Ayurveda concepts of nephrotic syndrome in pediatrics

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Introduction

Nephrotic syndrome is a pathological condition of glomeruli in the kidney that result from increased permeability of the glomerular basement membrane to plasma protein and is characterized by excessive proteinuria, hypo-albuminemia, hypercholesterolemia and edema. A nephrotic syndrome that accounts for roughly 20% of all End-Stage Kidney Disease causes (ESRD) [1,2]. Disease burden: Nephrotic syndrome is found in every age, irrespective of gender and race. However, prevalence is more in adults in comparison to children with a ratio of 26:1. Males are more prone than females with a ratio of 2:1[3]. Adults with the nephrotic syndrome had an annual incidence of three new cases per 100,000, all over the world [4]. Idiopathic nephrotic syndrome is answerable for around 12% of all causes of Chronic Renal Disease (CRD) and up to 20% of ESRD in kids [5]. One of the primary nephrotic syndrome, Focal Segmental Glomerulo Sclerosis (FSGS) has a high risk of recurrence (30-40%) after kidney transplant and is the most common recurrence disease that results in allograft loss [6]. Patients often require immune suppression to complete decrease, yet many patients also relapse later decrease or are resistant to therapy. The better regimen for “frequent relapses” and “steroid dependent” patients is, however not yet established. Therefore is a need for time to find and establish scientifically a safe regimen for this kind of disease.

Literature Review

Nephrotic syndrome causes the kidney to leak big volumes of protein into the urine. This can lead to a range of difficulties including swelling of body tissues and a greater chance of catching an infection though idiopathic or unknown; Researchers have connected specific diseases and genetic abnormalities that affect the kidneys to the condition, which is the most common cause of primary childhood nephrotic syndrome. The aetiology of following childhood nephrotic syndrome is an underlying illness of infection. A primary disease produces aberrant renal function, which may also lead to subsequent paediatric nephrotic syndrome Genetic illnesses, which are a disease that is present at birth, can also cause childhood nephrotic syndrome.

Primary childhood nephrotic syndrome

• Changed kinds of idiopathic paediatric nephrotic syndrome Include:

• Minimal change disease, which causes damage to the glomeruli that can be observed under a type of optical microscope In terms of presenting minute details, this type of microscope outperforms all others. Scientists are baffled as to what causes minimum change sickness. Minimal change disease is the most common cause of Idiopathic Childhood Nephrotic Syndrome

• Focal segmental glomerulosclerosis is a type of glomerulosclerosis that causes scarring in many parts of the kidney:

• Membranoproliferative glomerulonephritis is a series of illnesses characterised by antibody deposits that thicken and destroy the glomeruli. Antibodies are proteins produced by the immune system to fight infections.

Secondary childhood nephrotic syndrome

Diabetes, a condition in which the body is unable to use glucose, is one of the most common disorders that can cause secondary childhood nephrotic syndrome.

• IgA vasculitis is a disorder in which the body’s tiny blood vessels become damaged and leak. hepatites, aCongenital diseases and childhood nephrotic syndrome virus-induced inflammation of the liver.

• Human Immunodeficiency Virus (HIV), a virus that causes immune system dysfunction.

• Lupus is an autoimmune illness that happens when the body’s immune system assaults itself.

• Malaria, a blood-borne illness spread by mosquitos.

Congenital diseases and childhood nephrotic syndrome

Genetic nephrotic syndrome is an occasional condition that disturbs new-borns throughout the primary three months of their lives. This kind of nephrotic syndrome, also known as infantile nephrotic syndrome, is caused by a variety of factors.

Signs and symptoms

• Edema-swelling, utmost commonly in the limbs, usually in the foot or ankle, but less frequently in the arms or face

• Albuminuria-when a child’s urine contains excessive quantities of albumin, this is known as

• Hypoalbuminemia-when a kid’s blood contains a small amount of albumin

• Hyperlipidaemia-when a kid’s blood cholesterol and fat levels are higher than normal Furthermore, kids with nephrotic syndrome may experience the following symptoms:

• Blood in the urine

• Infection symptoms such as fever, tiredness, irritability, or abdominal pain

• Loss of appetite

• Diarrohea

• High blood pressure

Complications

Infection is one of the possible consequences of childhood nephrotic syndrome. Because the body loses proteins that typically fight, against infection when the kidney is destroyed, a youngster is more likely to get an infection to treat infections, and doctors will advise treatments. To avoid infection, children with childhood nephrotic syndrome should have the pneumococcal vaccine and annual influenza vaccine. Children should also receive age-appropriate vaccinations, while certain live vaccines may be delayed while a child is taking certain drugs, as determined by a health care practitioner.

Clots in the blood Thrombosis can obstruct the flow of blood and oxygen via any major artery in the body. Clots are more likely to occur when a child loses proteins through the urine. The health-care provider will look after you.

Diagnosis

A medical and family history, as well as a physical exam, is used to identify childhood nephrotic syndrome.

• Urine test

• A blood examination

• Kidney ultrasonography

• A biopsy of the kidney

Discussion

Treatment

The type of childhood nephrotic syndrome will determine how it is treated by health care providers:

• Medication for primary childhood nephrotic syndrome.

• Congenital nephrotic syndrome: drugs, surgery to remove one or both kidneys, and transplantation.

• Secondary childhood nephrotic syndrome: treat the underlying sickness or disease

Idiopathic children’s nephrotic syndrome is treated with a variety of drugs that regulate the immune system, eliminate excess fluid, and lower blood pressure.

Corticosteroids are a class of drugs that suppress the immune system’s activity, reduce albumin loss in the urine, and reduce edoema. Prednisone or a similar corticosteroid is widely used to treat idiopathic childhood nephrotic syndrome. With daily corticosteroids for 6 weeks and subsequently a slightly lesser dose every other day for 6 weeks, almost 90% of children achieve remission. A phase of remission occurs when the youngster is symptom-free. After the first medication, many children relapse, and doctors treat them with a shorter course of corticosteroids until the condition goes into remission. Multiple relapses are common in children, although they usually recover without long-term renal impairment. When a child relapses frequently or does not respond to treatment.

A diuretic, a medicine that aids the kidneys in removing excess fluid from the blood, may be prescribed by a doctor. Blood pressure can often be reduced by removing excess fluid.

High blood pressure can develop in kids with paediatric nephrotic syndrome, and they may need to take supplementary drugs to control it. Angiotensinconverting enzyme inhibitors and angiotensin receptor blockers, two categories of blood pressure drugs, have the added benefit of delaying the course of renal disease. Many children with nephrotic syndrome require two or more drugs to manage their blood pressure. Secondary Nephrotic Syndrome in Children Secondary childhood nephrotic syndrome is treated by treating the underlying cause of the first sickness. A health care provider might, for example, treat children by

• changing or stopping drugs that are known to induce secondary childhood nephrotic syndrome

• providing antibiotics for an infection

• adjusting medicine to treat lupus, HIV, or diabetes

While addressing the underlying cause, the child’s kidney function will be improved or restored using the same medications that are used to treat primary childhood nephrotic syndrome. Children’s caregivers should ensure that they take all prescribed drugs and adhere to their health care provider’s treatment plan.

Congenital Nephrotic Syndrome (CNS) is a condition in which the kidneys are Researchers have discovered that drugs are ineffective in treating congenital nephrotic syndrome and that by the age of two or three years old, the majority of children would require a kidney transplant. A kidney transplant is an operation that replaces a healthy kidney with one from another person.

• Growing hormones to promote growth and help bones mature.

• Amputation of one or both kidneys to reduce the loss of albumin in the urine.

• Dialysis to artificially filter wastes from the blood if the kidneys fail.

When the reason is idiopathic or congenital, researchers have yet to discover a technique to prevent childhood nephrotic syndrome. Eating, Nutrition, and Diet Children with nephrotic syndrome may need to make dietary changes such as

• Minimising the amount of sodium they consume each day (typically from salt); and

• Reducing the number of liquids they consume each day.

• Consuming a low-saturated-fat, low-cholesterol diet to support minor cholesterol levels before making any modifications to a child’s diet, parents or caregivers should consult with the child’s health care practitioner.

The Ayurvedic classical text texts do not address nephrotic syndrome by term. Albuminuria with hyperlipidemia and oedema may be classified as prameha (a disease of urinary system with altered composition, frequency and quantity of urine). Urine with albuminuria is concentrated, viscid, or dense. These characteristics are linked to sandrameha, a prameha subtype. The kapha vata dominant tridosha, as well as rasa, mutra, udaka, and ojas, are vitiated in this ailment, according to Ayurveda. Ayurveda’s essential concepts of causation and therapy can be applied to any ailment, even if it isn’t addressed in an ancient literature. Nephrotic syndrome is defined as an increase in kapha dosha, as well as vitiation of rasadhatu, ojas, Mutra, and udaka, involving mutravaha and udakavaha srotas. Ayurveda is a medical system that employs a variety of treatment methods. The synergistic effects of combining diverse therapy aspects are beneficial to the outcome. Nephrotic syndrome is caused by the blocking of minute bodily channels called strotas in the kidney, according to Ayurveda. Mutravaha Strotas are bodily channels that convey urine and are responsible for the passage of liquid into and out of the kidney. If the incoming strotas are blocked, the kidneys are deprived of fluids, resulting in shrinkage, and if the outgoing strotas are obstructed, swelling occurs.

Punarnava-Specific action on the heart increases the output of blood from the heart. It also increases the circulation of blood to the kidney thus reviving the kidney from many diseases like renal failure, nephrotic syndrome and GFR and others.

Gokshuru-It is the best genitu urinary tonic and giving strength to the kidney, urinary bladder, ureter and penis by increases the blood circulation.

Raktchandan-Diuretic and Anti-infective also act as urine alkalizer.

Palaash-It acts as urine alkalizer.

Gokshuradi Guggul-It is the combination of various herbs for diseased kidneys and they improve the renal function at all levels.

Conclusion

Ayurvedic treatment for Nephrotic syndrome has specific herbs which directly affect the kidney cell to improve their function stop the Auto-immune and antiinflammatory pathology and regenerate the new normal cell. Despite the fact that modern medicine has advanced many treatment hypotheses, effective management of nephrotic syndrome, it is still rewarded with a higher recurrence rate. Whereas Ayurveda works best in many disease conditions where conventional medicine falls short.

References

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