E-ISSN:2456-3110

Case Report

Nephrotic Syndrome

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 9 September
Publisherwww.maharshicharaka.in

Ayurvedic treatment approach for Primary Nephrotic Syndrome - A Case Study

Qadari AAJ1*, Shrinidhi Kumar K2, Ankita3
DOI:10.21760/jaims.10.9.54

1* Aisha Amrin Jahan Qadari, Post Graduate Scholar, Department of Kaumarbhritya, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.

2 Shrinidhi Kumar K, Associate Professor, Department of Kaumarbhritya, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.

3 Ankita, Post Graduate Scholar, Department of Kaumarbhritya, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.

Background: Up to 20% of end-stage renal disease and 12% of the causes of chronic kidney diseases are related to primary nephrotic syndrome. Nephrotic syndrome is one such burning problem which effects the school going child due to exaggerated immune response like auto-immunity following a viral infection. The incidence is 2 to 7 per 1,00,000 children per year. Corticosteroids are frequently needed by patients to achieve remission, however many patients either relapse after remission or do not react to them. The better alternative is, however far from established.

Objectives: To evaluate the efficacy of a multimodal Ayurvedic treatment for nephrotic syndrome patient.

Methods: A 10-year-old boy, diagnosed case of primary nephrotic syndrome, with complaint of swelling of face, proteinurea and recurrent respiratory tract infection. Based on the patient's observed indications and symptoms, a treatment plan was developed. The protocol includes Ksheerpaka of herbal drugs powder (Yashtimadhu, Shatavari, Guduchi, Gokshura, Musta, Punarnava, Mandukparni and Vidari) along with Chandanasava, Punarnavasava, Gokshuradi Guggulu and Arogyavardhini Vati, Chandraprabha Vati orally, with some dietary modifications.

Results: The treatment approach demonstrated success in reducing proteinuria and facial swelling. During the follow-up period, no unfavourable impacts were observed.

Keywords: The treatment approach demonstrated success in reducing proteinuria and facial swelling. During the follow-up period, no unfavourable impacts were observed

Corresponding Author How to Cite this Article To Browse
Aisha Amrin Jahan Qadari, Post Graduate Scholar, Department of Kaumarbhritya, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.
Email: 		Qadari AAJ, Shrinidhi Kumar K, Ankita, Ayurvedic treatment approach for Primary Nephrotic Syndrome - A Case Study. J Ayu Int Med Sci. 2025;10(9):337-341.
Available From
https://jaims.in/jaims/article/view/4812/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-07-12 2025-07-22 2025-08-02 2025-08-15 2025-08-28
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Not required 10.57

© 2025 by Qadari AAJ, Shrinidhi Kumar K, Ankita and 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].

J Ayu Int Med Sci 2025;10(9)337
Download PDFBack To ArticleIntroductionObjective of the studyMaterials and MethodsResultsDiscussionConclusionReferences
Qadari AAJ et al. Ayurvedic treatment approach for Primary Nephrotic Syndrome

Introduction

Disorders related to immune system specially aberration of immune response leading to auto-immune disorders becoming more common now-a-days. Nephrotic syndrome is one such burning problem which effects the school going child due to exaggerated immune response like auto-immunity following a viral infection.

Nephrotic syndrome is primarily a paediatric disorder and is 15 times more common in children than adults (minimal change nephrotic syndrome). The incidence is 2 to 7 per 1,00,000 children per year.[1] It can occur in any age and both in males and females but it is more common in males. It is a nonspecific kidney disorder characterised by proteinuria, hypoalbuminemia and oedema. According to International Study of Kidney Diseases in Children (ISKDC classification)[2] the characteristics are heavy/massive proteinuria (>3.5 gms/24hrs in adults or 4 mg/meter 2/hr in children), hypoalbuminemia (<2.9 gm/dl), oedema, hyperlipidaemia (>220mg/dl), Predisposition for coagulation.

Glomeruli are affected by inflammation or hyalinization (the formation of a homogenous crystalline material within cells) that allows proteins such as albumin, anti-thrombin or the immunoglobulins to pass through the cell membrane and appear in urine.[3] Loss of protein from the body leads to pressure changes in vascular bed leading to oedema.[4]

Recurrency and relapse is quite common in nephrotic syndrome especially after a viral infection, and with each recurrency disease become more and more chronic, but effective treatment is lacking. Steroids, diuretics and other immune-suppressive treatment are presently used as main stay of treatment. Steroids are extensively used as immune-suppressant action which does not solve the purpose of correction of immune-response.[5] Adverse effect and steroids dependency has been emerged as major hazard which also interfere with growth and development of child.

Ojas which is essence of Sapta Dhatus of the body is such an entity in the body which is responsible for existence of this human body and its fluctuations, disturbances, deficiencies, malfunctioning result in uncertain human life. Stable Ojas maintain whole body just like a sheet anchor.

Its deficiency can be Ojo-Kshaya, its malfunctioning can be Ojo-Vayapath, and its fluctuations may be Ojo-Visarmasa. It is one of the Paranayatana and usually its Kshaya occurs in chronic disorders like Rajayakshayama, Parmeha etc. Ojas is also called is Sara of the body, Bala of the body and responsible for Vayadhi-Kshamatwa.

Hence for all clinical purpose in detail analysis of literature of Ojas, it can be well compared with immune system of body. Body immune system is distributed locally and peripherally or local or generalised similarly Ojas is either Para or Apara. Each system tissue, cells shows certain degree of its own immunity which can be compared with generalised distribution of Ojas.[6]

It is quite obvious that aberrations of body immune system is the root cause of all disorders. Pronicity of infections increase with Ojas Kshaya while immune regulation is disturbed by Ojo-Vayapatha and Visaramasa.

Hence an exaggerated immune response leading to auto-immunity like presentations is possible in aberration of Ojas especially Vayapath / Visramsa as evidenced in Nephrotic Syndrome like condition (another examples are RHD, SLE, RA etc.). This condition should not be treated with immune-suppressive therapy like steroids as it further depresses the immune system instead of immune-modulation.[7]

Objective of the study

To determine the efficacy of Ayurvedic treatment in Nephrotic Syndrome, as mentioned in classical Ayurveda text.

Brief history of patient

Present case a 10-year-old male child has complaints of recurrent heavy proteinurea, peri-orbital edema, pedal edema and excessive fatigue. First peri-orbital edema in morning hours developed that spread to pedal edema and generalized edema over a quick time period on consultation urine examination was done that reveals heavy proteinurea and patient being diagnose with minimal change nephrotic syndrome.

Developmental history

Patient’s development was appropriate as per the age in all the domains (e.g. Gross motor, Fine motor, social and speech domain).


J Ayu Int Med Sci 2025;10(9)338
Qadari AAJ et al. Ayurvedic treatment approach for Primary Nephrotic Syndrome

Immunization history

Patient was immunized as per the age as per the guidelines of National Immunization Schedule.

Past history

Medicinal history of oral steroid taken for 3 months after that proteinurea subsides, remission occurred after 2 months, then again oral steroid taken for 4 months.

Family history - Not significant.

Personal history

  • Appetite - Unaltered
  • Diet - Vegetarian
  • Bowel habits - Regular, with no abnormalities noted.
  • Bladder habits - Regular with increased frequency, foamy urine.
  • Sleep - Sound sleep, approximately 8–9 hours at night.
  • Allergy - None reported.
  • Addiction - None Reported

Baseline findings

Patient’s general condition was moderate with 30 kg weight and height 140 cm and 15.3 kg/m2 of body mass index. The patient’s vitals were 98.2°F temperature, 80 beats/min of pulse rate, 22 breaths/ min of respiratory rate, and 110/70 mm Hg of blood pressure. On systemic examination, patient was conscious and well oriented; on auscultation of heart S1, S2 heard, chest was clear with air entry to lungs bilaterally equal, and gastro-intestinal system examination showed that abdomen was soft, non-tender with normal bowel sound.

Clinical findings

Peri-orbital edema +++

Pedal edema +

Foamy urine ++

Heavy proteinurea ++

Materials and Methods

Assessment Criteria

As per symptoms such as peri-orbital swelling, pedal edema, generalized edema, fatigue,

foamy urea and laboratory investigations such as urine examination, serum albumin, serum creatinine and serum cholesterol.

Grading for Generalized edema

GradeDefinition
0Absent
1Mild: both feet/ankle
2Moderate: both feet with lower parts of legs and lower parts of hands
3Severe: generalized bilateral pitting edema including both feet, legs, arms and face

Grading for Pedal edema

GradeDefinition
0No pitting edema
1Mild pitting edema
2mm depression rebound immediately
2Moderate pitting edema
4mm depression takes a few seconds to rebound
3Moderately severe pitting edema
6mm depression takes 10-12 seconds to rebound
4Severe pitting edema
8mm depression lasts for more than 20 seconds to rebound

Grading for Periorbital edema

GradeDefinition
1No coverage of iris with eyelids
2Slight coverage of iris with swollen eyelids
3Full coverage of iris with swollen eyelids
4Full closure of eyes

Grading for Foamy Urine

GradeDefinition
0No layers in urine
1Single layer of bigger and clear bubbles
2Multiple layers of white colored small to medium bubbles

Grading for Fatigue

GradeDefinition
1Mild fatigue relieved with rest
2Fatigue not relieved by rest and limits instrumental activities of daily living
3Severe fatigue that limits self-care activities of daily living, hospitalization is needed
4Life-threatening fatigue that requires urgent intervention

Laboratory Investigations

  • Urine - Routine and microscopy
  • Serum Albumin
  • Serum Creatinine
  • Serum Cholesterol

J Ayu Int Med Sci 2025;10(9)339
Qadari AAJ et al. Ayurvedic treatment approach for Primary Nephrotic Syndrome

Grading for proteinuria

GradeScore
Nil0
Trace(5-20mg/dl)1
+ (30mg/dl or <0.5g/day)2
++ (100mg/dl or 0.5-1g/day)3
+++ (300mg/dl or 1-2g/day)4
++++ (>300mg/dl or >2g/day)5

Treatment Plan

SNMedicineMain IngredientsDoseDuration
1.Ksheerapaka of herbal drugsYashtimadhu, Shatavari, Guduchi, Gokshura, Musta, Punarnava, Mandukparni and Vidari20 ml twice a day1 year
2.ChandanasavaChandana, Hribera, Musta, Lodhra etc.10 ml twice a day1 year
3.PunarnavasavaPunarnava, Gokshura, Guduchi etc.10 ml twice a day1 year
4.Gokshuradi GugguluGokshura, Shuddha Guggulu etc.1 tab twice a day1 year
5.Arogyavardhini VatiKutaki, Shuddha Parada, Shuddha Gandhaka etc.1 tab twice a day1 year
6.Chandraprabha VatiKarpura, Loha Bhasma, Shilajatu, Guggulu etc.1 tab twice a day1 year

Pathya - Protein rich diet - Egg, Moong Dal, cheese etc.

Results

Symptoms before and after treatment

SNSymptomBefore TreatmentAfter Treatment
1.Peri-orbital edema20
2.Pedal edema10
3.Generalized edema00
4.Foamy urine20
5.Fatigue20

Laboratory investigations before and after treatment

SNInvestigationBefore treatmentAfter treatment
1.Proteinuria30
2.Serum albumin3.2 g/dL5.32 g/dL
3.Serum Creatinine0.90mg/dL0.50 mg/dL
4.Serum Cholesterol200 mg/dL176.5 mg/dL

Discussion

Mode of action of Ksheerapaka

  • Enhance the tolerance level of body immunity (Ojovardhaka): Guduchi, Yasthimadhu

  • Decrease the edema (Mutrala): Gokshura, Punarnava
  • Regenerate the damaged tissue (Rasayana): Guduchi, Yasthimadhu, Punarnava and

Chandraprabha Vati - Rasayana, it aids in parenchymal tissue regeneration, limiting additional harm to the renal parenchyma.[8]

Gokshuradi Guggulu - Mutrala, Rasayana [9]

Arogyavardhini Vati - Sroto Vishodhana, it improves digestion and metabolic activities.[10]

Chandanasava – Balakara - immunity booster[11]

Punarnavasava – Shothahara - anti-inflammatory.[12]

Conclusion

Nephrotic syndrome occurs due to vitiation of Oja, Therefore, such herbs & Herbo-mineral formulation are required, which not only break down the pathogenesis of nephrotic syndrome but also make homeostasis among the vitiated Doshas. In the case we can conclude that conventional treatment of nephrotic syndrome added with Ayurvedic Treatment is highly beneficial in controlling pathology, decreasing recurrency and symptomology in comparison to conventional treatment of same without adverse effect.

Declaration of patient consent

Obtained the parent’s consent form, on which the parent has granted permission for the case to be published in the journal along with clinical data. The parent understands that although every effort will be made to keep the child’s identity anonymous, confidentiality cannot be ensured, the name and initials of their child will remain private.

ADR declaration

Throughout the course of treatment and the follow-up period, no adverse drug reactions were observed.

References

1. Kliegman RM. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: Saunders; 2011. p.1753 [Crossref][PubMed][Google Scholar]


J Ayu Int Med Sci 2025;10(9)340
Qadari AAJ et al. Ayurvedic treatment approach for Primary Nephrotic Syndrome

2. Bagga A, Mantan M. Paediatric nephrotic syndrome. Indian J Med Res. 2005 Jul;122(1):13–28. [Crossref][PubMed][Google Scholar]

3. Vogt BA, Avner ED. Nephrotic syndrome in children. In: Avner ED, Harmon WE, Niaudet P, editors. Pediatric Nephrology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 545–76 [Crossref][PubMed][Google Scholar]

4. Behrman RE, Kliegman RM, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics. 18th ed. Vol. 2. Philadelphia: Saunders; 2008. p.2190–5, 2223–8 [Crossref][PubMed][Google Scholar]

5. Kliegman RM. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: Saunders; 2011. p.1753 [Crossref][PubMed][Google Scholar]

6. (Duplicate of Ref 1, retained as per instruction). . 17th ed. Philadelphia: Saunders; 2011. p.1753 [Crossref][PubMed][Google Scholar] [Crossref][PubMed][Google Scholar]

7. Acharya YT, editor. Sushruta Samhita of Sushruta with Nibandhasangraha Commentary by Dalhana. Sutra Sthana, Chapter 15. Varanasi: Chaukhambha Orientalia; reprint edition. [Crossref][PubMed][Google Scholar]

8. Dutt K, Acharya SK. Role of Sthiradi Yapana Basti and an Indigenous Compound in the Management of Minimal Change Nephrotic Syndrome W. S. R. to Aberrations of Ojas. J Ayurveda. 2019;13(2):20–7 [Crossref][PubMed][Google Scholar]

9. Sharangadhara. Sharangadhara Samhita. Madhyama Khanda, Chapter 7, Verses 40–45. Varanasi: Chaukhambha Publishers; reprint edition. [Crossref][PubMed][Google Scholar]

10. Sharangadhara. Sharangadhara Samhita. Madhyama Khanda, Chapter 7, Verses 84–87. Varanasi: Chaukhambha Publishers; reprint edition. [Crossref][PubMed][Google Scholar]

11. Anonymus. Rasendrasara Sangraha. Jwara Rogadhikara, Verse 13–105. Varanasi: Chaukhambha Orientalia; reprint edition. [Crossref][PubMed][Google Scholar]

12. Govind Das Sen. Bhaishajya Ratnavali. Shukrameha Chapter, Verses 34–38. In: AFI Formulations. Vol. 1. New Delhi: CCRAS; reprint edition [Crossref][PubMed][Google Scholar]

13. Govind Das Sen. Bhaishajya Ratnavali. Shoth Roga Adhikara, Verses 197–201. Varanasi: Chaukhambha Orientalia; reprint edition. [Crossref][PubMed][Google Scholar]

Disclaimer / Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of Journals and/or the editor(s). Journals and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.


J Ayu Int Med Sci 2025;10(9)341