaceae.

Habitat: Native to Europe; introduced in Kashmir, Himachal Pradesh, Bhutan and the Nilgiris.

English: Buckthorn (related species), Cascara Sagrada, Sacred Bark.

Action: Bark—stool-softener, non-habit forming stimulant laxative, pancreatic stimulant. Used for dyspepsia and habitual constipation.

Key application: In occasional constipation. (German Commission E, ESCOP, WHO.) As a stimulant laxative. (The British Herbal Pharmacopoeia.)

The bark contains up to 10% an- thraquinone glycosides, consisting of the cascarosides A, B, C and D, about 70% of the total; other glycosides in minor concentrations include barbaloin, frangulin, chrysanol, glycosides based on emodin, aloe-emodin, emodin- oxanthrone and chrysophanol; dianthrones, and free aglycones.

The cascarosides act on large intestines and stimulate peristalsis. The emodin exhibits antispasmodic activity in isolated rat intestine. Its anti- inflammatory and antiseptic action was also demonstrated.

Rhamnus catharticus Linn., is equated with common Buckthorn, R. purpurea Edgew. with Purple Buckthorn. R. purpurea is found in the Himalayas from Kashmir to Nepal.

Dried bark of Rhamnus frangula L. (Alder Buckthorn) and dried ripe berries of Ramnus catharticus are also used against constipation. (German Commission E, WHO.)

Long term use or excessive amounts may cause albuminuria, haematuria, slowing ofintestinal transit and cardiac irregularities. (Sharon M. Herr.)

Rhamnus triquetra Brandis (known as Gudlei, Fagoraa, Gardhan in Punjab; Gaunt in Garhwal and Kumaon and Katheraa in Jaunsar) is found in the Himalayas from Kashmir to Nepal. The bark is used as a tonic, astringent and deobstruent. Kaempferol, its 7-O- methyl ether and 4'-O-methyl ether, physcion-8 beta-D-glucoside, emodin and its 8 beta-D-glucoside were isolated from the whole plant. Emodin exhibited CNS depressant activity. (Fi- toterapia, 65, 1994.) The plant exhibited significant anti-inflammatory and a nonspecific antispasmodic activity. It induced cardio-stimulation which might be due to the endogenous release of catecholamines.

Rhamnus napalensis Wall. ex M. Laws. (known as Archal in Nepal; Biringa and Birringguli in Assam) is found in eastern Himalayas and the hills and plains ofAssam, Bihar, Orissa, Madhya Pradesh and northern Andhra Pradesh, ascending up to an altitude of 2,000 m. The fruit, pounded and macerated in vinegar, is prescribed for the treatment of herpes.... rhamnus purshiana

Lam.

Family: Rhizophoraceae.

Habitat: The Sunderbans and along the Coromandel Coast and the Andamans.

English: True Mangrove.

Siddha/Tamil: Peykkandal, Kandal, Sorapinnai.

Folk: Kamo (Bengal), Kandal (Maharashtra).

Action: Bark—astringent. Used in the treatment of haemorrhages, haematuria.

The leaves contain 9.1, unripe fruits 12.0, ripe fruits 4.2, twig bark 9-12, and wood 7-14% tannins.

The leaves gave campesterol, cholesterol, 28-isofucosterol, beta-sitosterol, stigmasterol and stigmast-7-en-3 betaol. The plant gave alpha-and beta- amyrins, betulin, lupeol, oleanolic and ursolic acids; gibberellins have also been reported.

Honey collected from the flowers is reported to be poisonous.

R. apiculata Blume, also known as Kandal, is found mixed up with R. mucronata in the tidal marshes of India and the Andamans.... rhizophora mucronata

Also known as BILHARZIASIS. This infection results from one of the human Schistosoma species. It is common in Africa, South America, the Far East, Middle East, and, to a limited extent, the Caribbean. The life-cycle is dependent on fresh-water snails which act as the intermediate host for the ?uke; the cercarial stage of the ?uke enters via intact human skin and matures in the portal circulation. Clinically, ‘swimmers’ itch’ may occur at the site of cercarial skin penetration. Acute schistosomiasis (Katayama fever) can result in fever, an urticarial rash (see URTICARIA), and enlargement of LIVER and SPLEEN. The adult male is about 12 mm and the female 24 mm in length.

S. haematobium causes CYSTITIS and haematuria – passage of blood in the urine; bladder cancer and ureteric obstruction, giving rise to hydronephrosis and kidney failure, are long-term sequelae in a severe case. S. mansoni can cause colonic symptoms and in a severe case, POLYPOSIS of the COLON; diarrhoea, which may be bloody, can be a presenting feature. In a heavy infection, eggs surrounded by granulomas are deposited in the liver, giving rise to extensive damage (pipe-stem ?brosis) associated with PORTAL HYPERTENSION, oesophageal varices, etc. However, unlike in CIRRHOSIS, hepatocellular function is preserved until late in the disease. S. japonicum (which is con?ned to the Far East, especially Indonesia) behaves similarly to S. mansoni infection; liver involvement is often more severe.

Diagnosis can be made by microscopic examination of URINE or FAECES. The characteristic eggs are usually detectable. Alternatively, rectal or liver BIOPSY are of value. Serological tests, including an ELISA (see ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA)), have now largely replaced invasive procedures used in making a parasitological diagnosis.

Treatment CHEMOTHERAPY has been revolutionised by the introduction of praziquantel (administered orally); this compound has no serious side-effects, although its cost may limit its use in developing countries. Oxamniquine is cheaper and e?ective in S. mansoni infection, although evidence of resistance has been recorded in several countries. Metriphonate is also relatively cheap and is of value in S. haematobium infection. Prevention is by complete avoidance of exposure to contaminated water; all travellers to infected areas should know about this disease. It is increasing in frequency as new expanses of fresh water appear as a result of irrigation schemes and dam projects. Molluscicides can be employed for snail-control.... schistosomiasis

Blume.

Synonym: T. amboinensis auct. non Blume.

Family: Ulmaceae.

Habitat: Throughout India in humid regions, up to 2,430 m.

English: Charcoal tree, Indian Nettle tree.

Siddha/Tamil: Ambaratthi, Chenko- lam.

Folk: Gio.

Action: Root—astringent and styptic; prescribed for diarrhoea, haematuria. Bark—analgesic.

Used as poultice for muscular pain. Root, bark and leaves—used in epilepsy.

The bark contains 16% tannin. Stem- bark gave triterpenoid alcohols simi- arenol and tremetol; a triterpene sim- iurenone; octacosanoic acid and 1- octacosanyl acetate.

Alcoholic extract of the roots produced a progressive depression of blood pressure (a total of 50% in 1 h) in cats.... trema orientalis

Schum. &Thonn.

Synonym: T. angustata Bory & Chaub.

Family: Typhaceae.

Habitat: Throughout India, up to an altitude of 1,730 m.

English: Lesser Indian Reed-Mace.

Ayurvedic: Gundra, Gundraa, Gundraka, Guntha. (Gundraa has also been interpreted as Bhadramustaa, Cyperus rotundus Linn.)

Siddha/Tamil: Sambu.

Folk: Pater, Gondapateraa.

Action: Rhizomes—astringent and diuretic. Spikes—ash is used for healing wounds. The pollen, mixed with honey, is applied to wounds and sores or taken internally for treating uterine bleeding and haematuria.

The plant contains isorhamnetin, pentacosane and sterols. A flavonol glucoside, yielding quercetin on hydrolysis, has been reported in the plant.

Dosage: Rhizome—50-100 ml decoction. (CCRAS.)... typha australis

Analysis of the physical and chemical composition of URINE to detect variations in the substances normally present, and to identify any abnormal constituents such as sugar, blood, drugs or alcohol. Sugar, protein and blood can be identi?ed using chemically impregnated dipsticks which change colour in the presence of these substances. The presence of microscopic HAEMATURIA (blood in the urine) should be con?rmed by microscopic examination of a fresh, midstream urine specimen. The specimen should also be sent for bacteriological culture to exclude or identify infection. If protein in the urine is suspected, a 24-hour collection of urine should be assessed. Cytological examination will identify abnormal or malignant cells in the urinary tract.... urinalysis

Diseases of the URINARY BLADDER are diagnosed by the patient’s symptoms and signs, examination of the URINE, and using investigations such as X-RAYS and ULTRASOUND scans. The interior of the bladder can be examined using a cystoscope, which is a ?breoptic endoscope (see FIBREOPTIC ENDOSCOPY) that is passed into the bladder via the URETHRA.

Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).

Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.

Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.

Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.

Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.

Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).

Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.

Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.

Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of

Waste substances resulting from the body’s metabolic processes, selected by the KIDNEYS from the blood, dissolved in water, and excreted. Urine is around 96 per cent water, the chief waste substances being UREA (approximately 25 g/1), common salt (approximately 9 g/l), and phosphates and sulphates of potassium, sodium, calcium, and magnesium. There are also small amounts of URIC ACID, ammonia, creatinine, and various pigments. Poisons, such as MORPHINE, may be excreted in the urine; and in many infections, such as typhoid fever (see ENTERIC FEVER), the causative organism may be excreted.

The daily urine output varies, but averages around 1,500 ml in adults, less in children. The ?uid intake and ?uid output (urine and PERSPIRATION) are interdependent, so as to maintain a relatively constant ?uid balance. Urine output is increased in certain diseases, notably DIABETES MELLITUS; it is diminished (or even temporarily stopped) in acute glomerulonephritis (see under KIDNEYS, DISEASES OF), heart failure, and fevers generally. Failure of the kidneys to secrete any urine is known as anuria, while stoppage due to obstruction of the ureters (see URETER) by stones, or of the URETHRA by a stricture, despite normal urinary secretion, is known as urinary retention.

Normal urine is described as straw- to amber-coloured, but may be changed by various diseases or drugs. Chronic glomerulonephritis or poorly controlled diabetes may lead to a watery appearance, as may drinking large amounts of water. Consumption of beetroot or rhubarb may lead to an orange or red colour, while passage of blood in the urine (haematuria) results in a pink or bright red appearance, or a smoky tint if just small amounts are passed. A greenish urine is usually due to BILE, or may be produced by taking QUININE.

Healthy urine has a faint aroma, but gives o? an unpleasant ammoniacal smell when it begins to decompose, as may occur in urinary infections. Many foods and additives give urine a distinctive odour; garlic is particularly characteristic. The density or speci?c gravity of urine varies normally from 1,015 to 1,025: a low value suggests chronic glomerulonephritis, while a high value may occur in uncontrolled diabetes or during fevers. Urine is normally acidic, which has an important antiseptic action; it may at times become alkaline, however, and in vegetarians, owing to the large dietary consumption of alkaline salts, it is permanently alkaline.

Chemical or microscopical examination of the urine is necessary to reveal abnormal drugs, poisons, or micro-organisms. There are six substances which must be easily detectable for diagnostic purposes: these are ALBUMINS, blood, GLUCOSE, bile, ACETONE, and PUS and tube-casts (casts from the lining of the tubules in the kidneys). Easily used strip tests are available for all of these, except the last.

Excess of urine It is important to distinguish urinary frequency from increase in the total amount of urine passed. Frequency may be due to reduced bladder capacity, such as may be caused by an enlarged PROSTATE GLAND, or due to any irritation or infection of the kidneys or bladder, such as CYSTITIS or the formation of a stone. Increased total urinary output, on the other hand, is often a diagnostic feature of diabetes mellitus. Involuntary passage of urine at night may result, leading to bed wetting, or NOCTURNAL ENURESIS in children. Diagnosis of either condition, therefore, means that the urine should be tested for glucose, albumin, gravel (fragments of urinary calculi), and pus, with appropriate treatment.... urine

Schistosomiasis. One of the serious diseases of the tropics, caused by schistosomes, or blood flukes. Goes back into Egyptian history by 3,000 years when it was referred to as ‘blood in the urine’ (haematuria).

Bilharzial calcified eggs have been found in the rectum and bladder of mummified bodies. There is evidence that they received treatment with the plants Valerian and Hyoscyamus. Today, Poke root is favoured.

More than 300 million people are infected. Cure is difficult, in spite of our greater knowledge. No natural medicine has yet been discovered to kill the parasite worms except deep-acting poisons: Antimony (tartar emetic).

Causative organism pierces the skin or mucous membranes of walkers, swimmers, or farmers wading in contaminated water.

Medicinal plants are used, with varying degrees of success to discourage the flukes from invading the host and to make good their depredations.

Anti-Bilharzials – Gum arabic, Cannabis sativa (hemp), Citrullus colocynthis, Citric acid (from lemons), Cyperus esculentus, Douma thebaica, Hordeum vulgare (Barley), Phoenix dactylifera, Ricinus communis (Castor oil), Thymus capitata (Thyme), Vitis vinifera (Grapes), Pistacea terebinthus (the Mastic Tree), Morus nigra (fresh fruits, root bark and leaves of the Mulberry Tree), Ficus carica (Common Fig), Thymus vulgaris (Thyme similar to English Garden Thyme). Later in history these remedies were joined by Ginger and Ambrosia artemisia. (Samir Yahia El-Gammal, MD, in “Medical Times”, Journal for the Promotion of Eastern Medicine. Hamdard Centre, Nazimabad, Karachi, Pakistan. Vol XIX, Winter 1984)

Ginger, powdered root and aqueous extract, prevents hatching of schistosome eggs in host. In trials with schoolchildren, bloody urine stopped and egg count in the urine dropped. (Kucera et al., 1975; Theakston et al., 1975)

CORIANDER SEED. Tea. Original research, Lawrence D. Hills, Henry Doubleday Research Association.

Note: Berries of a native Ethiopian plant, the endod or Soapberry (Phytolacca dodecandra) contain a potent toxin that can, in minute quantities, kill the snails carrying the schistosomes. (New Scientist, 1989, No 1690, p21)

To be treated by or in liaison with a general medical practitioner. ... bilharzia

Haemorrhage. Bleeding from arteries is bright red, escaping in jerks; from the veins it is darker; steadier from the capillaries. There is an oozing of bright red blood from a cut. In an extravasation blood pours into lax tissues beneath the skin; the part becoming swollen with the appearance of a bruise.

To strengthen veins – Gentian. To enhance resistance – Echinacea. To counter failing strength – Ginseng. To promote granulation – Comfrey. To restore lacerated nerves – St John’s Wort. Nettles are a well-known traditional anti-haemorrhagic.

If bleeding is serious, control with firm finger pressure. Any one of the following may be used in the form of teas, tinctures, powders, etc.

Bowels. Ladies Mantle, Avens, Horsetail, Shepherd’s Purse, Tormentil, Raspberry leaves, Yarrow, Cranesbill, Bilberry.

Gums. Tea. Equal parts: Horsetail, St John’s Wort. (Maria Treben) Or:– Paint gums with Tincture Myrrh, Blood root, Goldenseal or Marigold.

Post-partum. (After child-birth) Goldenseal BHP (1983); Lady’s Mantle BHP (1983).

Lungs. Haemoptysis. Blood spitting. Blood root, Beth root, Lungwort, Mullein, Horsetail, St John’s Wort, Cranesbill. Bur-Marigold. Sage. Mouse Ear, Bugleweed. Nettle tea is a good stand-by.

Post-menopausal bleeding: Internal: Raspberry leaves, Ladies Mantle, Shepherd’s Purse. Plantain tea as an injection. Plugs of cotton wool saturated with Witch Hazel. To be investigated by a competent authority.

Mucous surfaces: tongue, mouth, throat, gullet. Marigold, Yarrow, Rue, Clematis erecta, Life root.

Blood root (tincture: 10-15 drops in water). Ice to suck.

Nose. Witch Hazel. Nettles. Vinegar water: to snuff into nostrils. Apply sponge soaked in cold water to back of the neck. Or: plug nose with Witch Hazel saturated cotton wool.

Hymen. See entry.

Skin. Superficial. Buckwheat, Marigold, Daisy, Tormentil, Witch Hazel, Blood root (tincture),.

Stomach. Haematemesis. The vomit of blood has the appearance of coffee grounds and is a symptom of gastric ulcer. Teas: Avens, Meadowsweet, Yarrow, Bur-Marigold, Cranesbill, Mullein.

Decoctions: Cranesbill root, Beth root, Oak bark.

After Surgery. After tissue excisions, blood clotting or wound-healing disorders for safe haemostasis: Beth root, Cranesbill root, Lady’s Mantle, St John’s Wort.

Blood in the urine. See: HAEMATURIA.

Bleeding of menses: See: MENSTRUATION.

IUD bleeding. Bleeding from intra-uterine devices: Injection: teas – Lady’s Mantle, Cranesbill, Tormentil, Marigold.

Vitamin E supplementation (International Journal of Fertility, Vol 28. 1983) Suggested dose: One 500iu capsule morning and evening.

Retinal haemorrhage. Buckwheat tea. Vitamin C: 1-3g daily. Evening Primrose oil.

Red cell stimulators: Yellow Dock root, Red Clover, Gentian.

White cell stimulators: Liquorice, Ginseng (Siberian) and Korean, Goldenseal, Echinacea.

Vitamins. C. D. K. P.

Minerals. Calcium, Iron, Selenium, Zinc.

Note: Any new episode of bleeding (rectal, gastric, etc) in those 45 and over should be investigated in hospital. Alteration of bowel habit, with bleeding, in young people should lead to referral to a doctor. ... bleeding

A sex-linked hereditary bleeding disease associated with a deficiency of Factor VIII in the blood. Closely related to Christmas disease which has a deficiency of Factor IX. Transmitted by mothers with the recessive gene. Disease exclusive to males, blood failing to clot, resulting in bleeding from minor injury, such as tooth extraction. Possible blood in the urine (haematuria). No cure. A course of Goldenseal (liquid extract) 3-5 drops for 1 week, at bedtime, every 3 months, is said to be of value. Alternatives. Treatment. To increase tone in blood vessels (Gentian). To promote healing and toughen vessels (Horsetail). Blood in the urine (Shepherd’s Purse). Tendency of mucous surfaces to bleed (Goldenseal). Bleeding from the lungs (Elecampane); from the alimentary tract, bowel (American Cranesbill); from the throat (Sage). From the nose: inject equal parts Cider vinegar and water.

To strengthen vascular system. Tea. Equal parts: Horsetail, Nettles, Mullein. 1-2 teaspoons to each cup boiling water; infuse 15 minutes. One cup once or twice daily.

Topical. For bleeding of skin: Witch Hazel (distilled extract). Marigold tincture, cream, etc.

Diet. High calcium and phosphorus diet. Low salt. An article in a scientific journal describes how one sufferer arrested attacks with handful of unsalted peanuts.

Supplementation. Niacin, Vitamin C, Calcium, Zinc.

See: HAEMOSTATICS.

Treatment by a general medical practitioner or hospital specialist. ... haemophilia

Growths originating in the inner lining of the bladder. Many are papillomas (small wart-like growths), which tend to recur and will eventually become cancerous. Other, more malignant, growths may extend not only into the bladder cavity but may also spread through the bladder wall to involve nearby organs such as the colon, rectum, prostate gland, or uterus.

Bladder cancer is more common in smokers and workers in the dye and rubber industries. Haematuria (blood in the urine) is the main symptom of bladder cancer. A tumour may obstruct the entry of a ureter into the bladder, causing back pressure and pain in the kidney region, or may obstruct the urethral exit, causing difficulty in passing, or retention of, urine.

Bladder tumours are diagnosed using cystoscopy and biopsy of the abnormal area. If small, they can be treated by heat or surgically during cystoscopy. They tend to recur at the same or other sites within the bladder, so that regular follow-up cystoscopy is needed. Bladder tumours that have spread through the bladder wall may be treated by radiotherapy or by surgical removal of part or all of the bladder.... bladder tumours

A stone in the kidneys, ureters, or bladder formed from substances in urine.

Most urinary tract stones are composed of calcium oxalate or other salts crystallized from the urine. These may be associated with a diet rich in oxalic acid (found in leafy vegetables and coffee); high levels of calcium in the blood as a result of hyperparathyroidism; or chronic dehydration. Other types of stone are associated with gout and some cancers. An infective stone is usually a result of chronic urinary tract infection.

In developing countries, bladder stones usually occur as a result of dietary deficiencies. In developed countries, they are usually caused by an obstruction to urine flow from the bladder and/or a longstanding urinary tract infection.

The most common symptom of a stone in the kidney or ureter is renal colic (a severe pain in the loin) that may cause nausea and vomiting. There may be haematuria (blood in the urine). A bladder stone is usually indicated by difficulty in passing urine. The site of the stone can usually be confirmed by intravenous or retrograde urography.

Renal colic is treated with bed rest and an opioid analgesic (painkiller).

With an adequate fluid intake, small stones are usually passed in the urine without problems.

The first line of treatment for larger stones is lithotripsy, which uses ultrasonic or shock waves to disintegrate the stones.

Alternatively, cytoscopy can be used to crush and remove stones in the bladder and lower ureter.

In some cases, surgery may be needed.... calculus, urinary tract

An infection anywhere in the urinary tract. It has differing symptoms, depending on the area affected. Urethritis causes a burning sensation when urine is being passed. Cystitis causes a frequent urge to pass urine, lower abdominal pain, haematuria, and, often, general malaise with a mild fever. Pyelonephritis causes fever and pain in the back under the ribs. Cystitis and pyelonephritis are almost always the result of a bacterial infection. Urethritis is often due to a sexually transmitted infection, such as gonorrhoea, but may have other causes. Urethral infections are more common in men. Infections further up the urinary tract are more common in women. In men, there is often a predisposing factor, such as an enlarged prostate gland (see prostate, enlarged). In women, pregnancy is a risk factor.

In both sexes, causes of urinary tract infections include stones (see calculus, urinary tract), bladder tumours, congenital abnormalities of the urinary tract, or defective bladder emptying as a result of spina bifida or a spinal injury. The risks of developing a urinary tract infection can be reduced by strict personal hygiene, drinking lots of fluids, and regularly emptying the bladder.

Urethritis can lead to the formation of a urethral stricture. Cystitis usually only causes complications if the infection spreads to the kidneys. Pyelonephritis, if it is left untreated, can lead to permanent kidney damage, septicaemia, and septic shock.

The infection is diagnosed by the examination of a urine culture. Further investigations using urography or ultrasound scanning may be necessary. Most infections of the urinary tract are treated with antibiotic drugs.... urinary tract infection

Urine may be produced in abnormal amounts or have an abnormal appearance or composition.

Conditions of abnormal production of urine include excessive production (see urination, excessive), oliguria, and anuria. Abnormal appearances of urine include cloudiness (which may be caused by a urinary tract infection, a calculus, or the presence of salts); haematuria; discoloration from certain foods or drugs; and frothiness (which may be caused by an excess of protein).Abnormal composition of the urine may occur in diabetes mellitus, kidney failure, and sometimes glomerulonephritis and nephrotic syndrome, as well as in other kidney disorders such as Fanconi’s syndrome and renal tubular acidosis.... urine, abnormal

a rare X-linked (see sex-linked) recessive inherited condition usually presenting in childhood or early adult life with polyuria, microscopic haematuria, renal stone disease, or rickets. The majority of patients have a mutation of the gene encoding chloride channel 5 (CLCN5); others have a defect of the OCRL1 gene, normally associated with Lowe’s syndrome, but do not present with the cataracts, learning disability, and tubular acidosis associated with this condition. In still others the genetic defect has yet to be defined but is not associated with either CLCN5 or OCRL1. Patients with Dent’s disease have evidence of proximal tubular dysfunction. [C. E. Dent (1911–76), British physician]... dent’s disease

either of two inherited disorders in which renal cysts are a common feature. Autosomal recessive polycystic kidney disease (ARPKD) occurs in about 1 in 20,000 live births. It is due to a single mutation on chromosome 6 for the gene encoding the protein fibrocystin. The majority of cases are diagnosed before or at birth. The most severely affected fetuses have enlarged kidneys and *oligohydramnios due to poor fetal renal output. These fetuses develop the ‘Potter’ phenotype with characteristic facies, pulmonary hypoplasia, and deformities of the spine and limbs. Those surviving the neonatal period (50–70%) develop varying degrees of renal impairment but this may not proceed to end-stage until early adulthood.

Autosomal dominant polycystic kidney disease (ADPKD) affects between 1 in 400 and 1 in 1000 individuals and is one of the most common hereditary diseases. Two types have been defined. ADPKD 1 is the commonest and responsible for about 85% of cases. It is due to a mutation in the PKD1 gene on chromosome 16, which encodes polycystin 1, an *ion-channel-regulating protein. ADPKD2 is due to a mutation in the PKD2 gene on chromosome 4, which encodes the protein polycystin 2, a calcium-release channel. ADPKD2 tends to be a milder disease with later presentation.

ADPKD is a multisystem disorder that is also associated with cyst formation in other organs (particularly the liver), cardiovascular disorders, and colonic diverticular disease. Renal disease presents in early adult life with haematuria, loin pain, urinary tract infection, hypertension, renal stone disease, or the finding of a mass in the abdomen. Other cases are identified by family contact tracing; the findings of a few cysts on renal ultrasonography in a young adult with a family history of ADPKD is highly suggestive of the disease. Renal disease is progressive and about 50% of patients will have reached end-stage by the time they enter their seventh decade. The progress of the renal failure can be slowed by good blood pressure control. In the UK, patients with ADPKD are responsible for 5–10% of the total on renal replacement therapy.

There are a number of separate rare autosomal dominant conditions other than ADPKD1 and ADPKD 2 that can present with polycystic kidneys. These include *von Hippel-Lindau disease and *tuberous sclerosis.... polycystic disease of the kidneys

n. radiological examination of the urinary tract. This traditionally involves the injection of radiopaque contrast material and observation of the flow with X-rays (see cystography; intravenous urography; pyelography; urethrography). In CT urography contrast is injected in the vein and CT of the urinary tract acquired when the contrast arrives there. The technique is used in *haematuria to exclude the presence of a tumour within the renal pelvis, ureter, or bladder. MR urography is used to visualize the urinary tract by *magnetic resonance imaging. An MR contrast medium is injected into a peripheral vein and passes to the kidneys and ureters, when images of thin sections can be obtained. These can be manipulated by computer to reveal the anatomy and any pathology (e.g. stones, tumours) of the imaged structures. MR urography is particularly useful in children.... urography