Nephrotic Syndrome- Ayurvedic Treatment, Diet, Exercises, Research Papers, Yoga & Pranayama

Introduction

Nephrotic syndrome is primarily a paediatric disease. It affects children fifteen times more than adults. It’s a group of symptoms that can appear if the kidneys aren’t working right.

Normally, small blood vessels in the kidneys function as a filter, clearing out waste and extra water from blood. That waste and water ends up in the bladder and leaves the body in the form of urine. These vessels are part of “glomeruli,” the filtering part of kidney.

When they’re damaged, too much protein slips through the filters into the urine. The result is nephrotic syndrome.

Signs & symptoms

There are four main signs or symptoms make up nephrotic syndrome. They are:

  1. Too much protein in urine, or proteinuria.
  2. High fat and cholesterol levels in the blood. The medical term for it is “hyperlipidaemia.”
  1. Swelling of legs, feet and ankles, and sometimes hands and face. This is called oedema.
  2. Low levels of albumin in the blood or hypoalbuminemia.

Causes

It can be due to either a primary cause, that affects only kidneys or a secondary cause that is an issue with another part of the body that also affects the kidneys.

Some of the conditions that can damage your glomeruli include:

Minimal change disease, which is the main cause of nephrotic syndrome in children. Kidney tissue from people with this disease looks relatively normal under a microscope but stops the kidneys from working properly. Some potential causes of the disease include infections from viruses, allergic reactions, taking certain medications, and using non-steroidal anti-inflammatory drugs (NSAIDs)

Focal segmental glomerulosclerosis, or FSGS, is a disease that scars the glomeruli. It’s the most common primary cause of nephrotic syndrome in adults. FSGS can be caused by a virus, such as HIV, or medications.

Membranous nephropathy, in which the membranes of the glomeruli thicken. Causes may include cancer, malaria, hepatitis B, and lupus.

Diabetes, which is the most common secondary cause of nephrotic syndrome in adults. It can cause kidney damage, known as diabetic nephropathy

Lupus (systemic lupus erythematosus), a chronic disease of the immune system, can seriously damage the kidneys.

Amyloidosis, a build-up of substances called amyloid proteins in the blood, can damage the kidneys

Taking nonsteroidal anti-inflammatory drugs (NSAIDs) regularly.

Pathophysiology

The formation of oedema is prevented in healthy patients by a balance between forces favouring oedema (capillary hydrostatic pressure [Pcap]) and those opposing it (capillary oncotic pressure [πcap]). The slight tendency toward fluid accumulation is counterbalanced by the lymphatics in the interstitial space. In nephrotic patients, hypoalbuminemia results when the liver fails to synthesize the loss of albumin through urine. The hypoalbuminemia results lead to low capillary oncotic pressure (πcap), which leads to relatively unopposed capillary hydrostatic pressure (Pcap) and subsequent oedema formation. Relative intravascular volume reduction is due to oedema formation. The intravascular volume which triggers neurohumoral compensatory mechanisms including sympathetic nervous system (SNS), arginine vasopressin (AVP), and the renin angiotensin aldosterone system (RAAS), with the net causes being sodium and water retention by the kidney. In the background of nephrotic syndrome, aortic arch, left ventricle, mechanoreceptors in the carotid sinus, and afferent arterioles in the glomeruli detect reduced pressure distension. This produce (1) SNS outflow increases from the central nervous system, (2) RAAS activation, and (3) non-osmotic release of AVP from the hypothalamus. These three changes lead to peripheral vasoconstriction (increased SNS and angiotensin II), sodium retention (angiotensin II, aldosterone, and increased SNS), and water retention.As a result of these mechanisms, it is greatly accepted that patients with nephrotic syndrome have an excess of total body water and sodium. 

Diagnosis

A urine test, to measure how much protein the kidneys are filtering out.

A complete kidney function blood & urine examination

Ultrasound scan

Renal biopsy taking a tissue sample of kidney for study under a microscope.

Treatments

Treatment depends upon the cause of the disease. Aim of the treatment is to control blood pressure & cholesterol and to relieve oedema.

Medicines include:

  • Blood-pressure medications called ACE inhibitors and ARBs
  • Diuretics, to reduce swelling
  • Cholesterol-lowering drugs
  • Anticoagulants, to make blood clots less likely
  • Corticosteroids

Cut down salt and fatty items in diet

Dialysis in severe conditions

Prognosis

The prognosis for nephrotic syndrome under treatment is generally good although this depends on the underlying cause, the age of the person and their response to treatment. It is usually good in children, because minimal change disease responds very well to steroids and does not cause chronic kidney failure.

Complications

Blood clots inside the body or circulatory system

High cholesterol and triglycerides

High blood pressure

Kidney failure

Pneumonia

Meningitis

Disease & Ayurveda

        There is no direct correlation or description in Ayurveda for nephrotic syndrome. But while explaining disorders of the urinary system where urine output is less than normal, Kaphaja mootrakrucchra can be compared with nephrotic syndrome to an extent by their clinical features.

Nidana

        Causative factors for the vitiation of Kapha

            Acharya Kashyapa explains the nidaana & samprapti for children seprarately. Due to carrying the child over waist or shoulders for long time, aggravated doshas settle over vasti, vitiating the same to produce the disease.

Purvaaroopa

        Not mentioned separately

Samprapti     

        Normally, mootravahasrotas works through continuous filtration and filling of vasti by minute and numerous tubules. This process includes Vrkka (Kidney)gavini(ureter), mootravaha dhamanis and siras & nadi (Renal vessels and nerves associated) Vasti(badder) and mootrapraseka (urethral opening). When the vitiated Kapha causes any obstruction in this system, the disease manifests.

Lakshana

Vasti-medhara gourava & sopha- Heaviness & oedema of Bladder and penis/area of urethral opening

Sapiccham mootram- Turbidity of urine

Savibandham mootram- Obstructed urination

Divisions

            No divisions

Prognosis

            Sadhyam

Chikithsa

Samana

Teekshna-ushna-katu bhojanam(pungent,hot and spicy diet)

Diet with Yava (Barley)

Ksharam (Alkaline diet and drinks)

Kaalaseyam-buttermilk

Dhatreephalarasa+ela

Madya+ela

Kantakariswarasa+honey

Sodhana

Vamanam

Swedanam

Commonly used medicines

        Bruhatyadi kashayam

            Veerataradi kashayam

            Kumaryasavam

            Gokshuradi guggulu

            Punarnavasavam

Rasasindhooram

Pravala Bhasma

Kamdudha Ras       

Brands available

AVS Kottakal

AVP Coimbatore

SNA oushadhasala

Vaidyaratnam oushadhasala

Home remedies

Low sodium intake

Omega 3 fatty acid intake

Gluten free diet

Diet

  • To be avoided

Heavy meals and difficult to digest foods – cause indigestion.

Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine

Carbonated drinks – makes the stomach more acidic and disturbed digestion

Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)

Milk and milk products – increase kapha, cause obstruction in channels and obesity

Curd – causes vidaaha and thereby many other diseases

  • To be added

Light meals and easily digestible foods

Green gram, soups.

Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc

Behaviour:

Protect yourself from hot climate.

Better to avoid exposure to excessive sunlight wind rain or dust.

Maintain a regular food and sleep schedule.

Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.

Avoid sedentary lifestyle. Be active.

Yoga

No hectic exercises or physical activities are recommended in severe cases of nephroic syndrome, especially children.

Regular stretching and cardio exercises are advised in mild cases. Also, specific yogacharya including naadisuddhi pranayama, & pavanamuktasana is recommended.

Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.

 Yoga can maintain harmony within the body and with the surrounding system.

Pavanamuktasana

Nadisudhi pranayama

All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.

Research articles

https://pubmed.ncbi.nlm.nih.gov/28914167/

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