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This article is based on a lecture delivered by Prof. (Dr.) S.N. Gupta, Distinguished Professor, Post Graduate Department of Kayachikitsa in J.S Ayurveda College, Nadiad, Gujarat, India, in Prof. M. S. Baghel Memorial Lecture Series on December 09, 2021.

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|description= Diagnosis and management of Kidney diseases in Ayurveda

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==Incidence of chronic kidney disease==

==Incidence of chronic kidney disease==

===Pathogenesis of ESRD===

===Pathogenesis of ESRD===

When any pathological changes occur in kidney, initially there is hyperfiltration leading to minor damages to the kidney. Because of this hyper filtration, there is over burden to the remaining healthy nephrons to compensate it. This causes further damage in the healthy nephrons and progressive dysfunction ultimately leading to ESRD. Initially it will be evidenced by biochemical abnormalities, but gradually it leads to excretory, metabolic and endocrinal deficiencies related to the functions of kidney.

When any pathological changes occur in kidney, initially there is hyperfiltration leading to minor damages to the kidney. Because of this hyperfiltration, there is over burden to the remaining healthy nephrons to compensate it. This causes further damage in the healthy nephrons and progressive dysfunction ultimately leading to ESRD. Initially it will be evidenced by biochemical abnormalities, but gradually it leads to excretory, metabolic and endocrinal deficiencies related to the functions of kidney.

===Etiological factors===

===Etiological factors===

   

   

'''Congenital causes:''' Polycystic kidney, congenital hypoplasia

'''Congenital causes:''' Polycystic kidney, congenital hypoplasia

'''Vascular causes:''' Arteriosclerosis, renal artery stenosis, diabetic nephropathy, haemolytic uremic syndrome, vasculitis

'''Vascular causes:''' Arteriosclerosis, renal artery stenosis, diabetic nephropathy, haemolytic uremic syndrome, vasculitis

'''Glomerular disease:''' Various types of glomerulonephritis (primary glomerular disease such as focal segmental glomerulosclerosis and IgA nephropathy)

'''Glomerular disease:''' Various types of glomerulonephritis (primary glomerular disease such as focal segmental glomerulosclerosis and IgA nephropathy)

'''Intestinal diseases:''' Chronic pyelonephritis, vesico-ureteric reflux, tuberculosis, calcinosis, analgesic nephropathy

'''Intestinal diseases:''' Chronic pyelonephritis, vesico-ureteric reflux, tuberculosis, calcinosis, analgesic nephropathy

'''Obstructive uropathy:''' Calculus, prostatic hypertrophy, pelvic tumours

'''Obstructive uropathy:''' Calculus, prostatic hypertrophy, pelvic tumours

'''Auto-immune diseases:''' Lupus, systemic sclerosis

'''Auto-immune diseases:''' Lupus, systemic sclerosis

In children: Congenital anomalies of kidney and urinary tract(49.1%), steroid resistant nephrotic syndrome(10.4%), chronic glomerulonephritis, e.g., lupus nephritis, Alport syndrome (8.1 %), renal ciliopathies(5.3%).<ref>Francesca Becherucci,Rosa Maria Roperto,MarcoMaterassiand Paola Romagnani- Chronic kidney disease in children- Clinical Kidney Journal 2016 Aug; 9(4): 583–591.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957724/</ref>

In children: Congenital anomalies of kidney and urinary tract(49.1%), steroid resistant nephrotic syndrome(10.4%), chronic glomerulonephritis, e.g., lupus nephritis, Alport syndrome (8.1%), renal ciliopathies(5.3%).<ref>Francesca Becherucci,Rosa Maria Roperto,MarcoMaterassiand Paola Romagnani- Chronic kidney disease in children- Clinical Kidney Journal 2016 Aug; 9(4): 583–591.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957724/</ref>

Some of the less common causes are thrombotic microangiopathies (especially, atypical haemolytic uraemic syndrome), nephrolithiasis/nephrocalcinosis, infectious and interstitial diseases.

Some of the less common causes are thrombotic microangiopathies (especially, atypical haemolytic uraemic syndrome), nephrolithiasis/nephrocalcinosis, infectious and interstitial diseases.

*Psychotherapy (sattvavajayachikitsa) and spiritual therapy (daivavyapashrayachikitsa)

*Psychotherapy (sattvavajayachikitsa) and spiritual therapy (daivavyapashrayachikitsa)

====I. Avoiding the cause (nidanaparivarjana)====

'''I. Avoiding the cause (nidanaparivarjana)'''

With the advice for avoiding the causative factors like dietary, life style modifications etc. the underlying disease conditions should be addressed first.

With the advice for avoiding the causative factors like dietary, life style modifications etc. the underlying disease conditions should be addressed first.

In cases of polycystic kidneys, manage the condition with suitable medicines like Kanchanaraguggulu, Varunadikwatha etc. For example, in case of hypertension, use of antihypertensive drugs to control blood pressure and overload on kidneys. In case of diabetic nephropathy, treatment for diabetes should be done first.

In cases of polycystic kidneys, manage the condition with suitable medicines like Kanchanara guggulu, Varunadi kwatha etc. For example, in case of hypertension, use of antihypertensive drugs to control blood pressure and overload on kidneys. In case of diabetic nephropathy, treatment for diabetes should be done first.

====II. Repairing the damage at kidneys (origin of disease)====

'''II. Repairing the damage at kidneys (origin of disease)'''

Herbs having [[rasayana]] (rejuvenating) activities on urinary system (mutravahasrotas) should be used. Crataeva religeosa (varuna), Boerrhavia diffusa (punarnava), Tribulus terrestris (gokshura), and Phyllanthus niruri (bhumyamalaki) show potent rejuvenating activities on urinary system. The compound preparation called “Chyavanaprasha”, other preparations like Jivitapradavati [Bheshaj Samhita],<ref>Bheshajasamhita( Ayurvedic pharmacopeia)Edited by Gujarat state bheshaja samiti 1st edition, Ministry of health, Gujarat State; 1966 P 468-9</ref> shilajatwadivati etc. with [[rasayana]] drugs like black bitumen (shilajatu) and Commiphora wightii (guggulu) are found very effective for this purpose.

Herbs having [[rasayana]] (rejuvenating) activities on urinary system (mutravahasrotas) should be used. Crataeva religeosa (varuna), Boerrhavia diffusa (punarnava), Tribulus terrestris (gokshura), and Phyllanthus niruri (bhumyamalaki) show potent rejuvenating activities on urinary system. The compound preparation called “Chyavanaprasha”, other preparations like Jivitapradavati [Bheshaj Samhita],<ref>Bheshajasamhita( Ayurvedic pharmacopeia)Edited by Gujarat state bheshaja samiti 1st edition, Ministry of health, Gujarat State; 1966 P 468-9</ref> shilajatwadivati etc. with [[rasayana]] drugs like black bitumen (shilajatu) and Commiphora wightii (guggulu) are found very effective for this purpose.

====III. Establishing the normal state of [[srotas]] (mutravaha, udakavaha and swedavaha)====

'''III. Establishing the normal state of [[srotas]] (mutravaha, udakavaha and swedavaha)'''

In order to support the excretory functions and maintenance of fluid and electrolyte balance, the therapeutic procedure called ‘[[basti]]’ is found highly effective. The decoction enema (niruha basti) with punarnavadi kwatha, and unctuous enema (anuvasana basti) with gokshuradi taila, the drug Boerrhavia diffusa (punarnava) in a palatable and convenient form 3-5 g twice a day is advisable.

In order to support the excretory functions and maintenance of fluid and electrolyte balance, the therapeutic procedure called ‘[[basti]]’ is found highly effective. The decoction enema (niruha basti) with punarnavadi kwatha, and unctuous enema (anuvasana basti) with gokshuradi taila, the drug Boerrhavia diffusa (punarnava) in a palatable and convenient form 3-5 g twice a day is advisable.

The status of important electrolytes like sodium and potassium should be considered. In cases of hypernatremia and associated cardiac failure, salt should be restricted. Rock salt (saindhava lavana) is advisable if needed. In cases of hyperkalaemia, intake of fruits and vegetables should be restricted. In case of hypokalaemia, intake of fruits and coconut water is useful.

The status of important electrolytes like sodium and potassium should be considered. In cases of hypernatremia and associated cardiac failure, salt should be restricted. Rock salt (saindhava lavana) is advisable if needed. In cases of hyperkalaemia, intake of fruits and vegetables should be restricted. In case of hypokalaemia, intake of fruits and coconut water is useful.

====IV. Nourishment ofdhatu (body constituents)====

'''IV. Nourishment of dhatu (body constituents)'''

For correction of anaemia, Chyavanaprasha or any iron containing preparations are effective. Role of erythropoietin shall be considered here. If only the excretory function of kidney is impaired and endocrinal functions are proper, then erythropoietin supplementation is not needed. In case of deficiency of erythropoietin only, it should be supplemented. Fruits of prickly pear, beetroot are natural supplements having similar action to erythropoietin. These are used for promoting blood tissue ([[rakta dhatu]]).

For correction of anaemia, Chyavanaprasha or any iron containing preparations are effective. Role of erythropoietin shall be considered here. If only the excretory function of kidney is impaired and endocrinal functions are proper, then erythropoietin supplementation is not needed. In case of deficiency of erythropoietin only, it should be supplemented. Fruits of prickly pear, beetroot are natural supplements having similar action to erythropoietin. These are used for promoting blood tissue ([[rakta dhatu]]).

For managing myopathy and neuropathy, a very effective therapeutic measure is massage (abhyanga) with medicated oils. This pacifies aggravated [[vata dosha]].  For osteodystrophy, Shankhabhasma, compounds of mukta (pearl) and pravala (coral) are used. They are good natural source of calcium and also help in managing hyperacidity. Mukta is an antidepressant too.

For managing myopathy and neuropathy, a very effective therapeutic measure is massage (abhyanga) with medicated oils. This pacifies aggravated [[vata dosha]].  For osteodystrophy, Shankhabhasma, compounds of mukta (pearl) and pravala (coral) are used. They are good natural source of calcium and also help in managing hyperacidity. Mukta is an antidepressant too.

====V. Management of associated conditions====

'''V. Management of associated conditions'''

In cases of hypertension, Triphala guggulu 1gm three times a day along with powder of Terminalia arjuna (3g) is effective. The powder of Rauwolfia serpentina (sarpagandha) 500mg-1gm can also be given to control hypertension. Symptomatic treatments are given in cases of nausea, vomiting, hiccup etc.

In cases of hypertension, Triphala guggulu 1gm three times a day along with powder of Terminalia arjuna (3g) is effective. The powder of Rauwolfia serpentina (sarpagandha) 500mg-1gm can also be given to control hypertension. Symptomatic treatments are given in cases of nausea, vomiting, hiccup etc.

====VI. Psychotherapy====

'''VI. Psychotherapy'''

Proper counselling of the patients, giving positive outlook and assurance comes under sattvavajaya chikitsa. This has a great role in such conditions.

Proper counselling of the patients, giving positive outlook and assurance comes under sattvavajaya chikitsa. This has a great role in such conditions.

An extra 100 ml of boiled milk (cow’s) is also advisable during day time, if the patient feels hungry.

An extra 100 ml of boiled milk (cow’s) is also advisable during day time, if the patient feels hungry.

Food items to be avoided:

'''Food items to be avoided:'''

*All other flour items like wheat, millet, corn etc.

*All other flour items like wheat, millet, corn etc.

==Current research==

==Current research==

[[File: EGFR.JPG|500px|'''Image 1: Estimated marginal means of eGFR'''|thumb]]

[[File: EGFR_final.jpg|500px|'''Image 1: Estimated marginal means of eGFR'''|thumb]]

 

 

[[File: Hemoglobin_final.jpg|500px|'''Image 3: Estimated marginal means of hemoglobin'''|thumb]]

A clinical study of 100 patients of chronic renal failure (other than diabetic nephropathy) to study effect of [[ayurveda]] therapy was conducted. Decoction enema (niruha basti) with punarnavadi kwatha daily and oral administration of gokshuradi guggulu, rasayana churna and varunadi kwatha as per the protocol were prescribed for a period of one month. In this study, statistically significant results were obtained in levels of serum creatinine, blood urea and albumin in urine along with considerable relief in signs and symptoms.<ref>Patel MV, Gupta SN, Patel NG. Effects of Ayurvedic treatment on 100 patients of chronic renal failure (other than diabetic nephropathy). Ayu. 2011;32(4):483-486. doi:10.4103/0974-8520.96120</ref>

A clinical study of 100 patients of chronic renal failure (other than diabetic nephropathy) to study effect of [[ayurveda]] therapy was conducted. Decoction enema (niruha basti) with punarnavadi kwatha daily and oral administration of gokshuradi guggulu, rasayana churna and varunadi kwatha as per the protocol were prescribed for a period of one month. In this study, statistically significant results were obtained in levels of serum creatinine, blood urea and albumin in urine along with considerable relief in signs and symptoms.<ref>Patel MV, Gupta SN, Patel NG. Effects of Ayurvedic treatment on 100 patients of chronic renal failure (other than diabetic nephropathy). Ayu. 2011;32(4):483-486. doi:10.4103/0974-8520.96120</ref>

*Compensation by intact  nephrons/by other organs

*Compensation by intact  nephrons/by other organs

Clinical Studies on effect of Ayurvedic treatment on dialysis dependent patients are under progress.

Clinical Studies on effect of Ayurvedic treatment on dialysis dependent patients are under progress.

 

 

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