E-ISSN:2456-3110

Case Report

Chronic Kidney Disease

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 7 July
Publisherwww.maharshicharaka.in

Management of Chronic Kidney Disease - An Ayurveda Case Study

Aggarwal A.1*, Sokiya G.2, Sharma G.3
DOI: http://dx.doi.org/10.21760/jaims.8.7.46

1* Ankita Aggarwal, Post Graduate Scholar, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

2 Gracy Sokiya, Assistant Professor, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

3 Gaurav Sharma, Assistant Professor, Department of Rachana Sharir, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

CKD has become a common disease with a high Prevalence rate of nowadays [1] in people including young individuals, with dialysis and renal transplant as its mainstream healing treatment, but due to low financial backgrounds among large percentage of individuals in India, everyone cannot afford to live a good quality of life. Hence, every individual is not a candidate for renal transplant or dialysis. So, to overcome this issue, an alternate has to be taken keeping in mind a healthy life which is the need of hour. CKD, i.e., Chronic Kidney Disease itself indicates chronicity with irreversible damage to the kidneys due to main leading factor in many cases nowadays as a major cause which is Hypertension and Diabetes mellitus type 2, which clinically presents as symptomless sometimes in initial stages and further presents with pedal edema, decreased appetite, nausea, difficulty in micturition/decreased urine output, frothy/foamy urine, fatigue.[2] Usually it is manifested through various lab investigations such as kidney function test in which increase in serum urea levels, serum creatinine and other are seen i.e., a waste product made by our muscles, also Kidney’s one of the vital function is production of erythropoietin[3] gets hampered due to underlying cause results in decline in Hb levels. So, to overcome this Punarnavadi Mandoor along with other were advised to the patient. Here the focus is on improvement in various Hematological levels before and after treatment of CKD, by giving Renogrit tablet, Punarnavadi Mandoor, Corighan Vati etc., having special effect on kidneys/as renoprotective.

Keywords: Serum Creatinine, Serum Urea, Renogrit, Corighan Vati

Corresponding Author How to Cite this Article To Browse
Ankita Aggarwal, Post Graduate Scholar, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.
Email: 		Ankita Aggarwal, Gracy Sokiya, Gaurav Sharma, Management of Chronic Kidney Disease - An Ayurveda Case Study. J Ayu Int Med Sci. 2023;8(7):250-256.
Available From
https://jaims.in/jaims/article/view/2508

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-05-25 2023-05-27 2023-05-30 2023-06-06 2023-06-13
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2023by Ankita Aggarwal, Gracy Sokiya, Gaurav Sharmaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Aggarwal A et al: Management of Chronic Kidney Disease An Ayurveda Case Study

Introduction

India like any other developing country is facing a silent epidemic of chronic renal failure (CRF-A) facet of the health transition associated with industrialization partly fuelled by increase in sedentary lifestyle, low birth weight and malnutrition.[4]

Chronic renal failure (CRF) refers to an irreversible deterioration in renal function, which develops over a period of years.

This initially manifests only as a biochemical abnormality. CRF is considered when glomerular filtration rate (GFR) falls below 30 ml/min.[5]

Type 2 diabetes mellitus is one among the main causative factor of CKD. The presence of high glucose levels for prolonged period leads to the thickening of the glomerular basement membrane and mesangial expansion which further affects the glomerular filtration rate (GFR).[6]

According to National Kidney foundation (NKF), Kidney has seven vital functions such as removal of toxins, control of blood pressure, water balance including production of Erythropetin etc.

Thus, here in CKD, the levels of Haemoglobin gets reduced due to the same underlying cause as mentioned.

Normally, kidney filter creatinine from blood, which is further excreted out through urine.

Case Report

A 61 years old male patient named XYZ reported first time in Kayachikitsa department OPD of Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar in April 2023 as a diagnosed case of Chronic kidney disease with chief complaints of -

Table 1: Chief complaints

SN Chief complaints Duration
1. bilateral swelling in foots 4 months
2. difficulty in walking due to swelling
3.  frothy urine
4. Decreased appetite 3 months
5. Nausea
6. Fatigue
7. Reduced frequency of micturition 2 months


Table 2: General examination

Pedal edema 2+
Pallor 1+
Blood pressure 144/90 mmHg
Built Obese
Weight 72kg

As per the patient, he was a chronic hypertensive patient who was controlled by the prior medications since many years and the above symptoms appeared 4 months ago. For these complaints he visited nearby hospital for the management but no improvement was seen in his symptoms and was advised for renal transplant as soon as possible. He denied for renal transplant and visited our hospital for a conservative treatment.

Material and Methods

As far as Chronic Kidney disease is concerned, in Ayurveda texts, CKD is not separately mentioned so, can be taken under disorders of Mutra Vaha Srotas Dushti Vikaras such as Mutrakriccha or Vrikk Nishkriyata due to similarity of major symptoms are seen. Here, the patient was given oral medications under the following way;

Table 3: Treatment schedule

SN Shamana Aushadhi Matra and Sevan Kaala
1. Sarvakalp Kwath, Vrikkdoshhar Kwath, Gokhru Kwath 100 ml x BD-Empty stomach
2. Renogrit tablet (500mg) 2 tab X BD-Before meals
3. Corighan tablet (500mg) 1 tab X BD-Bfeore meals
4. Punarnavadi Mandoor tablet 2 tab X BD-After meals
5. Mukta Vati extra power tablet (500mg) 2 tab X BD-after meals
6. Haritaki Churna 1 Tsf-HS with lukewarm water

Results

Patient’s kidney profile was improved with decline in Serum Creatinine level, Haemoglobin level was increased and other associated lab investigations got normal in 1 month of medications followed by strict Pathya diet, marked decline in symptoms were seen.

Decline in the levels of creatinine along with improvement in other lab investigations are mentioned below-

Table 4: Before treatment

Date Haemoglobin Neutrophils S.Creatinine B.Urea SGOT
28/3/2023 13.3 gm% 78% 2.1mg/dl 62.0mg/dl 39U/L

Table 5: After treatment

Date Haemoglobin Neutrophils S.Creatinine B.urea SGOT
04/05/2023 14.3gm% 53% 1.2mg/dl 32.51mg/dl 18U/L

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Blood investigations before treatment

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Blood investigations after treatment



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Discussion

As mentioned earlier, CRF/CKD is specific form of renal disease. According to Ayurveda, CRF is a disease of Mutravaha Srotas. Though all the three Doshas as well as all the Dushyas are involved in the disease, Kapha is responsible in blocking microvessels and developing microangiopathy. Vata is responsible for degeneration of the structure of the kidney.[7]

So, to prevent the resistance of tissues, Rasayana drugs were chosen such as Renogrit, containing Gokshur, Punarnava, etc. so as to prevent and repair the tissue damage and enhance the quality of tissues.

Also, Lekhan Dravyas such as Apamarg, Gokshur, Kasni etc. having Tikta Rasa and Rooksha Guna which help in drying of Ama, bring out a clear Rasa Dhatu and clear the Srotus, further helping in good circulation making way for proper Dhatu nourishment.

Especially Punarnava, Gokshura are recommended exclusively in the disorders of Mootravaha Samsthana. These drugs should be accepted as Naimittika Rasayana for kidney and other organs of Mootravah Srotas. Rasayana drugs bear the property of anti-oxidant and work as free radical scavengers.[8]

Also, the above mentioned drugs have Mutral properties which resolve the problem of Mutrakriccha.

Renogrit tablet: Since, chronic kidney disease has a Pitta dominant Tridosha in its pathology, Renogrit is a compound containing extracts of Varun, Kasni, Pashanbheda, Punarnavamoola, Gokshur, Varuna, Apamarg specifically has Pitta Shamaka properties, Tridoshahara Guna, Madhur Vipaka with Mutral properties and having Tikta Rasa predominant drugs, having properties of igniting Jatharagni to correct out the invariably presenting Mandagni in CKD; thus, brings Niramata.

Keeping in mind, Haritaki Churna have Anuloman property, thus helps in balancing Apana Vaayu, which relives a symptom of constipation. The use of such Mridu Virechan Dravya is recommended in Vata predominant disorders and diseases situated in central locations of Vata Dosha.[9]


Punarnavadi Mandoor: Since Panduta (Paleness) as well as Shotha (Edema) with Alpa Rakta is also a major sign of patients with kidney failure, to combat this, Punarnavadi Mandoor was advised to the patient which also acts as Rasayana for Vrikkas.

Though, Punarnavadi Mandoor is the best formulation told by Acharyas specifically on Pandu. Key ingredients of Punarnavadi Mandoor are useful in Pandu Roga Chikitsa. It also contains drugs that improve liver functioning which is very useful to remove toxins from the body. So, there is proper functioning of Rasa Dhatwagni and Raktadhatwagni which is a very important factor to cure the disease.[10]

Vrikkdoshhar Kwath: As the name says, it contains drugs such as Dhak (Butea monosperma), Pittpapda (Fumaria indica), Punarnavamool (Boerhhaavia diffusa), Pashanbhed (Saxifraga ligulata), Varun (Crataeva nurvala), Kulthi (Dolichos biflorus), Apamarg (Achyranthus aspera), Kasni (Cichorium intybus), Peepal (Ficus religiosa), Neem (Azadirrachta indica), Makoy (Solanum nigrum), Gokharu (Tribulus terrestris), Dhamasa (Fagonia arabica), Kush (Desmostachya bipinnata), Kas (Saccharum spontaeum), Dhan (Oryza sativa), Sarkanda (Saccharum officinarum), Ekh (Saccharum munja), Untkatara (Echinops echinatus), Giloy (Tinospora cardifolia), Arni (Premna integrifolia), Amaltas (Cassia fistula), Bala (Sida cordifolia), Shatavari (Asparagus racemosus), Vidari (Puerarua tuberosa), Kateri Chhoti (Solanum xanthocarpum), Kateri Badi (Solanum indicum), Jou (Hordeum vulgare), Kutaki (Picrorhiza kurroa) which have effect on Vrikka (Kidneys).

Since this Kwath includes Mutral Dravyas mentioned as Mutravirechaniya Dashemani of Charak Acharya are considered as best diuretics. It is helpful in treating the infections inside the kidney and other kidney related diseases.[11]

Sarvakalp Kwath: It contains Punarnava (Boerhaavia diffusa), Bhumi Amla (Phyllanthus niruri), Makoy (Solanum nigrum) helps in conditions of reduced urine content, stomach and pelvis pain, indigestion, lack of appetite and others. Since these drugs are considered as best hepatoprotective agents as per Ayurveda texts, thus helps in strengthening liver which results in proper formation of Aadhya Rasa Dhatu. Phyllanthus niruri is one of the commonly used species of this family for the treatment of liver and kidney disorders.[12]


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S. nigrum L. also known as “Makoy” contains several steroidal glycosides, steroidal alkaloids and steroidal oligoglycosides that also act as antioxidants reducing hepatic injuries through amelioration of oxidative stress [13,14]

Mukta Vati extra power: It contains Gajwa (Onosma bracteatum), Brahmi (Bacopa monnieri), Shankhpushpi (Convolvulus pluricaulis), Ghodbach (Acorus calamus), Ashwagandha (Withania somnifera), Malkangani (Celastrus paniculatus), Saunf (Foeniculum vulgare), Pushkarmool (Inula recemosa), Ustekhaddus (Lavandula stoechas), Fine Powders of Jata Manasi (Nardostachys jatamansi), Sarpgandha (Rauwolfia serpentina), Mukta Pishti. Among these, Brahmi and Shankhpushpi possess antihypertensive, antidepressant and antianxiety properties. Anti-hypertensive activity of reserpine which is major phyto-constituent of Sarpagandha. Significant reduction in systolic and diastolic blood pressure with Malkangani. Vacha possesses anti-hypertensive effect mediated through Ca+2 antagonism and NO pathways.[15]

Overall, this drug cures high blood pressure or heart disease caused by the disorders of the kidneys etc. So, this was chosen to control hypertension which ultimately prevents kidneys.

Corighan Tablet: It contains extract of Coriandrum sativum, an important medicinal plant, is known for its hepatoprotective, diuretic, carminative, digestive and Antihelminthic potential. Moreover, the plant was also reported to treat jaundice.

Treatment with Coriandrum sativum extract prevented a rise of urea, creatinine and blood urea nitrogen in serum. Coriandrum sativum is a potential source of nephroprotective phytochemical activity, with flavonoids and polyphenols as the major components.[16]

Gokhru Kwath: contains Yavakuta powder of Gokhru. Its ethanolic extract has already proved as

 hepatoprotective and nephroprotective action.[17]

Table 6: Pathya-Apathya

Pathya diet Apathya diet
Mudgarasa -once weekly Protein diet - including milk/dairy products except Takra
Yava Anna Sewan Godhum
Patol Sewan, Urvaruk (snake cucumber) and boiled vegetables Heavy pulses
Saindhav Lavana Packed items
Fruits - Apple, Papaya Citrus fruits
Strict fluid intake - 1 to 1.5litres/day Spice and pickles

Pathya-Apathya diet[18]

Pathya diet was recommended by keeping in mind the dietary plans for Mootravaha Sroto Vikaras-

Conclusion

In this case, treatment of the patient was also focused on strictly following Pathya diet, thereby preventing from Nidana and further possibility of Dushti of Dhatus and Doshas, which lead to tremendous results in small period of time.

The disorder of Mutravaha Srotas has resemblance with the description of urological disorders of modern parlance. On the basis of history and clinical presentation, the patient was diagnosed as case of CKD, it's treatment with Ayurveda was found encouraging.[19] In all types of urine disorders, Vata dosha is the prime causative factor collaborating with Pitta and Kapha. Hence, general treatment is applied considering Tridoshas, drug and disease,[20] especially Vata and Kapha Shamak Dravyas were chosen for management of this case to break the Samprapti Chakra, hence emitting the symptoms, thus preventing kidneys from its failure to perform its vital functions. Also, the drugs chosen showed promising results in parameters pertaining to quality of life. So, it shows that the patient must strictly follow proper dietary habits with proper Dincharya and Rituchraya which is equally important along with the conservative treatment. As the disease nowadays has to be focused due to its high prevalence rate, this case study becomes a ray of hope for the patients suffering from the same.

Acknowledgement

I would like to express my gratitude and appreciation to my institution and hospital management who gave me the possibility to complete this project. Also, I take this opportunity to express my deep sense of gratitude to my guides and co-guides under whose valuable guidance; this project work has been carried out.

Reference

1. Kampmann JD, Heaf JG, Mogensen CB, Mickley H, Wolff DL, Brandt F. Prevalence and incidence of chronic kidney disease stage 3-5 - results from KidDiCo. BMC Nephrol. 2023 Jan 19;24(1):17. doi: 10.1186/s12882-023-03056-x. PMID: 36658506; PMCID: PMC9849831


Journal of Ayurveda and Integrated Medical Sciences 2023;8(7)254
Aggarwal A et al: Management of Chronic Kidney Disease An Ayurveda Case Study

2. Chen TK, Knicely DH, Grams ME. Chronic Kidney Disease Diagnosis and Management: A Review. JAMA. 2019 Oct 1;322(13):1294-1304. doi: 10.1001/jama.2019.14745. PMID: 31573641; PMCID: PMC7015670.

3. https://www.kidney.org/kidneydisease/howkidneyswrk

4. Prashanth GS, Baghel MS, Ravishankar B, Gupta SN, Mehta MP. A clinical comparative study of the management of chronic renal failure with punarnavadi compound. Ayu. 2010 apr;31(2):185-92. Doi: 10.4103/0974-8520.72388. Pmid: 22131708; pmcid: pmc3215362.

5. Patel MV, Gupta SN, Patel NG. Effects of ayurvedic treatment on 100 patients of chronic renal failure (other than diabetic nephropathy). Ayu. 2011 oct;32(4):483-6. Doi: 10.4103/0974-8520.96120. Pmid: 22661841; pmcid: pmc3361922.

6. Rachana MS, Totad M., Girish KJ, Vasantha B, Powar Vibhu. Ayurvedic management of Chronic Kidney Disease : A Case Report. J Ayurveda Integr Med Sci 2019;6:285-290

7. Patel MV, Gupta SN, Patel NG. Effects of ayurvedic treatment on 100 patients of chronic renal failure (other than diabetic nephropathy). Ayu. 2011 oct;32(4):483-6. Doi: 10.4103/0974-8520.96120. Pmid: 22661841; pmcid: pmc3361922

8. Prashanth GS, Baghel MS, Ravishankar B, Gupta SN, Mehta MP. A clinical comparative study of the management of chronic renal failure with Punarnavadi compound. Ayu. 2010 apr;31(2):185-92. Doi: 10.4103/0974-8520.72388. Pmid: 22131708; pmcid: pmc3215362.

9. Sawarkar, Punam & Sawarkar, Gaurav. (2022). Management of Chronic Renal Failure (CRF) through Ayurveda –A Case Report. International Journal of Ayurvedic Medicine. 13. 243-250. 10.47552/ijam.v13i1.2432.

10. Vinila Vilas Desai: a comprehensive review of Punarnavadi Mandoor and its effect on Pandu w.s.r. To iron deficiency anaemia. International ayurvedic medical journal {online} 2022 {cited december 2022} available from: http://www.iamj.in/posts/images/upload/3353_3357.pdf

11. Bhat SD, Ashok BK, Acharya R. Critical analysis of herbs acting on Mutravaha srotas. Ayu. 2010 Apr;31(2):167-9. doi: 10.4103/0974-8520.72379. PMID: 22131705; PMCID: PMC3215359.

12. Sowjanya K, Girish C, Bammigatti C, Prasanna Lakshmi NC. Efficacy of Phyllanthus niruri on improving liver functions in patients with alcoholic hepatitis: A double-blind randomized controlled trial. Indian J Pharmacol. 2021 Nov-Dec;53(6):448-456. doi: 10.4103/ijp.IJP_540_20. PMID: 34975132; PMCID: PMC8764976.

13. Kirtikar K.R., Basu B.D. Indian Medicinal Plants. 2nd ed. Lalit Mohan Basu Publication; Allahabad, India: 1956. p. 852.

14. Chang J.-J., Chung D.-J., Lee Y.-J., Wen B.-H., Jao H.-Y., Wang C.-J. Solanum NigrumPolyphenol Extracts Inhibit Hepatic Inflammation, Oxidative Stress, and Lipogenesis in High-Fat-Diet-Treated Mice. J. Agric. Food Chem. 2017;65:9255–9265. doi: 10.1021/acs.jafc.7b03578.

15. Sharma R, Goyal A, Singh R, Khanduri S, Ota S, Goel S, Rana RK, Singhal R, Shahi VK, Srikanth N, Swasticharan L, Dhiman KS. Effect of Ayurveda intervention in the integrated management of essential hypertension- a retrospective observational study. J Ayurveda Integr Med. 2021 Jul-Sep;12(3):521-528. doi: 10.1016/j.jaim.2021.04.012. Epub 2021 Aug 4. PMID: 34362604; PMCID: PMC8377180.

16. Lakhera A, Ganeshpurkar A, Bansal D, Dubey N. Chemopreventive role of coriandrum sativum against gentamicin-induced renal histopathological damage in rats. Interdiscip toxicol. 2015 jun;8(2):99-102. Doi: 10.1515/intox-2015-0015. Pmid: 27486367; pmcid: pmc4961904.

17. Rajashekar V, Rao EU, P S. Biological activities and medicinal properties of Gokhru (Pedalium murex L.). Asian Pac J Trop Biomed. 2012 Jul;2(7):581-5. doi: 10.1016/S2221-1691(12)60101-4. PMID: 23569975; PMCID: PMC3609349.

18. Amit Kumar Karna, S. A. Doddamani, Surekha S. Medikeri. Concept of Pathyapathya w.s.r. to Mutravaha Sroto Vikaras. J Ayurveda Integr Med Sci 2020;4:199-203


Journal of Ayurveda and Integrated Medical Sciences 2023;8(7)255
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19. https://www.ayucare.org/article.asp?issn=2667-0593;year=2020;volume=3;issue=1;spage=14;epage=19;aulast=Kapoor

20. Sharma PV, editor. Commentary of Dalhan on Sushruta Samhita of Sushruta, Uttar Tantra. Ch. 58. Verses 27. Varanasi: Chaukhambha Vishvabharti Prakashana; 2014. p. 571-2.


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