Chronic Kidney Diseases – An Ayurvedic Perspective

Systemic lupus erythemotosus (SLE), commonly known as lupus is a disease characterized by chronic inflammation. Lupus causes the immune system to attack different systems of the human-body (integument, heart, lungs, joints, nervous system, blood vessels and kidneys). Systemic lupus erythemotosus or lupus is known as systemic as it can strike the whole body.

Systemic lupus erythemotosus like other autoimmune diseases prevents the functioning of the antibodies in a smooth manner. With lupus around, the antibodies aren’t in a position differentiating between the body’s own healthy cells and tissue and harmful foreign substances. As a consequence, the immune system targets or attacks its own body organs, causing varying degrees of inflammation and tissue damage.

Cause

Systemic lupus erythemotosus in severe form can target multiple organs, including the kidneys, which are the most commonly involved. Till to date, the exact cause of systemic lupus erythemotosus is not known. However, there is linkage between systemic lupus erythemotosus and heredity plus environmental factors. The disease primarily targets women in their childbearing years. Systemic lupus erythemotosus also occurs more often in small age group.

Signs and symptoms

  • Arthritis
  • Facial “butterfly” rash
  • Fatigue
  • Joint aches
  • Loss of appetite
  • Low-grade fever
  • Raynaud’s phenomenon (poor circulation in the fingers and toes with cold exposure)
  • Ulcers of the mouth and nose
  • Unusual sensitivity to sunlight

Systemic lupus erythemotosus and kidney

The kidneys are especially vulnerable in patients diagnosed with people with systemic lupus erythemotosus. Systemic lupus erythemotosus results in varying degrees of inflammation leading to lupus nephritis and even renal failure.

Lupus nephritis is a term reserved for kidney disease that occurs in patients diagnosed with systemic lupus erythemotosus. In the disease process, damage to the tiny filters in the kidneys results in a loss of renal function. The consequence is fluid retention, weight-gain and swelling (oedema). Other than swelling, there are very few signs or symptoms.

 Some facts about Lupus nephritis

  • Lupus nephritis doesn’t produce pain in the abdomen or back, or burning during urination.
  • Not all kidney problems in lupus patients are caused by lupus nephritis.
  • Urinary tract infections (UTI) occur frequently in patients of systemic lupus erythemotosus and antibiotic therapy is required.
  • Medicines used for treating systemic lupus erythemotosus may result in signs of renal disease. This may be confused with lupus nephritis. As an instance, aspirin, or painkillers (ibuprofen and diclofenac sodium), are commonly consumed by patients of systemic lupus erythemotosus, resulting in loss of renal function and fluid retention. However, the listed problems are reversed the medicines are discontinued.

Signs and symptoms of Lupus nephritis

  • Fever with no known cause
  • Joint pain or swelling
  • Muscle pain
  • Red rashes, often on the face, (butterfly rashes).

Diagnosis

  • Urinalysis: One may detect protienuria or hematuria
  • Blood analysis: High levels of serum creatinine are presented
  • Biopsy may be suggested.

Complications of lupus nephritis

  • Kidney failure.

Allopathic treatment

  • Lupus nephritis is treated with a class of drugs known as immunosuppressants. A corticosteroid, prednisone is prescribed to reduce signs of nephritis. An immunosuppressant (cyclophosphamide) is typically used as concomitant therapy with prednisone.
  • Hydroxychloroquine is another popular drug for treating patients with lupus nephritis.
  • Patients with lupus nephritis that is causing hypertension may require drugs to lower the blood pressure and can also significantly slow down the progression of the kidney disease.
  • Despite appropriate treatment, some patients with lupus nephritis will develop kidney disease that could lead to renal failure. The condition can be treated with dialysisor a kidney transplant.

Ayurvedic treatment

  • Gokshuradi guggul is the drug of choice in treating kidney diseases. One tablet is given with six teaspoonfuls (30 ml) of Gokshura-quatha, twice a day.
  • Chandraprabha-vati, two tablets three times a day, is helpful in reducing burning sensation. Once relief is there, one tablet twice a day should be consumed for seven more days to prevent recurrence.
  • Chandrakala rasa is the drug of choice for treating haematuria. One tablet, thrice a day is given in severe cases. In mild haematuria, one tablet twice a day is recommended. Prolonged use should be avoided.
  • One teaspoonful of Ashwagandha churana, thrice a day is good for reducing anxiety and producing sleep.
  • Punarnava mandura is the drug of choice in treating inflammation. Two tablets three times a day are recommended with buttermilk.

Diet

  • Diet is very significant as the patients of lupus nephritis may need to restrict proteins, potassium and sodium.
  • Maintaining a balanced diet is critically important.
  • If diet modifications are vital, the doctor will instruct the patient know and refer to a dietician for maintaining optimal nutrition.
  • In case of peritoneal dialysis diet,
  1. Eat more protein as patients on peritoneal dialysis are at risk of developing infection.
  2. Keep normal or low potassium levels.
  3. Consumption of phosphorus requires limitation.
  4. Sodium and fluid intake should be within the goals.
  • In case of peritoneal dialysis diet,
  1. Higher amount of high-quality protein
  2. Foods containing high amounts of sodium are restricted.
  3. Fruits, dairy products, and vegetables containing high amount of potassium should be restricted from the diet.
  4. Consumption of phosphorus requires limitation.
  5. Gelatin, ice, sherbet, watermelon, sauces and gravies should be limited keeping in mind fluid accumulation.

Lifestyle

  • Lifestyle changes should be given importance, like staying out of the sun, using sun block and removing the stress.
  • Getting enough sleep,
  • Do regular exercise in order to prevent muscle weakness and fatigue.
  • Support groups and counselling can act as stress busters.
  • Avoid smoking and drinking alcohol.
  • Regular visits to the physician are of utmost importance.

References

Ortega LM, Schultz DR, Lenz O, Pardo V, Contreras GN. Lupus nephritis: pathologic features, epidemiology and a guide to therapeutic decisions. Lupus. 2010;19:557–574.

Weening JJ, D’Agati VD, Schwartz MM et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004; 15:241–50.

Henderson L, Masson P, Craig JC, Flanc RS, Roberts MA, Strippoli GF, Webster AC. Treatment for lupus nephritis. Cochrane Database 2012; Syst Rev 12: CD002922.

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