An Ayurvedic intervention in the management of pramehajanya upadrava Vis-a-Vis Diabetic Nephropathy with Special reference to Microalbuminuria: A Pilot Study.

About Author

Correspondence Address

Shukla Viraj V. Professor Dept.Of Kayachikitsa, LKR Ayurved College Gadhinglaj
Contact No. : 9822936193, Email : rajvishukla@gmail.com

Date of Acceptance : 11 Sep 2024

Date of Publication : 27 Sep 2024

Article ID : SD-IJAY_107

How to cite this article : http://doi.org/10.55552/SDNJAY.2024.2310

Abstract

Diabetes mellitus is a multifactorial clinical syndrome affecting multiple systems and organs. Type-1 DM is an autoimmune disease characterised by antibody-mediated and cell-mediated destruction of pancreatic cells, while Type-2 DM is characterised by relative deficiency and resistance to insulin action. One of the microvascular complications of diabetes mellitus is diabetic nephropathy, also known as diabetic kidney disease (D.K.D.), leading to end-stage renal disease (ESRD) in due course of time.

In Ayurveda classical texts, although there is no direct reference in Prameha Chapter of renal complications, in 'Mutraghata Chapter' a few similar conditions are explained and hence may be co-related with nephropathies. The disease prameha happens due to derangement into Tridoshas (three humors), and especially Vata dosha dominance in etiopathogenesis leads to Madhumeha, the nearest co-relate of D.M.

In the present study, pre-diagnosed patients of Type-2 D.M. were randomly selected and screened for microalbuminuria levels, i.e., the albumin levels in urine ranging between 30-300 mg/24 hr. urine. An Ayurvedic drug 'Gokshura-BBrihatyadi Kashaya' was administered in the dose of 50 ml twice daily for 60 days. The subjective and objective parameters were assessed before treatment and after completion of 60 days, which shows a significant reduction in both types of parameters.

KEY WORDS:-  Diabetic Nephropathy, Gokshura Brihatyadi Kashay, Complications Of DM, Microalbuminuria

Introduction

Diabetic nephropathy is a microvascular complication, meaning it affects mostly the capillary level of renal vasculature, which eventually leads to glomerular basement membrane thickening, mesenchymal cell proliferation, and glomerulosclerosis [1]. The four major pathological pathways due to hyperglycemia are a) non-enzymatic glycosylation, b) polyol pathway, (c) hexose monophosphate shunt pathway, and d) protein kinase-c pathway, resulting in overproduction of superoxides leading to increased oxidative stress and glomerular damage. [2] Diabetic nephropathy is one of the leading causes of end-stage renal disease and accounts for 25%–40% of all cases of ESRD's [3].

In a cross-sectional epidemiological study in diebetics, the prevalence of microalbuminuria was found to be 39.8%, and the prevalence of macroalbuminuria was 18.8%. [4] The Egyptian renal data system (1996-2001), evaluated for the prevalence of diabetic nephropathy, showed a gradual increase from 8.9% in 1996 to 14.5%. in 2001. [5] Renal failure is the second leading cause of death in diabetics. [6]

Although angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are used for the prevention of nephropathies, these drugs are not always safe and effective. Hemodyalisis significantly impairs quality of life, and renal transplants are having their own limitations. [7]

In the present study, the earliest manifestation of diabetic nephropathy—microalbuminuria, i.e., urinary excretion of albumin, i.e., 30-300 mg/24 hr urine—is considered as a central parameter [8] and analysed for the effect of the Ayurvedic intervention 'Gokshura-Brihatyadi Kashaya' mentioned by Acharya Vagbhata in 'Ashtanga Hridayam' [9 The whole idea behind the study is to prevent the stage of overt nephropathy and thereby prevent the progress of the disease. Six patients with Type-2 DM were screened for microalbuminuria studies on the basis of inclusion-eexclusion criteria, and an aurvedic drug was administered in prespecified dosages. The subjective and objective assessment after 60 days showed encouraging results.

Discussion

In this study, 6 individuals fulfilling the criteria for diagnosis were selected. It is observed that in most subjective parameters there is more than 50% relief.

Sarvang shotha was mild grade and present in 3 patients only. Hrillas and Chhardi symptoms are reduced by 46%. Microalbuminuria levels showed a decline, showing that glomerular alterations are stable or declining.

Probable made of action-

Brihatyadi Gana drugs are stated tridosha Shamak, Pachaneeya, Hridrogaghna, and mutrakrichrahara by Acharya Sushruta and Acharya Vaghhata.

Drugs like brihati, kantakari, and patha have Katu, tikta rasa dominance with ushna Virya. These durgs are especially tridosha Shamak, Deepaneeya, and Pachaneeya, and have diuretic action.

Drugs like madhuka and gokshura are rasayana, diuretic, and detoxifiers.

With these properties, this unique combination may be helpful in reducing the hyperglycaemic effect on the glomerulus and thereby maintaining a normality to the glomerular basement membrane; it restricts the progression of glomerulosclerosis.

Conclusion

The study concludes that 'Gokshura Brihatyadi Kashaya' in the dose of 50 ml twice a day helps in restricting albumin loss in urine and thereby delaying the progression of glomerulosclerosis. Along with preserving renal functions, it pacifies other symptoms.

The present study is a pilot study on a small sample. In future multicentric studies, a larger sample size may be required to validate the nephroprotective effect of the trial drug.

References

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