Efficacy of Treatment in Ayurveda for the Management of Diabetic Nephropathy: A Case Study

Diabetic Nephropathy is one of the serious clinical condition that originated as a complication of the Diabetes Mellitus. It is the main culprit for end-stage renal diseases, which ultimately may lead to life-threatening conditions. A 58 years old male patient was having diabetes mellitus and hypertension for 15 years came to Mahatma Gandhi Ayurved College, Hospital and research centre, Wardha, Maharashtra (India) having bilateral pedal edema, vomiting, nausea, general weakness, frequent nocturnal micturition, hiccough from last two months. He was treated with Gokshuradi Guggulu, Chandraprabha Vati, Bhumyamalaki Churna, a freshly prepared decoction of Trunpanchmula [combination of Kush (Desmostachya bipinnata), Kash (Saccharum pontaneum), Darbha(Saccharum munja), Nal (Saccharum officinarum)and kandeshu] 50 ml daily twice a day Case Study Sharma et al.; JPRI, 33(38B): 1-7, 2021; Article no.JPRI.71125 2 after food. All other allopathic treatments for hypertension and Diabetes were continued as before, but the patient took only Ayurveda’s treatment for Nephropathy. After continuous treatment for two months, Blood Urea level was remarkably decreased from 51 mg/dl to 45 mg/dl & Serum Creatinine also reduced from 3.0 mg/dl to 1.5 mg/dl with a gross decrease in proteinuria. Both Blood sugar fasting & postprandial were also reduced from 246mg/dl & 346 mg/dl to 190mg/dl & 225mg/dl respectively. The present Case report is discussed here to show the efficacy of Ayurveda in diabetic Nephropathy.


INTRODUCTION
Diabetic Nephropathy is the common entity in diabetes mellitus [DM] which occurred as a result of chronic loss of kidney function. It is the main etiological factors of the chronic kidney disease (CKD) and end-stage renal disease (ESRD) [1]. The current faulty and stressful lifestyle is provoking the higher incidence rate of diabetes mellitus in early adulthood. As a result of that & poor glycemic control, such patients are more prone to develop multiple complications of DM such as cardiac disorders, cerebro-vascular strokes, diabetic retinopathy, gangrene etc. Among them, diabetic nephropathy [DN] is one the commonest entity. The clinical features of this nephropathy are also observed as complications of Prameha Vyadhi which mimics with the Diabetes mellitus in the modern science. As per Ayurveda's classics, Upadravas of Prameha is bilateral pedal edema, vomiting, nausea, general weakness, and frequent nocturnal micturition, hiccough, etc. Though complications of Prameha are well mentioned in Ayurveda's texts, there is no clear description of pathology that can explain Dosha Dushya Sammurchchhana (Involvement of bio-humors and associated tissue) involved in them. But the signs and symptoms of DN match very well with the Vrukka Roga (kidney disease), as mentioned in Bhaishajyaratnavali [2].

DIAGNOSIS
In view of modern sciences, the final diagnosis of the patient was DN. According to Ayurveda, the patient clearly showed the symptoms of Prameha Upadrava, such as having Ubhaypaada Shotha (bilateral pedal edema), Chhardi (vomiting), Hrullas (nausea), Daurbalya (general weakness), Naktamutrata (frequent nocturnal micturition), Hikka (hiccough), etc. Vrukka Roga mentioned in Bhaishajyaratnavali also matches very well with the signs and symptoms of DN. So precise diagnosis established was as Prameha Upadravajanya Vrukka Roga (Kidney disease induced as a complication of DM). No edema-0 3+ Slight pitting 2mm, disappears, rapidly-1 Deep pitting 4mm, disappears in 10-15secs-2 Deeper pitting 6mm, may last > 1 min.- 3 2 Chhardi (Vomiting) Complete absence of nausea -0 4+ Regular Frequency of salivation i.e. on every day-1 Feeling of nausea and vomiting occasionally-2 Frequency of vomiting 2-3 times or more/weeks -3 Daily frequency of vomiting-4 Regular frequency of vomiting just after every meal or even without meal-5 3 Hrullas (Nausea) No nausea i.e. another sip of food would be nice-0

3+
Feeling of not eating more , yet the person can able to take ghee without force and without nausea-1 Nausea by tasting, person can able to take ghee on forcing but with feeling of nausea Nausea, vomiting on thought and sight of food and tasting, person cant able to take at all- 4 4 Daurbalya (General weakness ) No weakness-1 3+ Occasional feeling of tiredness on light activity-1 Constant feeling of tiredness on heavy activity-2 Feeling tiredness all the time-3 5 Naktamutrata (Nocturia) No urination times at Night -0 3+ One -two times/Night -1 Three -four times/Night -2 Five -six times/Night -3 6 Hikka (Hiccough) No Hiccough at all-0 2+ Frequency of Hiccough occasionally -1 Frequency of Hiccough on every day but not inducing disturbance to person -2 Frequency of Hiccough but creating little disturbance to patient -3 Frequency of Hiccough but creating much disturbance to patient -4

TREATMENT
The patient was treated with palliative treatment in Ayurveda that is mentioned in table no.2. All other allopathic treatments for hypertension and Diabetes were continued as before, but the patient did not take any medicine other than palliative treatment in Ayurveda for Nephropathy.

RESULT & OBSERVATIONS
During two months of the treatment period, the patient got a remarkable improvement in the renal function tests and signs and symptoms of DN, as shown in Table no. 3. The severity of the Subjective parameters such as Ubhaypada Shotha (bilateral pedal edema), Chhardi (vomiting), Hrullas (nausea), Daurbalya (general weakness ), Naktamutrata (Nocturia) & Hikka (hicough) were significantly reduced from 3+,4+,3+,3+,2+,2+ respectively after first follow up and resolved completely after second follow up i.e. after 2 months. Moreover, blood urea level was remarkably decreased from 51 mg/dl to 45 mg/dl and serum creatinine also reduced from 3.0 mg/dl to 1.5 mg/dl with a gross decrease in proteinuria after two months. Both blood sugar fasting & post-prandial were also reduced from 246mg/dl & 346 mg/dl to 190mg/dl & 225mg/dl respectively. Besides, the treatment also improved the general condition of the patient.

DISCUSSION
DN is the clinical condition characterized by progressive deterioration of kidney function preceded by excessive urinary albumin excretion, resulting from reduced glomerular filtration rate (GFR). According to Ayurveda, nephropathy can be considered Prameha Upadravajanya Vrukka Roga kidney disease induced as a complication of DM, and in such conditions, it is advised to use Mutual (diuretics), Deepan-Pachan (appetizers), Raktaprasada (blood purifier), Virechak (laxative), and Rasayana (adapt genic) medicines [3]. Though it is Tridoshaja Vyadhi, the involvement of all the three Doshas (Bio-humors) with the involvement of all the Dushyas in it, vitiated Kapha Dosha is the prime pathological factor that is responsible for blocking micro-vessels and developing microangiopathy. Vitiated Vata Dosha induces the degeneration of the various minute structures of the kidney i.e. nephrons. The basic treatment principles of Ayurveda recommend the use of Rasayana drugs to repair damaged tissue and to prevent further damage by improving the quality of tissues and hence increasing their resistance power.

CONCLUSION
As the number of diabetics is increasing worldwide, the number of patients suffering from nephropathy is also rising. It is an observation of a single case, and more studies are needed to establish treatment protocol in an Ayurveda in this condition. Significant relief can be achieved in patients of DN by applying principles of Ayurveda in general, and the diagnosis and treatment of Prameha and Vrukka Roga in particular. It is a single case study that can lay down the road ahead for further research in the future.

DISCLAIMER
Authors have declared that no competing interests exist. The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

ETHICAL APPROVAL & CONSENT
As per international standard or university standard guideline patients consent and ethical approval has been collected and preserved by the authors.