Universal Journal of Pharmacy

28 downloads 0 Views 150KB Size Report
CKD is caused by a variety of factors but diabetes and hypertension .... Diabetes and Digestive and Kidney Diseases ... (Tribulus terrestris,L.) in drug induced.
Gohil et al. UJP 2013, 02 (04): Page 44-47

www.ujponline.com

Universal Journal of Pharmacy

Case Study ISSN 2320-303X

Take Research to New Heights

POLYHERABAL TREATMENT FOR CHRONIC KIDNEY DISEASE – A CASE STUDY Gohil Unnati V*1, Mandaliya Vipul1, Patel MV2, Gupta SN2, Patel KB3 1

Department of Pharmacology and Toxicology, Faculty of Pharmacy, Dharmsinh Desai University, Nadiad, Gujarat, India 2 Department of Kayachikitsa, J. S. Ayurved College, Nadiad, Gujarat, India 3 Department of Panchakarma, J. S. Ayurved College, Nadiad, Gujarat, India

Received 12-04-2013; Revised 17-05-2013; Accepted 25-06-2013

ABSTRACT Kidneys are the organs that have numerous biological roles. They maintain the homeostatic balance of body fluids by removing waste out of body. Kidney disease not only has a significant morbidity, but a high mortality as well. Chronic Kidney disease (CKD) or 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. CKD is considered when Glomerular Filtration Rate (GFR) falls below 30 ml/min. The conventional approach of management includes dialysis and renal transplantation, which are involving the high costs and complexity so very few patients are able to obtain adequate treatment for kidney disorders because of financial limitation. Therefore, exploration of a safe and alternative therapy is needed, which proves to be helpful in reducing the requirement of dialysis and in postponing the renal transplantation. The use of herbal drugs for the prevention and treatment of various diseases is constantly developing throughout the world. In present study a case was taken of chronic kidney disease with hypertension and chronic nephritis. He was given Niruha basti of Punarnavadi kvatha daily with oral polyherbal medicaments including Goksuradi guggulu, Rasayana churna, Tamalaki rasayan and Varunadi kvatha. This treatment approach has significantly improved condition of patient eliminating dialysis requirement. Keywords: Chronic Kidney Disease, Niruha basti, Goksuradi guggulu, Rasayana churna, Varunadi kvatha

INTRODUCTION The Kidney is a sophisticated processing system which removes waste products from the body. Renal disorders have always remained a major area of concern for physicians since a long time. It is the 9th leading cause of death in United States1. Incidences of kidney diseases leading to kidney failure are increasing day by day. Some people develop irreversible kidney disease called Chronic Renal Failure (CRF) or Chronic Kidney Disease (CKD), the most common type of kidney disease today which can most of time terminate into final stage called End Stage Renal Disease (ESRD). It is estimated that over 10% of the adult population in developed countries have some degree of CKD. CKD is a progressive and irreversible deterioration of the renal excretory function that results in implementation of renal replacement therapy in the form of dialysis or *Corresponding author: Ms. Unnati V. Gohil, V-13/ Radhesh apartments, Near Udgam school, Thaltej, Ahmedabad-380054, Gujarat, India. E-mail: [email protected]

renal transplant, which may also lead to death. CKD poses a growing problem to society as the incidence of the disease increases at an annual rate of 8%, and consumes up to 2% of the global health expenditure2. CKD is caused by a variety of factors but diabetes and hypertension are the two leading causes of CKD3-4. However, as the disease progresses, a common renal phenotype develops regardless of the aetiology, with involvement of tissue destruction, inflammation and scarring. Persistent insults to renal cells by chemical or physical action eventually activate inflammatory and fibrotic responses that not only interfere with the repair processes, but also redirect the renal tissue status through similar mechanisms of irreversible degeneration. The treatment of CKD consists of treatment of the underlying cause if possible, aggressive treatment of high blood pressure and other symptoms, liquid and diet control, cessation of smoking, use of various pharmacological drugs. But with progressive end-stage disease, restoration of kidney function can only be possible with dialysis or a kidney transplant. So, the treatment modalities are very costly and may not be affordable by all. CKD affects about 175 to 200 millions

Universal Journal of Pharmacy, 02(04), July-Aug 2013

44

Gohil et al. UJP 2013, 02 (04): Page 44-47 in India (roughly 17.4%), says the latest study by the Indian Society of Nephrology and University of Harvard. Nearly 18,000-20,000 patients (10% of new ESRD cases) in India get renal replacement therapy5. Ayurveda is ancient traditional approach of medicine in India. It can complement with western medicines. Ayurveda treatments are based on balance of body, mind and spirit. They work on principles of tridosha. The advantage of using ayurvedic medicines in CKD is that in most patients, the kidney damage can be either partly or fully reversed, the frequency of dialysis can be reduced, and the increased risk of death can be significantly reduced. Thus, ayurvedic medicines have the potential for an important therapeutic contribution in all the stages of this condition. A CASE STUDY A case detail is taken from P.D.Patel Ayurved hospital, Nadiad, Gujarat, India. The patient is male and having 54 years of age. He was diagnosed with CKD in 1997. He was presented with symptoms like oliguria, weakness, loss of appetite, oedema, dyspnoea. The patient was having history of hypertension for more than 15 years and of chronic nephritis for 3 years when first came for visit. As per ayurvedic diagnosis patient was having all the three doshas such as vata, pita and kapha increased and agni

www.ujponline.com manda. The laboratory diagnostic tests, radiosonological investigation and biopsy had confirmed the presence of chronic kidney disease. Patient was taking amlodipine for hypertension. In his ayurvedic treatment following treatment regimen was followed. 1. Gokshuradi Guggulu (compound ayurvedic preparation: Gokshura, Guggulu, Triphala, Trikatu, Musta) – 1 g, 3 times in a day after food with warm water. 2. Varunadi kvath (ingredients: Varuna tvak, Bilva moola, Apamarga, Chitrak moola, Arani, Shigru, Bruhati, Kirattikta, Karanja, Shatavari) – 40 ml 2 times in a day after food. 3. Rasayan Churna (powder of Gokshura, Amalaki, Guduchi in equal quantities) – 3 g, 3 times a day with water. 4. Bhumyamalaki (Tamalaki Rasayan)-Phyllanthus Urinaria tablet – 1 g, 2 times in a day after food with water. 5. Uricare- Shilajatu, Guggulu, Guduchi, Gokshura tablet – 1 g, 3 times in a day after food with warm water. 6. Niruha Basti (procto-colonic administration of ayurvedic medicine) with Punarnavadi kvath (decoction) – in the morning, before one hour of the lunch.

RESULTS AND DISCUSSION Sign and Symptoms: Sign And Symptoms Urine output (ml) Weakness Loss of Appetite Oedema B.P.(mmHg) Dyspnoea

Initial Value 400 ++ +++ ++ 160/100 +

After 1 Month Treatment 2400 + + 0 142/90 0

Laboratory Tests: Laboratory investigation

Initial Value

Hb (13.5 - 17.5 g/dL) S.Creatinine (0.2 - 2.2 mg/dl) Bl.Urea (7–21 mg/dL) Urine Albumin RBC in Urine (0 – 2/hpf) S. Na+(142.9 ± 1.9) S. Electrolytes S. K+ (4.2 ± 0.3†) (In mM / L) S. Cl- (104.6 ± 1.8†)

10.0 3.0 64.0 + 22-25 148.0 5.2 110.0

The ayurvedic treatment of CKD is based on three principles; treating the damage kidneys, treating the body tissues (dhatus) which make up the kidneys and treating the known cause. As mentioned earlier, CKD is

After 1 Month Treatment 11.0 2.2 44.5 Trace 8-10 132.0 4.2 98.0

specific form of renal disease. According to ayurveda, CKD 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

Universal Journal of Pharmacy, 02(04), July-Aug 2013

45

Gohil et al. UJP 2013, 02 (04): Page 44-47 microvessels and developing microangiopathy. Vata is responsible for degeneration of the structure of the kidney6. The kidneys are made up of principally the “Rakta” and “Meda” dhatus. Treating these two dhatus imbalance is also an effective way to treat the kidneys. So the herbal drugs which can modulate these dhatus are effective in kidneys disease. According to Ayurvedic principles of management of the disease, tissue damage can be prevented and repaired by Rasayana drugs because they have the capability to improve qualities of tissues and hence increase resistance of the tissues. On the other hand, blockage can be removed by Lekhana drugs having scraping effect on blocked channels6. Goksuradi guggul (combined Ayurvedic preparation) is Rasayana for Mutravaha Srotas and it has also Lekhana (scraping) effect because of Guggulu (Commiphora mukul)7-9. Varunadi kvath is also helpful to relieve the Kapha and Vata doshas10. Rasayan churna has Rasayan properties11. Niruha basti is a minor alternative of dialysis. Laboratory tests showed good improvement even within a month and serum creatinine, blood urea and albuminuria were reduced to good extent. The patient had shown great relief in all the signs and symptoms. The probable mode of action of various drugs in improvement of disease may be as follow: Rasayan drugs: Punanava, Guduchi, Gokshura, Shatavari, Shilajit used come under the list of Rasayana drugs. Especially Punarnava, Gokshura, Shilajit 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. These drugs by their virtue of Rasayana properties increase in Jatharagni, quantity and quality of sleep, sense of well being, increase in functional capacity, along with decrease in disease features up to certain extent. Modern researches have shown ample evidence that Ayurveda Rasayana drugs bear the property of antioxidant and work as free radical scavengers. Even plenty of research works through invivo and invitro studies have supported the rich anti-oxidant activity and free radical scavenging properties present in these drugs12. Gokshuradi Guggulu: It is a traditional Ayurvedic compound used to support the proper function of the genitourinary tract. It strengthens and tones the kidneys, bladder and urethra as well as the reproductive organs. The main ingredient, Gokshura, is renowned for its rejuvenating action on the kidneys and prostate. The diuretic action was attributed to the presence of high concentration of potassium salts13. Combined with Guggulu, Triphala and Trikatu, it detoxifies the urinary system and maintains

www.ujponline.com healthy urinary composition, thus reducing the risk factors that may lead to stone formation. Balancing all doshas, Gokshuradi Guggulu revitalizes kidneys weakened by vata, calms pitta inflammations, and reduces stones and swelling due to excess kapha14. Piper longam present in this formulation is containing piperine which is found to enhance the bioavailability of structurally and therapeutically diverse drugs, possibly by modulating membrane dynamics due to its easy partitioning and increase in permeability characteristics along with induction in the synthesis of proteins associated with cytoskeletal function, resulting in an increase in the small intestine absorptive surface, thus assisting efficient permeation through the epithelial barrier15-18. So it imparts bioavailability enhancing effect to the formulation. Niruha basti: The medications introduced through the anus in the rectum and colon, reach the entire body. The diseases pertaining to extremities, bowels and those arisen in the vital parts, proximal parts of body, in short all the parts of human body are affected by Vayu which can be relieved by basti. Basti denotes a Karma where in the drugs administered through the anal canal stay for certain time in the body, then produces a coating of Sneha in the body and draws the waste substances through all over body into colon and eliminates them out of the body by producing the movements in the colon, resulting into pleasant effect19. So this helps in detoxification of body. Bhumyamalaki (Tamalaki Rasayan): It is a traditional medicinal plant that contains tannins and flavonoids, both being active antioxidants20. Apart from this it showed improvement in renal conditions by supporting the regenerative capability of the renal tubules21.

CONCLUSION The patient has shown encouraging results during the management of CKD with given ayurvedic treatments. The improvement obtained may be attributed to the disease modifying effect of given ayurvedic treatment by means of its Rasayana and anti Vata– Kapha properties. These significantly correct uremia, which is the cardinal feature of CRF, and improve the renal function which is evident by reduction in serum creatinine and other blood parameters. In addition, the treatments also improve the general condition of the patient. With this treatment requirement of dialysis is eliminated in patient. Currently patient is living healthy and happy life. This treatment approach is a safe and effective alternative in case of CRF. In a difficult condition where conventional treatments are beyond the financial capacities of a common man of the country, this therapy can be hopeful and promising.

Universal Journal of Pharmacy, 02(04), July-Aug 2013

46

Gohil et al. UJP 2013, 02 (04): Page 44-47 ACKNOWLEDGEMENTS The authors are thankful to the management of J.S Ayurveda College and P.D.Patel Ayurveda Hospital, Nadiad for providing the permission and facilities for this study.

REFERENCES 1. Javaid R, Aslam M, Nizami Q, Javaid R. Role of Antioxidant Herbal Drugs in Renal Disorders: An Overview. Free Rad. Antiox., 2012; 2 Suppl 1: 1-5. 2. Jose ML, Carlos MS, Ana BR, Francisco JL. Common pathophysiological mechanisms of chronic kidney disease: Therapeutic perspectives. Pharmacology & Therapeutics., 2010; 128: 61–81. 3. De ZD, Hillege HL, de Jong PE. The kidney, a cardiovascular risk marker, and a new target for therapy. Kidney Int Suppl., 2005; 68 Suppl 98: S25−S29. 4. U.S. Renal Data System, USRDS (2005). Annual data report: Atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases [updated in 2005; cited in 2012]. Available from: http://www.usrds.org/ atlas.htm. 5. National Kidney Foundation (2002). "K/DOQI clinical practice guidelines for chronic kidney disease". [updated in 2002; cited in 2008 June 29]. Available from: http://www.kidney.org/professionals/KDOQI/g uidelines_ckd/toc.htm . 6. Patel MV, Gupta SN, Patel NG. Effects of Ayurvedic treatment on 100 patients of chronic renal failure other than diabetic nephropathy. Ayu., 2011; 32 Suppl 4: 483–486. 7. Bhatta harishankara., editor. Sarangadharacharya, Sarangdhara Samhita (gujarati bhasantara sahita), Madhyamakhanda, Adhyaya. 2nd ed. Vol. 7. Mumbai: Pandit Narayan Mulaji Sanskrit pustakalaya; 1928. p. 85–88. 8. Dvivedi Vishvanath., editor. Bhavamishra, Bhavaprakash Nighantu, Karpuradi Varga, 38 – 40. 9th ed. Varanasi: Motilal Banarasidas Prakashan; 1998. p. 107. 9. Pandit Narahari, Raj Nighantu, Candanadi Varga, 105. 1st ed. Varanasi: Krishnadas Academy; 1982.

www.ujponline.com 10. Pade Shastri Shankar Daji. Aryabhishak, Purvardh – Vanaushadhi Gunadarsh. 22nd ed. Vol. 41. Ahmedabad: Sastusahitya Mudranalay Trust; 2004. p. 102. 11. Prashanth GS, Baghel MS, Ravishankar B, Gupta SN, and Mehta MP. A clinical comparative study of the management of chronic renal failure with Punarnavadi compound. Ayu., 2010; 31 Suppl 2: 185–192. 12. Rekha PS, Kuttan G, Kuttan R. antioxidant activity of brahma rasayan. Indian journal of experimental biology.,2001; 39 Suppl 5: 447452. 13. Kumari GS, Iyer GYN. Preliminary studies on the diuretic effect of Hygrophila spinosa and Tribulus terrestris. Ind. J. med. Res., 1967; 55 Suppl 7: 714-716. 14. Singh AK, Verma D, Singh O. A Critical Review on Historical Aspect of Basti, International Journal Of Research In Ayurveda & Pharmacy. 2011; 2 Suppl 5: 1408-1409. 15. Atal CK, Zutshi U, Rao PG. Scientific evidence on the role of Ayurvedic herbals on bioavailability of drugs. J Ethnopharmacol., 1981; 4 Suppl 2: 229-232. 16. Lala LG, D’Mello PM, Naik SR. Pharmacokinetic and pharmacodynamic studies on interaction of “Trikatu” with diclofenac sodium. J Ethnopharmacol., 2004; 91 Suppl 2: 277-280. 17. Khajuria A, Thusu N, Zutshi U. Piperine modulates permeability characteristics of intestine by inducing alterations in membrane dynamics: influence on brush border membrane fluidity, ultrastructure and enzyme kinetics. Phytomed., 2002; 9 Suppl 3: 224-231. 18. Singh A, Duggal S. Piperine- review of advances on pharmacology. International journal of pharmaceutical sciences and Nanotechnology., 2009; 2(3): 615-620. 19. Kulkarni YR, Apte BK, Kulkarni PH, Patil RR. Evaluation of nephro-protective and anti nephro toxic properties of Rakta Punarnava roots (Boerhaavia diffusa, L.) Gokshur fruits (Tribulus terrestris,L.) in drug induced nephrotoxicity. International Research Journal of Pharmacy., 2012; 3 (7): 329-334. 20. Kissane JM. Anderson’s pathology. 8th edition. Toronto: Washington University School of Medicine; 1985. p.754-759. 21. Dash B. Materia Medica of Ayurveda B. New Delhi: Jain Publishers; 1991.

Source of support: Nil, Conflict of interest: None Declared

Universal Journal of Pharmacy, 02(04), July-Aug 2013

47