In our Ayurveda Ancient Text especially Charaka Samhita, the kidney and bladder are told as the controlling organs for carrying urine and fat. And whenever their opening(s) are affected due to any pre-renal, renal or post-renal cause, this results in the manifestation of kidney disease or Vrikka Roga which is defined as a progressive and significant reduction in the glomerular filtration rate [GFR]. Which if left untreated or not managed properly results in either ARF [acute renal failure] and/or CRF [chronic renal failure] and may prove fatal unless renal placement therapy [DIALYSIS AND/OR KIDNEY TRANSPLANT] is assumed. Kidneys are highly adjustable and variable organ, thus is able to compensate for its lost function. Therefore, the physician’s outlook/viewpoint to establish and decide the cause of kidney disease should be like an investigator who after a careful history taking, evaluation of symptoms and laboratory investigations arrives at a diagnostic approach to kidney disorder.

CAUSES :

kidney-disease-causes

PRERENAL/RENAL:

  • Suppression of natural urges.
  • Hypovolaemia  due to:
    • Dehydration, burns, hemorrhage
    • GIT fluid loss: diarrhea, vomiting.
    • Low cardiac output.
  • Use of nephrotoxic drugs.
  • Infection or disease involving the kidney causing a decreased formation of urine.

RENAL:

  • Any obstruction to the passage of ureter, bladder or urethra.

Dietary regime:

Dietary-Regimen-For-Kidney-Disease

Nutritional therapy is a very important characteristic of traditional management and controlling of renal disease, and dietary prescription will change/alter depending upon the gravity of renal disease, as such plan and purpose of such regimen should be to delay the advancement of renal failure, to conserve sufficient nutritional status and to diminish the toxicity resulting from kidney failure.

  • Restrict fluid intake:  to avoid fluid overload, this depends upon the loss of fluid through urine, skin, intestine and degree of edema, so one has to maintain an input-output chart to check for above losses plus limit intake of fluids to 400 ml per day, and to maintain fluid intake one can suck in piece of ice or hard candy [sugar free if diabetic], chew gum, rinse your mouth.

PS:- The simplest method to monitor adequate sodium intake is to follow body weight, blood pressure, serum sodium and 24 hours urine sodium.

  • Low Protein Diet:  protein intake needs to be restricted and importance should be to deliver protein of high biological value. If levels are normal and there is protein in urine then one can take plenty of dals, sprouted pulses, beans, soybean, meat, otherwise only albumin infusion, if patient not able to tolerate oral feed then either gastrointestinal or parenteral nutrition is required.

PS:- Patients on a protein-restricted diet regularly have a scarce supply of water soluble vitamins predominantly of pyridoxine and folic acid along with Vitamin D and iron supplements.

  • Restrict salt: use of salt [sodium] has to be minimal, since its imprudent use will lead to volume expansion and overhydration, thus salt is restricted usually to about 2 gm/day, along with salt-rich items like pickles, papad, fast food, sauce, salted biscuits, chutney, popcorns.

Low sodium alternatives: lemon, garlic, losalt. In nutshell eat less salt and one will feel less thirsty. [It is said that when sodium balance is controlled, thirst mechanism controls water balance adequately]

  • Restrict Potassium:
  1. Take white bread, white rice, pineapple, black grapes, apple, pepper, lettuce, cucumber, rice, cabbage, unsalted popcorn, cherries, onion, strawberries, cauliflower, radishes, celery, and pears.
  2. Avoid papaya, fruit juices, banana, coconut water, dried fruits, bran products, tomatoes, raisins, spinach, potatoes, oranges, prunes, melons, avocado, kale, brown/wild rice, pumpkin, asparagus, kiwis, cantaloupe, and honeydew.

PS:- To remove potassium from leafy vegetables – cut them into small pieces and keep in water for 2 hours, then throw the water and cook the vegetable.

  • Restrict Phosphorus: such as milk, yogurt, cheese, peanut butter, chicken, nuts, caramel, beer, ice cream, whole grain bread.
  • Use of Calcium:  sitaphal [custard apple], guava, low fat milk, broccoli, green beans, almonds.

PS:-  Although calcium is found in dairy products, but same are high in phosphorus which are to be avoided in people with kidney disease, so it is best to consult your attending Physician/dietitian about specific recommendations.

  • Carbohydrates can be taken [if not diabetic], likewise Fats are good source [olive/canola/safflower oil]

SUMMARY

Kidney Disease-Summary

One has to check with his/her tests periodically and also to remain in the constant/regular supervision of a Urologist/attending since kidney function can/may deteriorate unexpectedly, thus natural remedies are not described since later patient(s) give undue blame for home remedies for unforeseen rise in their kidney function(s). Apart from available medicine(s) and dietary restriction in Ayurveda, both do play an important part in reducing the creatinine level, a frequency of dialysis can be significantly reduced and also bringing back kidney functions to normal although peritoneal/ hemodialysis along with kidney transplantation is the final step.

Anemia is although normocytic [normal sized RBC’s] and normochromic [concentration of hemoglobin in RBC’s is within standard range], however both are in insufficient number, and also refractory or resistant to therapy, as a result correction of anemia with iron supplements is not advisable as it may lead to iron toxicity, although recombinant human erythropoietin [EPO] is the logical treatment but is not widely used because of its high cost. Because kidney is accountable for excretion of many drugs and their metabolites and in renal failure the drug interaction may be modified because of kidney dysfunction thus drugs which are normally excreted by kidneys may require dose adjustment which can be done either by:

  • Interval extension method [lengthening the time interval to the extent of delayed excretion] or by
  • Dose reduction method: [reducing the amount of each dose, leaving the interval between the doses as usual]

When conservative/alternative treatment fails to assist quality of life, renal replacement therapy is recommended. In patients with reversible ARF, dialysis is mandatory, till the renal functions gets better, while in end stage renal disease [ESRD] where serum creatinine has gone above 10mg/dl the patient can have a choice of maintenance dialysis [peritoneal and hemodialysis] or renal transplantation.

PS:- The artificial kidney [dialyzer] can only achieve some of the excretory functions but cannot equal all the excretory functions of the nephrons, and also cannot execute the synthetic functions of the kidney, thus erythropoietin and Vitamin D metabolism remain wayward despite dialysis.

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Dr Munish Sood

Dr Munish Sood

B.A.M.S, MD (Ayu) Kayachikitsa
He is an Ayurveda Specialist with working experience of almost 18 years as: Sr. Consultant cum Physician (M.D.) & Sr. R.M.O, JNANI Hospital: (An Undertaking of Tibetan Craft Community, Tashijong, Kangra), Paprola. Consulting (M.D.) & Sr. R.M.O, DTIL Hospital, Chimbalhaar, Palampur. Sr. Medical Officer, Simla Sanitarium & Hospital, Himachal Pradesh. Assistant Professor & Medical Officer, SUDAC & Hospital, Hoshiarpur.