Mutrashmari(renal calculi) and the risk for ckd

1. MUTRASHMARI AND THE RISK FOR CKD
PRESENTER
Dr.KAMALAKAR
FINAL YR PG SCHOLAR
DEPT OF SAMHITAAND SIDDHANTA
SDMCAH HASSAN

2. WHY THIS TOPIC WAS CHOOSEN ???

3. CHRONIC KIDNEY DISEASE IN KIDNEY STONE FORMERS
 Stone formers had a 51% to 68% increased risk for CKD
 25% to 44% increased risk for CKD by elevated serum
creatinine levels.
 The increased risk for CKD with kidney stones was not
explained by several other risk factors for CKD, such as
diabetes, hypertension, and obesity, that are common in stone
formers
Clin J Am Soc Nephrol 6: 2069–2075, 2011. doi: 10.2215/CJN.10651110

4. 1.Vaataja - Ureteric stone (ureterolithiasis),
2.Pittaja - Vesicle stone (cystolithiasis),
3.Kaphaja -Kidney stone (nephrolithiasis),
4.Sukraja - Urethral stone(spermolith)
Ashmari is a grave disease so that it is included in
Ashtamahagada. It is not easily curable.
The 4 types of Ashmari indicate 4 locations of Mutravaha Srotas
where Ashmari is stagnated or lodged
MUTRASHMARI

5. Stone present in the Kidney may not have severe pain, however
dull, constant ache fixed to renal angle.(Kaphaja)
But same stone start descending from Kidney to ureter due to its
narrow passage, stone is arrested in ureter and sudden severe
colicky pain occurs in abdomen, which is radiating from loin to
groin.(Vataja)
When the same stone reaches U.B - burning type of pain in
supra- pubic region.(Pittaja)
P
K
V

6. Ureter
Ureter has 3 constrictions:
1.Uretero pelvic junction
2.When it crosses external iliac vessel
3.Vesico-ureteric junction

7.  Formerly called Chronic Renal Failure(CRF) or Chronic Renal
Insufficiency(CRI)
 End stage renal disease(ESRD) due to gradual loss of renal
function or sudden onset of rapidly progressive renal diseases
 May develop on top of Acute Renal Failure(ARF)
CKD

8. RESEARCH UPDATES

9. KIDNEY STONES AND THE RISK FOR CHRONIC
KIDNEY DISEASE
Conclusion:
 Kidney stones are a risk factor for CKD
 Kidney stones were predictive of developing CKD whether judged
by a clinical diagnosis, elevated SCr, or reduced eGFR.
Clin J Am Soc Nephrol 4: 804–811, 2009. doi: 10.2215/CJN.05811108

10. EFFECT OF RENAL INSUFFICIENCY ON STONE
RECURRENCE IN PATIENTS WITH UROLITHIASIS
Conclusion:
In this study, the estimated GFR was positively correlated with
urinary calcium, uric acid, and citrate excretion in patients with
urolithiasis and observed the effect of renal insufficiency on stone
recurrence in patients with urolithiasis.
http://dx.doi.org/10.3346/jkms.2014.29.8.1132•J Korean Med Sci 2014; 29: 1132-37

11. KIDNEY STONES AND KIDNEY FUNCTION LOSS:
A COHORT STUDY
Conclusion:
Graded association between episodes of kidney stones and the risk
of adverse renal outcomes, including ESRD.
BMJ 2012;345:e5287 doi: 10.1136/bmj.e5287 (Published 30 August 2012)

12. UROLITHIASIS AND THE RISK OF ESRD
Conclusion:
Symptomatic stone formers are at increased risk for ESRD
independent of several cardiovascular risk factors and CKD.
Other urological disease is relatively common among stone
formers who develop ESRD.
Clin J Am Soc Nephrol 7: 1409–1415, 2012. doi: 10.2215/CJN.03210312

13. KIDNEY STONE – KIDNEY DAMAGE

14. 1 2
An untreated obstructing stone
Persistent severe blockage
Atrophy in a kidney
resulting in a dilated,
thinned out kidney with
minimal function.
Infection related
stones(“staghorn”)
Chronic urinary tract infections
Damage slowly through
inflammation and
scarring of the kidney tissue.

15. PROBABLE MECHANISMS IN STONE FORMERS
LEADING TO CKD

16. Renal obstruction
Loss of functional Nephrons
Remaining functional nephrons
may hypertrophy and hyper-
filter
Long term, these “overworked”
nephrons may fail,
CKD
Renal obstruction
Renal parenchymal tissue
changes
Hydro- nephrosis
Untreated for longer duration
Decrease of eGFR
CKD

17. MUTRASHMARI
MUTRAKRICHRA(ASHMARIJA)
MUTRAGHATA(MUTROTSANGA)
VRIKKASOTHA
CKD

18. UPADRAVA
उष्णवात Burning sensation in basti, medra, guda with passing
of yellow or red coloured urine the symptoms of ushnavata are
similar to that of caliculi with cystitis
कार्श्य़ Kidney stone may give rise to wasting of muscle
पाांडुता Kidney stone may leads to anaemia
M.NI.32/15-16

19. ASADHYA LAKSHANA
प्रशून नाभि व्रुषण Swelling in scrotum and umbilical region
बद्ध मूत्र Obstruction in the channel of urinary system
ARISHTA LAKSHANA
Swelling in the scrotum, obstruction of urine due to renal stone
and severe pain are considered as arishta lakshana of ashmari
M.NI.32/17
V.SH.5/84

20. Signs Symptoms Mechanism
Generalized
oedema
Swelling Water retention due to a loss of GFR
leading to sodium and fluid
retention.
Anaemia
पाांडुता
Fatigue,
reduced
exercise
capacity,
and pallor
Erythropoietin (EPO), the major
erythropoiesis stimulator, is released
from the kidneys; with renal failure,
there is loss of EPO release.
Weight loss
कार्श्य़
Loss of lean
body mass
Protein-energy malnutrition due to
metabolic acidosis. Loss of kidney
function results in impaired H+
secretion from the body.

21. CONCLUSION
• Several studies have been undertaken to prove that stone
formers are at increased risk for CKD and ESRD, but still
further research is the need of the hour
• Upadravas and Asadhya Lakshanas of Ashmari are similar to
CKD
• Kidney stones can be a predicting tool for forthcoming CKD
which may be confirmed with the help of clinical diagnosis,
elevated S.Cr, or reduced GFR

22. THANK YOU