Kidney diseases

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.

Incidence of chronic kidney disease

Chronic kidney disease (C.K.D.) is a big challenge to the medical fraternity. About 9.1 % of world population is suffering from CKD. Kidney disorders are the 12th leading cause of death worldwide with an annual death rate of 15.7 per 100000. In India, it is the 8th leading cause of death. Currently, over 2 million people worldwide need dialysis or a kidney transplant for life. However, this number represents only 10% of the people who need these kinds of treatments to save their life. The majority of these patients belong to countries like United States, Japan, Germany, Brazil and Italy. In about 100 developing countries making 50% of world population, only 20% of patients receive these facilities. So, the accessibility and affordability of advanced conventional treatment facilities like dialysis and kidney transplantation are very poor especially in developing countries. Therefore, the need of systems like Ayurveda is high on rise.

Ayurveda treatment can provide relief in a patient of chronic kidney disease in either of the following three ways :

• Reduction in the frequency of dialysis (in patients who are already undergoing dialysis)
• Postponement of need of renal replacement therapy (RRT), if the patient has not yet started dialysis or not yet planned for kidney transplant
• Normal comfortable life without RRT (in less severe cases)

Ayurvedic perspective of chronic kidney disease

Chronic kidney disease (CKD) can be termed as “Jeerna or Pravruddha Vrikkadosha” in Sanskrit language. A disease condition with similar clinical features is described in Charak Samhita in Chhardi Chikitsa. [Cha. Sa. Chikitsa Sthana 20/16-17] It is a fatal condition. When the morbid vata occludes the channels carrying faeces, sweat, urine and body fluids and moves upwards, then the morbid matter from the koshtha (gastrointestinal tract), gets incited to cause vomiting. It has the following characteristics:

1. Vomitus having color and odor of the faeces and urine;
2. Persistent thirst, dyspnoea hiccup and pain
3. Vomiting of foul smelling or dushta (putrid material); and
4. Bouts of vomiting ejected with great force.

Such a patient succumbs to death quickly. This shows a clear picture of a uremic patient with vomiting, uremic smell, thirst, breathlessness and hiccup. Management of this condition is not described which shows that in that period management of this condition was not available.

Concepts of kidney and formation of urine

There are no direct references in Ayurvedic classics regarding the role of kidneys in the process of formation of urine. The word pakwashaya (colon) is mentioned as the site of formation of urine. It should not be considered in anatomical or physiological aspects of conventional medicine. Ayurvedic texts emphasize more on therapeutic relevance of the organs. The description may not always match with modern views. This concept has a very good therapeutic utility. The drugs and therapies having action on colon (pakwashaya) are successfully used for promoting proper formation of urine from its original site (kidney).

Word vrikka is found in Rigveda but not as an organ but as a medicinal plant. According to Bhashya the word vrikka means ‘averter of diseases’. Thus, in similar manner we may understand the vrikka as organ also. [Rigveda 1/187/10]

Similarly, the word “vrukka” used for denoting kidneys indicate that it has the capacity of healing itself. This self-healing power of vrukka (kidney) shall be explored and promoted by Ayurvedic treatment.

Chronic renal failure

By definition, chronic renal failure (C.R.F.) is an irreversible deterioration in the renal function, classically develops over a period of years with a decline in glomerular filtration rate (GFR) below 60 ml/min/1.73 m2 of body surface area for more than 3 months. However, clinically, the deterioration in renal function is found to be reversible to some extent. It is certainly not a completely curable disease. When the GFR becomes <15 ml/min/1.73 m2 of body surface area, it is known as end stage renal disease (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.

Etiological factors

Congenital causes: Polycystic kidney, congenital hypoplasia 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) Intestinal diseases: Chronic pyelonephritis, vesico-ureteric reflux, tuberculosis, calcinosis, analgesic nephropathy Obstructive uropathy: Calculus, prostatic hypertrophy, pelvic tumours 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%).

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

Etiopathogenesis as per Ayurveda

The etiological factors can be understood and categorized in the following manner.

• Genetic abnormalities (bija dosha)
• Suppression of natural urges, especially those related to the action of apanavayu (type of vata dosha responsible for excretory functions).
• Injury to vital organ (marmabhighata): Especially on three major vital organs (shira, hrudaya, basti)
• Faulty dietary habits (vishamashana)
• Diseases of urinary system (mutravahasrotas) e.g. mutrakricchra, mutraghata, ashmari, arbuda, granthi, prameha (especially madhumeha)
• Auto immune factors (balabhramsha)
• Accumulation of intermediate products produced during digestion, metabolism and transformation (amasanchiti)
• Chronic debilitating illnesses (jeernajwara)
• Unknown causes (daiva)