A male patient of age 62 yrs (shopkeeper) suffering frm hypertensive nephropathy. his detailed h/o is as follows..

on 9.01.2010 he suffered frm severe headache wth nausea whch ws relieved by vomiting.. he wnt 2 dr.took phexin bd n cap evion od for 2 days (dr. didnt monitor his b.p) lab investigations on 9.01.2010 hb = 12.3 TLC=13,400 DLC-- N 81 L15 M2 E2, RBS=117.3 mg% urine r/e 2-4 pus cells.

on14.01.2010..He went 2 civil hosp. his b.p. ws 240/136 mm hg n diagnosed as malignant hypertension.

on 21.01.2010 serum uricacid = 7.8mg/dl, urea = 71mg/dl, creatinine=6 mg/dl..lipid profile ---total cholesterol=155, triglycerides=156, HDL=42,LDL=82,VLDL=31,TOTAL LIPIDS=580..on d very next day uric acid=9.3,urea=161.2, creatinine=6.16.

USG report ----right kidney =5.8cm, left kidney= 7.8 cm ,corticomedullary differntiation lost, a tiny calculus of 3mm in left kidney. bilateral small kidneys wth parenchymal disease, cystitis and prostomegaly grade1..

on 11.02.2010 uric acid 4.4, urea=101, creatinine=6.4

on 3.03.2010 urea= 134,  creatinine=5.7 

on 10.03.10 serum electrolytes - Na=142.5, K = 4.4, Cl = 114.3

nw he s tkng * MINIPRIL XL 5 at bedtime(ace inhibitor)

* LASIX 2 stat     *PHOSTAT 1tds (calcium acetate fr hyperphosphataemia)

* LIVOGYN 1O.D

coz of pedal odema adv.restricted fluid intake n is complaining of generalised pruritis..

He is advised to hv renal transplant...as right kidney is nt working at all..( bt he cnt afford)

today  he came 2 me wth b.p 170/80 mm hg,, he s nt diabetic n no difficulty in voiding urine n his appetite s good n general built is thin.. wat we shud give dis patient as adjuvant therapy  2 improve his renal profile and wt shud be the DIET PLAN in dis case..???

Reply 10-3-10

This is a case of

hypertensive nephropathy,

malignant hypertension,

Renal calculus,

bilateral small kidneys wth parenchymal disease,

cystitis and prostomegaly grade1  ,  

right kidney is nt working.

When this patient came to you he seems to be improved.

I would like to suggest as under.

1.Start Jaimangal ras 1 pill twicw a day wwith fresh ginger juice and honey. For 10 days only.[Baidnaeh]

2.Shuddha Shilajeet liquid 5 Grms twice a day with non fat milk ( If possible with cow milk).

3. Trunkantmani pisti ( That is Kaheraba Pisti) [Baidnath] 250 Mg. twice a day with pure honey.

4. Agatsya Rasayan [Kottakal] 1 tea spoon full twicw a day with warm water.

5. Akla 5 syp {Charak} 2 tea spoon full with glash of water [dilute sp in glass of water twice a day.

Dietetics :

1.    Light diet . preferably soup of green gram for 15 days. Along with perched rice may be given.

2.    Avoid wheat and Flour preparation, Curd, sour things, sweets, cold drinks ice-cream,

3.    Ad. Him to consume less salt and sugar.

4.    Ad. Him to consume less quantity of vegetable but, after cutting vegetables keeping 1 hour in water then washed twice and then boiled to take .

He might have the h/o of frequent Jwar [fever] and subsiding by self medication.

Vaidya Dhirendra Joshi

Dear Dr,

After going through the case presentation, I suggest you to start Gokshuradi Guggulu at Apana Kaala with Punarnavadi Kashyam as Anupana. We had carried out study on Gokshuradi Guggulu on Hypertension and has shown good result. I also incorporate above medicine in treating HTN cases in my pvt practice which has proved its efficacy in controlling the HTN. Apart from above reason Gokshura is Ashmaree Bhedana and Mootrala Dravya which helps to regenerate Nephrons and also reduce the pedal edema and Kandu. You need to observe the tvacha carefully in this patient. Earlier we had treated male patient who had CRF with Vasthi karma. Also you can closely assess the action of above drugs and finally ascertain how these drugs are working. I would like to share my experiences with big list of medicines. At the end we do not know which medicine and how they worked on the individual and his disease. Hence use minimum drugs and make efforts to treat the patient. 

Regards

Dr.Kiran

first do shiravedh to pull out toxin creatinine and to reduce blood pressure. Good result cbtained by Trunpanchmool qwath and maheswarvati.

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Dr. Smiley,

Please donot mistake me for replying in a negative tone. This 62 year old gentleman is a clear cut case for renal transplantation. In case if he could not afford the cost of transplantation or is unwilling to undergo due to varied other reasons, then please tell him the prognosis (which is not encouraging over here) and then start with the Ayur treatment.

The above statement was said based on the consideration of bilateral shrinking of renal mass (small kidneys as stated by you). Advice him to be under the 3 modern medications adviced by nephrologist. Advice our medicne side by side nad not as a main stream one, especially in this case.

I am surprised considering the level of increased urea depicting the uremia, that he has not developed any symptoms like delirium or fever of unknown aetiology etc.,

Generalised pruritis in this case is becoz of uremia.

By this time, if I am not wrong, he would have even developed mild Ascitic changes, please correlate clinically.

There is no other go, than, that he should undergo transplanation or atleast other wise the P.D (Peritoneal Dialysis) or Haemo dialysis to reduce the increased BUN levels and cleanse the haemopoitic system.

Please donot advice him to to stop lasix and the other 2 allo' Rx.

I would suggest Punarnavadi mandoor for it's diuretic and hepato protective functions. Chandraprabha vati or gokshuradi guggulu or Punarnavadi guggulu once again for thier diuretic properties. All that any body can do help in this particular case is just give symptomatic relief and no for sure a hi-fi cure.

Prostatitis or prostatomegaly, cystitis etc., will get controlled with the above medicines in a slower rate.

It is very disappointing to reply in a negative tone for this is a clear cut case of asadhyaja vrkka roga. I PRAY THE ALMIGHTY TO BLESS THE PATIENT, RECOVER FROM THE CURRENT STATUS OF HEALTH.