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VRUKKA ROGA IN KAUMARBHRITYA a road map to ayurvedic treatment.pptx

kiney diseases in children

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GUIDED BY: PRESENTED BY: DR ANIL KALE SIR DR T Y SWAMI SIR DR A P RANA SIR PREPARED BY: JR1 JR2 JR3 VRUKKA ROGA IN KAUMARBHRITYA DR PRATIBHA WATTI DR PRACHI INGALE DR ASHWINI PATIL DR NISHANT WAKODE DR ASHISH SINGH
 Ayurvedic aspect and Embryology of kidney  Congenital and Neonatal Renal Disorders  Pediatric Renal Diseases  Investigation  Case Presentation OUTLINE OF PRESENTATION
व्युत्पत्ती: “वृष सेचने |” (अमरकोष) “वृक्कादाने |”- (सुश्रुत) निरुक्ति: “वर्षति इति वृक्क |” (अमरकोष) उत्पत्ती : रक्तमेद प्रसादात् वृक्कौ। (सु. शा. ४/३१) आयुर्वेदोक्त वृक्क
कोष्ठांग: “ ………… ” पंचदश कोष्ठांगानि वृक्कौ च। (च.शा. ७/१०) “ ……………… ” कोष्ठांगानि वृक्कौ। (अ.हृ. शा. ३/१२) “ …… तेषु प्रतिबद्धानि कोष्ठांगानि .……… ” वृक्कानत्रादीनि। (अ.स. शा.) “ ……… वृक्कौ कोष्ठांगानि वदन्ति ज्ञा: ” प्रत्यंगानि निबोध मे। (का.शा.शरीरविचयशारीरध्याय:) कार्य: “वृक्कौ पुष्टिकरौ प्रौक्तो जठरस्थस्य मेदस: |” (शा. सं. ५/८४)
अवयव भेद: यानिखल्वस्य गर्भस्य मातृजानि.....वृक्कौ च बस्तिश्च। (च.शा.३/६) मासानुमासिक उत्पत्ति: “ ………… तृतीये .अंगप्रत्यंगविभागश्च सूक्ष्मो ” भवति। “चतुर्थे सर्वांगप्रत्यंगविभाग: प्रव्यक्तो ” भवति। “ सप्तमे सर्वांगप्रत्यंगविभाग: प्रव्यक्तर: ” । (सु. शा. ३/२०,२१,३७) संख्या: “शरीरे द्वौ वृक्कौ |” (सु. नि. ९/१८ डल्हण) “वृकौ मांसपिण्डव्दयम् |”
• During intrauterine life, homeostasis of fetus is dependant upon integrity of placenta - fetal nutrition, respiration, metabolism and excretion of waste product • Urine production begins from about 10th -12th wks and it contribute towards formation and adequacy of amniotic fluid • The uncorrected GFR in newborn is 25ml/min/1.73m2 in term and triple by 3month of post term • After birth, GFR rises quickly- double by weeks and reaching the adult level by one year of age Physiological consideration
• The urogenital system is derived from intermediate mesoderm and the primitive urogenital sinus • The kidney is derived from interaction between the ureteral bud and metanephric blastema • During 5th week of gestation- the ureteric bud arises from mesonephric duct, • During 20th week of gestation- forms the entire collecting system- approx. 30% nephrons are present • Nephrogenesis cont. And it is complete by 36wks of gestation Embryonic development
COMMON CONGENITAL(CAKUT) & NEONATAL RENAL DISORDERS
ANAMOLIES OF KIDNEY • STRUCTURAL Eg Agenesis, horseshoe kidney, polycystic kidney etc • FUNCTIONAL Eg Congenital Nephrotic syndrome SYNDROMES ASSOCIATED WITH NEPHROTIC SYNDROME PRUNE BELLY SYNDROME FANCONI SYNDROME POTTER SYNDROME BARTTER AND GITELMAN SYNDROMES CONGENITAL NEPHROTIC SYNDROMES
CAKUT- CONGENITAL ANAMOLIES OF KIDNEY AND URINARY TRACT 20-30% detected in prenatal period Occurs in 1:500 newborns
History (How to approach) Prenatal history- H/O maternal drug – Enalapril, Indomethacin etc. Maternal uncontrolled diabetes- genitourinary malformation Oligohydramnios- fetal oliguria, B/L lower urinary tract obstruction Polyhydramnios- defect in urinary concentration , sign of congenital Nephrotic syndrome
Family history- eg. polycystic kidney disease, renal tubular disorders and congenital Nephrotic syndrome. Natal history- eg. Perinatal asphyxia, Respiratory distress, sepsis, shock, acute tubular necrosis.
RENAL AGENESIS (solitary kidney) • Fetal kidney fail to develop • B/L Renal Agenesis: Autosomal dominant, Seen in potter sequence • U/L Renal Agenesis: More Common Higher chances of hypertension
RENAL AGENESIS-RADIOGRAPHY
ECTOPIC KIDNEY Incidence- 1 in 1000 pregnancies Kidney in abnormal position
HORSESHOE KIDNEY • Most common Renal fusion anamoly • Wilms tumors are 4 times more commonly associated with horseshoe kidneys
Duplex Kidney • Kidney having two ureters
POLYCYSTIC KIDNEY • clusters of cysts develop in kidney • C/F: UTI Increased BP Haematuria Frequent urination
INFANT WITH POLYCYSTIC KIDNEY
OBSTRUCTIVE UROPATHY • Condition in which flow of urine is blocked
HYDRONEPHROSIS Dilatation of renal pelvis and calyces as a result of obstruction
UTI IN NEWBORN • Causative organism- E coli, klebsiella, proteus etc • Newborn with UTI may have no symptoms other than fever • Sometimes – lethargic,vomiting, diarrhea • Newborn prone to develop sepsis from UTI
WILMS TUMOR (NEPHROBLASTOMA) • Most common type of renal CA • Mostly unilateral C/F: Painless, palpable abdominal mass Nausea,vomitting Fever Haematuria Increased BP
CONGENITAL NEPHROTIC SYNDROME • Autosomal Recessive Disorder • CNS is rare kidney disorder characterised by heavy proteinuria, hypoproteinemia,edema starting soon after birth • Manifest in first 3 months of life
POTTER SYNDROME/SEQUENCE • Typical physical appearance caused by pressure in utero due to oligohydramnios • Usually associated with B/L Renal ageneis
CLUBBED FEET, PULMONARY HYPOPLASIA, CRANIAL ANAMOLIES
PRUNE BELLY SYNDROME • TRIAD- Cryptorchidism(undescended testis) Abdominal wall defects Genitourinary defects Abdominal area-prune like (wrinkled)
FANCONI SYNDROME • Proximal tubule dysfunction • Leads to excess loss of Glucose,Phosphate,Amino acids,HCO3,K+
ALPORT SYNDROME • Inherited disease • Basement membrane(glomerular)disease • Diagnosis- Kidney biopsy(basketwave appearance)
BARTTER AND GITELMAN SYNDROMES Inherited tubular transport abnormalities Both are autosomal recessive diseases Bartter syndrome- renal salt wasting, hypokalemia, metabolic acidosis Gitelman syndrome- Impared Na and Cl reabsorption in DCT
VACTERL
Inborn error of metabolism 1)Amino acid disorder- eg. Tyrosinemia type 1 – liver failure, septicemia, , hypoglycemia, fanconi syndrome(renal tubulopathy). 2)Fatty acid oxidation disorder- eg. Trifunctional protein deficiency -Recurrent rhabdomyolysis,cardiomyopthy,liver diseases. 3)Organic acidemia- eg. Cobalamin disorders -encephalopathy,ketoacidosis, hyperammonemia. 4)Urea cycle disorders- eg. Citrullinemia type 1 –failure to thrive, mild hperammonemia. 5)X -linked adrenoleukodystrophy- Adrenal insufficiency.
PEDIATRIC RENAL DISORDERS & MANAGEMENT 1.NEPHROTIC SYNDROME 2.AGN 3.UTI 4.VUR 5.SHAYYAMUTRATA (ENURESIS) 7.MUTRASHMARI (NEPHROLITHIASIS & NEPHROCALCINOSIS)
NEPHROTIC SYNDROME • Massive proteinuria ( > 1 G/m2/day ) • Hypoalbuminemia ( < 2.5g/dl ) • Edema • Hyperlipidemia 2 groups – 1) MCNS (Steroid sensitive nephrotic syndrome) 2) Nephrotic syndrome with significant lesion ( Steroid resistant )
Difference ACUTE GLOMERULONEPHRITIS NEPHROTIC SYNDROME Age of onset Usually older children (4-10 Yrs) Usually younger children (2- 6 Yrs) Preceding cause (illness) Preceding URTI/Pyoderma Not associated Clinical features oligouria , oedema, heamaturia, hypertention, anasarca,oliguria (hematuria and hypertention is rare) Onset Acute Incidious Hypertension Present Not present Recurrence Not seen /rare Insidious
MANAGEMENT • Reduction of protein excretion • Prednisolone is the drug of choice • 2mg/kg/day in divided doses for 6 wks f/b 1.5 mg/kg single dose on alternate day for 6wks • Diuretics Furosemide 2mg/kg/day oral • IV infusion of 20% albumin 1g/kg over 1-4 hrs
PREVALENCE & ETIOLOGY – • Boys – 1-3 % • Girls - 3-10% • Infancy – equally common ETIOLOGY – Microbiology – E.Coli Proteus Klebsiella Enterobacter Staphylococcus saprophyticus
Risk factors for UTI • Female child • Below 6 month child • Obstructive uropathy • Severe vesicoureteric reflux • Voiding dysfunction • Constipation • Repeated catheterization
C.F Neonate – Sepsis with fever • Vomiting • Diarrhoea • Jaundice Older infant- Unexplained fever • Frequent micturation • Occasionally convulsion • Crying ,staining during voiding • Dribbling Localised – Cystitis Pyelonephritis वृक्कजायां पृष्ठकटिगॄह: । च.सु.१७/१०१
TYPE 1) Simple UTI 2) Complicated UTI TREATMENT – Complicated UTI - 10-14 days Simple UTI - 7-10 days IV ORAL CEFTRIAXONE CEFIXIME CEFOTAXIME AMOXICILLIN AMIKACIN CEPHALEXIN GENTAMYCIN OFLOXACIN
ADV. – • Encouraged to take enough fluid • Empty the bladder frequently to prevent stasis of urine COMPLICATION • Renal stones • Renal abscess • Renal scarring • Renal failure • Pyelonephritis
VESICOURETERIC REFLUX (VUR) Def – Back flow of urine from bladder to ureters & pelvis at rest or during micturation • Isolated anomaly ( pri.) • Anomalies of the urinary tract (sec.) Severity of VUR grade I – V Inv – MCU Cystography
VUR Grades I – II Grades III & IV Antibiotic prophylaxis till 1 yr old till 5 yr old continue beyond 5 yr if bowel bladder dysfunction present Breakthrough febrile UTI Breakthrough febrile UTI Restart antibiotics prophylaxis Consider surgery
शय्यामुत्रता Hetu - • Srotovarodha • vitilation of sadhaka, tarpaka kapha • pachaka pitta • manovaha srotas and atinidra Ayurveda suggest importance of pharmacological as well as psychological treatment for the disease. बिम्बीमूलरस: पानात् शय्यामूत्रं प्रशाम्यति ॥ भै.र Bramhi vati:- it decrease stress and helps to increase mental capacity. Chandraprabha vati Ashwagangha vati Shilajatu vati.
ENURESIS Def – Normal, nearly complete evacuation of bladder at wrong place & time at least twice a month after 5 yr of age . - Up to 11 yrs enuresis twice common in boys than girls Etiology - • Maturational delay • Anxiety • ADH –circadian rhythm Sec.Enuresis precipitated by – • Stressful condition • Traumatic experience • UTI 1) Primary (75%) - Child never be dry 2) Secondary (25%) - Child was dry at night for at least a few months & then enuresis occurs .
Treatment • Active T/t should not given before age of 6yrs • Adequate fluid intake • Motivational therapy • Behavioral modification • Alarm therapy • Pharmacotherapy – Imipramine – 1-2.5 mg/kg/day ( altering the arousal –sleep mechanism) Anticholinergic drugs – (reduce uninhibited bladder contraction) Oxybutynin 5mg/kg , Tolterodine 2mg/kg Desmopressin (DDAVP) -10ug orally/intranasally ( Reduce the volume of urine )
RENAL CALCULI & NEPHROCALCINOSIS NEPHROLITHIASIS - Uncommon in children • Metabolic abnormalityHypercalciuria with hypercalcemia – • Hypercalciuria with normal sr. Calcium • Miscellaneous causes Symptoms – Dysuria Hypogastric pain Hematuria & occasionly urinary infections
अश्मरी- सशर्करातिमूत्रत्वम् मुत्रकाले च वेदना । प्रततंरोदति क्षामस्तं ब्रुयादश्मरीगदम् ॥ (का.सु.वेदनाध्याय) चिकीत्सा - पाषाणभेद गोक्षुर शिलाजित वरुण उशीर NEPHROCALCINOSIS – Formation of crystalline deposits within renal parenchyma ,presenting enhanced renal echogenicity which may be cortical ,medullary or diffuse. Etiology – UTI with urease producing organism like proteus
MANAGEMENT • Stone < 5-7mm size may pass spontaneously . • ESWL may suffice for small stones • Percutaneous nephrolithotomy if ESWL contraindicated or stones too large for lithotripsy . • Open surgery for stones >3cm in size or associated with PUJ . Adv – adequate fluid low salt intake dietary calcium restriction not necessary
• The dipstick : Proteinuria , hematuria, pyuria & Specific gravity • Urine microscopy : red blood cells, white blood cells and cast. • Proteinuria and albuminuria analysis – - The most appropriate, practical and precise method for estimation of proteinuria in children is to calculate the protein-to-creatinine ratio in spot urine specimen. - Patient with positive dipstick test finding (1+ or greater ) should undergo quantitative measurement within 3 months to confirm proteinuria . Urine studies
• Blood urea and creatinine • Serum cholesterol • Serum protein – Total protein and albumin / globulin ratio • Antistreptococcal antibody titre Blood Examination
• Plain X-rays : Renal size , shape and presence of radiopaque calculi • Ultrasonography : Initial assessment of the genitourinary system • Intravenous Pyelogram : To provide detail anatomical images of renal calyces, pelvis, and ureter • Micturating cysto-urethrogram (MCUG) : - Anatomy of the lower urinary tract , vesicoureteric reflux and posterior urethral valves - We recommend MCU for infant with antenatally detected hydronephrosis who develop a UTI • CT Scan and MRI : Renal and abdominal masses, CT guided biopsy, spinal imaging for neuropathic bladder Imaging Studies
• Renal biopsy is helpful in pathological diagnosis • Chronic glomerulonephritis • IgA nephropathy • Alport syndrome , etc Renal biopsy
First attack of febrile UTI Imaging Evaluation on after the first urinary tract infection • USG • MCU Age < 1 yr. • USG Age 1-5 yr. • If USG abnormal then MCU Age > 5 yr.
• We recommend that antenatal hydronephrosis be diagnosed and its severity graded based on antero-posterior diameter (APD ) of the renal pelvis Classification of antenatal hydronephrosis based on APD :- ANTENATAL EVALUATION AND MONITORING classification Second trimester Third trimester Mild 4-6 mm 7-9 mm Mod 7-10 mm 10-15 mm Severe >10 mm >15 mm
• USG advise during 18-20 weeks of gestation-congenital anomaly scan • Amniotic fluid analysis • Creatinine level during pregnancy • In cong. anomaly scan found unilateral renal agenesis so, we advice to continue the pregnancy and if both kidneys absent then advice abortion.
• Timing of Initial Ultrasound - a) All newborn with antenatal hydronephrosis : 1 st wk of life b) In neonate with suspected post. urethral valve, oligohydramnios or severe bil. hydronephrosis : within 24-48 hr. of birth c) In all other cases : within 3-7 days or before hospital discharge Postnatal evaluation
MCU - performed in patient with unilateral or bilateral hydronephrosis with renal pelvic APD > 10 mm. a) MCU be performed early within 24-72 hrs of life , in patient suspected lower urinary tract obstruction . b) In other cases , the procedure should be done at 4-6 weeks of age. Micturating cystourethrogram
Pediatric urine collector bag
• A method of sterile urine sample collection in which mid-stream urine collection is difficult. The procedure is most applicable in children < 2 years in whom distended bladder is situated in the abdomen. • If phimosis in male children and if vaginitis in female children. Indication of suprapubic catheterization
Suprapubic catheterization
विशेषतो वृक्क रोगो रक्तस्य परिवर्तनात। नराणां जायते देहे भिषजामिति निर्णय: ॥ (भै. र. ९३/२) मुत्रपरिक्षा
“MANAGEMENT OF PAEDIATRIC NEPHROTIC SYNDROME (Sandrameha) THROUGH AN INTEGRATED APPROACH ” Case - 1
Case Presentation 1 yr. 9 Months Female patient ( wt. 8.3 kg) presenting with following C / O - 1) Peri - orbital Swelling - 1 Month 2) Pitting Pedal Oedema - 15 Days 3) Abdominal Oedema - 15 Days 4) Oedema Over labia Majora - 15 Days 5) Anasarca - Generalized Oedema - 07 days 6) Fever & Irritability - 1 day 7) Loose motions - 1 day 8) O/E = Pulse – 120 / min , B.P – 120/ 90 mm of hg. Hepatomegaly and Fluid thrill was present. Treatment taken in private hospital and Civil Hospital , but had no relief so was referred to Higher Tertiary Center because of bad prognosis. For further management parents admitted baby in G. A. Hospital Osmanabad.
15/12/2025 Pallava-2019 70 Sr. No. CBC 31/12/18 on admission 05/01/19 11/01/19 14/01/19 23/01/19 on discharge 22/11/19 0n last Follow up 1. HB 9.9 ↓ 7 ↓ 15.8 ( B.T on 7/01/19 & 9/01/19) 15.4 12.5 12.7 2. WBC 14400↑ 11400 10800 10400 10200 9.8 3. Neutrophils/ Granulocytes 50-75 31 29 41 53 66 54 4. Lymphocytes 20-50 63 ↑ 66 ↑ 52↑ 36 26 38 5. Eosinophils 0-6 04 - - - 02 02 6. Monocytes 02 04 03 06 06 04 7. Basophils 0-1 00 00 00 00 00 01 8. Platalet 1.5-4.5 lakhs 623000 ↑ 521000 ↑ 256000 234000 263000 398000
15/12/2025 Pallava-2019 71 Sr. No. Urine 01/01/2019 13/01/2019 19/01/2019 23/01/2019 On discharge 22/11/19 0n last Follow up 1. Colour Pale Yellow Pale Yellow Pale Yellow Pale Yellow Pale Yellow 2. Appearance Slightly Turbid Clear Clear Clear clear 3. Specific Gravity 1.010 1.025 1.010 1.000 1.025 4. PH 6.0 6.5 7 8 6.5 5. Proteins 500 (4+)↑ 300 (4+) ↑ 60 ↑ ( 2+) Negative Negative 6. Sugar 100 50 Absent Absent Negative 7. Ketone Bodies Trace↑ Negative Negative Negative Negative 8. Leucocytes Absent 5 Negative Negative Negative 9. RBC 8 6 Negative Negative Negative 10. Pus Cells 2-4 Nil Nil Nil 01 11. Epithelial Cells 8-10 Nil Nil Nil 02 12. Casts Granular Nil Nil Nil Nil
15/12/2025 Pallava-2019 72 Sr. No. Investigation 31/12/18 05/01/19 11/01/19 14/01/19 22/11/19 0n last Follow up 1. Serum creatinine 0.7 0.7 0.39 0.40 0.36 2. S. Albumin 2.4 ↓ 2.2 ↓ 3.9 4.25 4.1 3. Blood Urea 26 22 20 - 28 4. Serum cholesterol 294 ↑ 274 ↑ 236 ↑ 172 156 5. Serum HDL Cholesterol 52 - 36.9 43.3 38 6. Serum Triglyceride 145↓ - 185 168 152 7. Serum LDL Cholesterol 215.40↑ - 149 120.1 114 8. Serum VLDL 26.60 - 65 93.6 62 9. Cholesterol / HDL Ratio 5.65 - 3.43 - - 10. LDL / HDL Ratio 4.14 - 1.046 - -
Sr. no Investi gation 04/01/2019 12/01/2019 1 USG -Mild Hepatomegaly - Echogenic Kidneys & -Mild Ascites with dilated -sluggish bowel loops -Rt. Kidney – 6.8* 2.9 cm - Lt. Kidney – 8.1*2.8 cm - Free fluid in abdomen & pelvis - Ascites - Increased ecotexture of Kidney
Pragati - 2017 74 DIAGNOSIS • Modern diagnosis – NEPHROTIC SYNDROME. • Ayurved diagnosis - 1) SANDRA PRAMEHA- Nephrotic syndrome have features like Albuminuria, Hyperlipidemia along with Oedema so it can be correlated with Prameha. • Albuminuria makes urine concentrated , viscid or dense,hence comparable to Sandrameha ( type of kaphaj prameha). 2) SARVANGA SHOTHA- Generalised swelling due to sodium retention. 3) KAPHAJ MUTRAKRUCHA – viscous or dense urine. “ बहुलं कुरुते मूत्रमल्पबाधं सितं घनम्। बस्तिगौरवशोथौ ” च मुत्रघाते कफ़ात्मके ॥ 23-12-2017
Pragati - 2017 75 TREATMENT PLAN • In nephrotic syndrome there is immunlogical disorder , T lymphocyte disregulation , decreased antioxidant defense & renal damage. • Ayurvedic medicines having Immunomodulator , nephroprotective and anti-oxidative properties can be used. 23-12-2017
Pragati - 2017 76  ON ADMISSION TREATMENT (31/12/19) 1. Punarnavashtak kwatha 2.5 ml tds . 2. Panchavalkal kwatha 2.5 ml tds . 3. Syp Amyron 2.5 ml bd . 4. Sanjivani vati 2 tds with curd for 5 Days. 5.Tab. Prednisolone – 10 mg bd. ( 31/12/18 -17/01/2019) Tab. Methyl Prednisolone 8 mg bd. ( from18/01/19) 6. Tab. Lasix - 10 mg bd . ( 31/12/19 to 11/01/2019 bd then od upto 22/01/19 ). 7. Inj. Cefoparazone with sulbactum 500 mg BD for 7 days 8. Inj. Amikacin 75 mg BD for 7 Days. 23-12-2017
15/12/2025 Pallava-2019 77  TREATMENT MODIFICATIONS - 1. Syp Neeri 2.5 ml bd since 11/ 01/ 19. 2. Tab. Sarpagandha (reserpine) by 0.01 mg/ kg. ( 02/01/19 – 06/ 01/19.) 3. Blood transfusion on 07/01/2019 & 09/01/2019 (150 ml over 6 hr.)  Advice - 1. Salt restriction - < 1500 mg daily 2. Fluid restriction. 3. Diet protein intake of 1.5 - 2 gm / kg / day.
15/12/2025 Pallava-2019 78  ON DISCHARGE MEDICATIONS (23/01/19)- 1) Punarnavashtak kwatha 2.5 ml BD 2) Panchavalkal kwatha 2.5 ml BD. 3) Syrup Neeri 2.5 ml BD. 4) Syrup Amyron 2.5 ml BD. 5) Tab. Methyl prednisolone 8 mg bd.
Pragati - 2017 79 BT AT Comparison BEFORERX DURING RX AFTERRXA
15/12/2025 Pallava-2019 80 4 yrs ( 14.6 kg ), Female c/o – • Fever with chill–2 days • Burning Micturition- 2 days Rx – • Cefixime ( 8 mg/ kg) • Chandraprabha vati 125 mg bd • Syp Renalka 5 ml bd • Syp Paracetamol ( 15 mg /kg ) * 7 days. • If no response to cefixime - Culture report CASE 2 – Urinary Tract Infection
15/12/2025 Pallava-2019 81 CASE 3 – Urinary Bladdar STONE
15/12/2025 Pallava-2019 82 8 yrs ( 21 kg ) , Male child with C / o – • Abdominal pain – 3 days. ( Rt. Lumbar and Hypogastric ) • Fever with headache - 1 day Rx – • Gokshuradi guggul 1 bd. • Punarnavashtak kwath 10ml bd • Tb. Cystone - ½ tab bd • Syp Cefixime ( 8 mg / kg ) • Syp Paracetamol ( 15 mg / kg) * 7 days . Cont…
AFTER Rx USG ABDOMEN Name Age / Sex 14 YRS / male Date 12 / 07 / 19 Ref By Dr. A YURV EDIC HOSPITAL USG ABDOMEN PELV IS Liver Normal in size shows normal echotexture. . No e/o focal lesion. No e/o dilated IHBR. CBD and portal vein appears Normal in course and caliber . Gall bladder is distended with normal caliber walls. No e/o pericho lic co llect ion. Spleen Normal in size and shows no rmal homogenous echotexture. No e/o focal lesion. Splenic veins Normal Pancreas: - head & part of body visualized Normal in size with Normal in echotexure .No e/o peripancreat ic collection noted . Excessive bowel gas. Right Kidney Normal in size, shape and posit ion. It show normal corticomedullary differentiation with Normal in echotexture . No e/o hydronephrosis and hydroureter No E/o calculus noted. Left Kidney Normal in size, shape and position. It show normal corticomedullary differentiation with Normal in echotexture . No e/o hydronephrosis and hydroureter No E/o calculus noted. Aorta & IVC shows normal appearance . Dilated Edematous Bowell loops noted in abdomen & pelvis with gases and mid Normal peristalsis noted . No e/o free fluid in abdomen and pelvis at present Urinary bladder is distended . No E/o calculus noted Prostate appear normal in size and echotexture . IMPRESSION: Normal USG Findings. Dr . DESHMUKH ANAND. Consultant Radiologist.
15/12/2025 Pallava-2019 84 CASE 4 – DENGUE Kidney FAILURE
Rx- • 10 yrs male child , Wt – 26 kg :- • IVF 0.45 % DNS – 5 ml / kg / hr • Inj Ceftriaxone – 75 mg / kg / day • Inj Amikacin – 15 mg / kg / day • Syrup Platboost 5 ml tds • Sanshamani vati 1 tab tds • Bhunimadi Kadha 10 ml tds • Oligouria – urine output < 1 ml / kg / hr. 3 rd space fluid loss . Renal imperfusion leading to kidney failure. • Intravenous Fluid under Jugular venous pressure measurement.
वृक्क रोग निदान: प्रायेण शैत्यस्य विशेषयोगाद्वृक्कद्व्ये वृक्कगदोऽभिजायते। मसूरिकायां च विसूचिकायां किंवाऽऽमवाते चिरजे ज्वरे अपि वा॥ उपद्र्वत्वेन गृहीतजन्मा भवेदसौ चेति मतं बुधानाम। (भै. र. ९३/१) वृक्क रोग में उपद्रव: मूर्च्छा कास: फु फ्फु सभित्तौ श्वयथुस्तथा हि उरस्तोय:। सलिलोदरश्च तद्वन्मूत्रविषस्य संक्रमणमध्य्स्त्रम॥ अधिवृक्करोगमेते ननु भवन्त्युपद्रवा विशेषेण॥ (भै. र. ९३/११,१२)
15/12/2025 Pallava-2019 87 Case 5 – Congenital Hydronephrosis
Antenatal U.S.G- • Antenatal hydronephrosis with APD > 15 mm requires very close repeated follow up . • Termination of pregnancy is not recommended in foetuses with unilateral or bilateral antenatal hydronephrosis , except in presence of extrarenal life threatening abnormality.
Post Natal U.S.G :- • Look for Urine pass within first 48 hours. • Watch for abdomonal distension ,irritability , Fever , Dehydration. • Ensure Breastfeeding / Intravenous fluid. • Post natal USG – 3rd day of life . • < 10 mm renal pelvis AP diameter - Repeat USG after 4-6 weeks • > 10 mm - Diuretic Renography . • Plan surgery if bilateral hydroneprosis / functioning deteriorates.
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VRUKKA ROGA IN KAUMARBHRITYA a road map to ayurvedic treatment.pptx

  • 1.
    GUIDED BY: PRESENTEDBY: DR ANIL KALE SIR DR T Y SWAMI SIR DR A P RANA SIR PREPARED BY: JR1 JR2 JR3 VRUKKA ROGA IN KAUMARBHRITYA DR PRATIBHA WATTI DR PRACHI INGALE DR ASHWINI PATIL DR NISHANT WAKODE DR ASHISH SINGH
  • 2.
     Ayurvedic aspectand Embryology of kidney  Congenital and Neonatal Renal Disorders  Pediatric Renal Diseases  Investigation  Case Presentation OUTLINE OF PRESENTATION
  • 3.
    व्युत्पत्ती: “वृष सेचने |”(अमरकोष) “वृक्कादाने |”- (सुश्रुत) निरुक्ति: “वर्षति इति वृक्क |” (अमरकोष) उत्पत्ती : रक्तमेद प्रसादात् वृक्कौ। (सु. शा. ४/३१) आयुर्वेदोक्त वृक्क
  • 4.
    कोष्ठांग: “ ………… ” पंचदशकोष्ठांगानि वृक्कौ च। (च.शा. ७/१०) “ ……………… ” कोष्ठांगानि वृक्कौ। (अ.हृ. शा. ३/१२) “ …… तेषु प्रतिबद्धानि कोष्ठांगानि .……… ” वृक्कानत्रादीनि। (अ.स. शा.) “ ……… वृक्कौ कोष्ठांगानि वदन्ति ज्ञा: ” प्रत्यंगानि निबोध मे। (का.शा.शरीरविचयशारीरध्याय:) कार्य: “वृक्कौ पुष्टिकरौ प्रौक्तो जठरस्थस्य मेदस: |” (शा. सं. ५/८४)
  • 5.
    अवयव भेद: यानिखल्वस्य गर्भस्यमातृजानि.....वृक्कौ च बस्तिश्च। (च.शा.३/६) मासानुमासिक उत्पत्ति: “ ………… तृतीये .अंगप्रत्यंगविभागश्च सूक्ष्मो ” भवति। “चतुर्थे सर्वांगप्रत्यंगविभाग: प्रव्यक्तो ” भवति। “ सप्तमे सर्वांगप्रत्यंगविभाग: प्रव्यक्तर: ” । (सु. शा. ३/२०,२१,३७) संख्या: “शरीरे द्वौ वृक्कौ |” (सु. नि. ९/१८ डल्हण) “वृकौ मांसपिण्डव्दयम् |”
  • 6.
    • During intrauterinelife, homeostasis of fetus is dependant upon integrity of placenta - fetal nutrition, respiration, metabolism and excretion of waste product • Urine production begins from about 10th -12th wks and it contribute towards formation and adequacy of amniotic fluid • The uncorrected GFR in newborn is 25ml/min/1.73m2 in term and triple by 3month of post term • After birth, GFR rises quickly- double by weeks and reaching the adult level by one year of age Physiological consideration
  • 7.
    • The urogenitalsystem is derived from intermediate mesoderm and the primitive urogenital sinus • The kidney is derived from interaction between the ureteral bud and metanephric blastema • During 5th week of gestation- the ureteric bud arises from mesonephric duct, • During 20th week of gestation- forms the entire collecting system- approx. 30% nephrons are present • Nephrogenesis cont. And it is complete by 36wks of gestation Embryonic development
  • 10.
  • 11.
    ANAMOLIES OF KIDNEY •STRUCTURAL Eg Agenesis, horseshoe kidney, polycystic kidney etc • FUNCTIONAL Eg Congenital Nephrotic syndrome SYNDROMES ASSOCIATED WITH NEPHROTIC SYNDROME PRUNE BELLY SYNDROME FANCONI SYNDROME POTTER SYNDROME BARTTER AND GITELMAN SYNDROMES CONGENITAL NEPHROTIC SYNDROMES
  • 12.
    CAKUT- CONGENITAL ANAMOLIES OFKIDNEY AND URINARY TRACT 20-30% detected in prenatal period Occurs in 1:500 newborns
  • 15.
    History (How toapproach) Prenatal history- H/O maternal drug – Enalapril, Indomethacin etc. Maternal uncontrolled diabetes- genitourinary malformation Oligohydramnios- fetal oliguria, B/L lower urinary tract obstruction Polyhydramnios- defect in urinary concentration , sign of congenital Nephrotic syndrome
  • 16.
    Family history- eg. polycystickidney disease, renal tubular disorders and congenital Nephrotic syndrome. Natal history- eg. Perinatal asphyxia, Respiratory distress, sepsis, shock, acute tubular necrosis.
  • 17.
    RENAL AGENESIS (solitary kidney) •Fetal kidney fail to develop • B/L Renal Agenesis: Autosomal dominant, Seen in potter sequence • U/L Renal Agenesis: More Common Higher chances of hypertension
  • 18.
  • 19.
    ECTOPIC KIDNEY Incidence- 1 in1000 pregnancies Kidney in abnormal position
  • 20.
    HORSESHOE KIDNEY • Mostcommon Renal fusion anamoly • Wilms tumors are 4 times more commonly associated with horseshoe kidneys
  • 21.
    Duplex Kidney • Kidneyhaving two ureters
  • 22.
    POLYCYSTIC KIDNEY • clustersof cysts develop in kidney • C/F: UTI Increased BP Haematuria Frequent urination
  • 23.
  • 24.
    OBSTRUCTIVE UROPATHY • Conditionin which flow of urine is blocked
  • 25.
    HYDRONEPHROSIS Dilatation of renalpelvis and calyces as a result of obstruction
  • 26.
    UTI IN NEWBORN •Causative organism- E coli, klebsiella, proteus etc • Newborn with UTI may have no symptoms other than fever • Sometimes – lethargic,vomiting, diarrhea • Newborn prone to develop sepsis from UTI
  • 27.
    WILMS TUMOR (NEPHROBLASTOMA) • Mostcommon type of renal CA • Mostly unilateral C/F: Painless, palpable abdominal mass Nausea,vomitting Fever Haematuria Increased BP
  • 28.
    CONGENITAL NEPHROTIC SYNDROME •Autosomal Recessive Disorder • CNS is rare kidney disorder characterised by heavy proteinuria, hypoproteinemia,edema starting soon after birth • Manifest in first 3 months of life
  • 29.
    POTTER SYNDROME/SEQUENCE • Typicalphysical appearance caused by pressure in utero due to oligohydramnios • Usually associated with B/L Renal ageneis
  • 30.
    CLUBBED FEET, PULMONARYHYPOPLASIA, CRANIAL ANAMOLIES
  • 31.
    PRUNE BELLY SYNDROME •TRIAD- Cryptorchidism(undescended testis) Abdominal wall defects Genitourinary defects Abdominal area-prune like (wrinkled)
  • 32.
    FANCONI SYNDROME • Proximaltubule dysfunction • Leads to excess loss of Glucose,Phosphate,Amino acids,HCO3,K+
  • 33.
    ALPORT SYNDROME • Inheriteddisease • Basement membrane(glomerular)disease • Diagnosis- Kidney biopsy(basketwave appearance)
  • 34.
    BARTTER AND GITELMANSYNDROMES Inherited tubular transport abnormalities Both are autosomal recessive diseases Bartter syndrome- renal salt wasting, hypokalemia, metabolic acidosis Gitelman syndrome- Impared Na and Cl reabsorption in DCT
  • 35.
  • 36.
    Inborn error ofmetabolism 1)Amino acid disorder- eg. Tyrosinemia type 1 – liver failure, septicemia, , hypoglycemia, fanconi syndrome(renal tubulopathy). 2)Fatty acid oxidation disorder- eg. Trifunctional protein deficiency -Recurrent rhabdomyolysis,cardiomyopthy,liver diseases. 3)Organic acidemia- eg. Cobalamin disorders -encephalopathy,ketoacidosis, hyperammonemia. 4)Urea cycle disorders- eg. Citrullinemia type 1 –failure to thrive, mild hperammonemia. 5)X -linked adrenoleukodystrophy- Adrenal insufficiency.
  • 37.
    PEDIATRIC RENAL DISORDERS& MANAGEMENT 1.NEPHROTIC SYNDROME 2.AGN 3.UTI 4.VUR 5.SHAYYAMUTRATA (ENURESIS) 7.MUTRASHMARI (NEPHROLITHIASIS & NEPHROCALCINOSIS)
  • 38.
    NEPHROTIC SYNDROME • Massiveproteinuria ( > 1 G/m2/day ) • Hypoalbuminemia ( < 2.5g/dl ) • Edema • Hyperlipidemia 2 groups – 1) MCNS (Steroid sensitive nephrotic syndrome) 2) Nephrotic syndrome with significant lesion ( Steroid resistant )
  • 39.
    Difference ACUTE GLOMERULONEPHRITISNEPHROTIC SYNDROME Age of onset Usually older children (4-10 Yrs) Usually younger children (2- 6 Yrs) Preceding cause (illness) Preceding URTI/Pyoderma Not associated Clinical features oligouria , oedema, heamaturia, hypertention, anasarca,oliguria (hematuria and hypertention is rare) Onset Acute Incidious Hypertension Present Not present Recurrence Not seen /rare Insidious
  • 40.
    MANAGEMENT • Reduction ofprotein excretion • Prednisolone is the drug of choice • 2mg/kg/day in divided doses for 6 wks f/b 1.5 mg/kg single dose on alternate day for 6wks • Diuretics Furosemide 2mg/kg/day oral • IV infusion of 20% albumin 1g/kg over 1-4 hrs
  • 41.
    PREVALENCE & ETIOLOGY– • Boys – 1-3 % • Girls - 3-10% • Infancy – equally common ETIOLOGY – Microbiology – E.Coli Proteus Klebsiella Enterobacter Staphylococcus saprophyticus
  • 42.
    Risk factors forUTI • Female child • Below 6 month child • Obstructive uropathy • Severe vesicoureteric reflux • Voiding dysfunction • Constipation • Repeated catheterization
  • 43.
    C.F Neonate – Sepsiswith fever • Vomiting • Diarrhoea • Jaundice Older infant- Unexplained fever • Frequent micturation • Occasionally convulsion • Crying ,staining during voiding • Dribbling Localised – Cystitis Pyelonephritis वृक्कजायां पृष्ठकटिगॄह: । च.सु.१७/१०१
  • 44.
    TYPE 1) Simple UTI 2)Complicated UTI TREATMENT – Complicated UTI - 10-14 days Simple UTI - 7-10 days IV ORAL CEFTRIAXONE CEFIXIME CEFOTAXIME AMOXICILLIN AMIKACIN CEPHALEXIN GENTAMYCIN OFLOXACIN
  • 45.
    ADV. – • Encouragedto take enough fluid • Empty the bladder frequently to prevent stasis of urine COMPLICATION • Renal stones • Renal abscess • Renal scarring • Renal failure • Pyelonephritis
  • 46.
    VESICOURETERIC REFLUX (VUR) Def– Back flow of urine from bladder to ureters & pelvis at rest or during micturation • Isolated anomaly ( pri.) • Anomalies of the urinary tract (sec.) Severity of VUR grade I – V Inv – MCU Cystography
  • 47.
    VUR Grades I –II Grades III & IV Antibiotic prophylaxis till 1 yr old till 5 yr old continue beyond 5 yr if bowel bladder dysfunction present Breakthrough febrile UTI Breakthrough febrile UTI Restart antibiotics prophylaxis Consider surgery
  • 48.
    शय्यामुत्रता Hetu - • Srotovarodha •vitilation of sadhaka, tarpaka kapha • pachaka pitta • manovaha srotas and atinidra Ayurveda suggest importance of pharmacological as well as psychological treatment for the disease. बिम्बीमूलरस: पानात् शय्यामूत्रं प्रशाम्यति ॥ भै.र Bramhi vati:- it decrease stress and helps to increase mental capacity. Chandraprabha vati Ashwagangha vati Shilajatu vati.
  • 49.
    ENURESIS Def – Normal,nearly complete evacuation of bladder at wrong place & time at least twice a month after 5 yr of age . - Up to 11 yrs enuresis twice common in boys than girls Etiology - • Maturational delay • Anxiety • ADH –circadian rhythm Sec.Enuresis precipitated by – • Stressful condition • Traumatic experience • UTI 1) Primary (75%) - Child never be dry 2) Secondary (25%) - Child was dry at night for at least a few months & then enuresis occurs .
  • 50.
    Treatment • Active T/tshould not given before age of 6yrs • Adequate fluid intake • Motivational therapy • Behavioral modification • Alarm therapy • Pharmacotherapy – Imipramine – 1-2.5 mg/kg/day ( altering the arousal –sleep mechanism) Anticholinergic drugs – (reduce uninhibited bladder contraction) Oxybutynin 5mg/kg , Tolterodine 2mg/kg Desmopressin (DDAVP) -10ug orally/intranasally ( Reduce the volume of urine )
  • 51.
    RENAL CALCULI &NEPHROCALCINOSIS NEPHROLITHIASIS - Uncommon in children • Metabolic abnormalityHypercalciuria with hypercalcemia – • Hypercalciuria with normal sr. Calcium • Miscellaneous causes Symptoms – Dysuria Hypogastric pain Hematuria & occasionly urinary infections
  • 52.
    अश्मरी- सशर्करातिमूत्रत्वम् मुत्रकाले चवेदना । प्रततंरोदति क्षामस्तं ब्रुयादश्मरीगदम् ॥ (का.सु.वेदनाध्याय) चिकीत्सा - पाषाणभेद गोक्षुर शिलाजित वरुण उशीर NEPHROCALCINOSIS – Formation of crystalline deposits within renal parenchyma ,presenting enhanced renal echogenicity which may be cortical ,medullary or diffuse. Etiology – UTI with urease producing organism like proteus
  • 53.
    MANAGEMENT • Stone <5-7mm size may pass spontaneously . • ESWL may suffice for small stones • Percutaneous nephrolithotomy if ESWL contraindicated or stones too large for lithotripsy . • Open surgery for stones >3cm in size or associated with PUJ . Adv – adequate fluid low salt intake dietary calcium restriction not necessary
  • 54.
    • The dipstick: Proteinuria , hematuria, pyuria & Specific gravity • Urine microscopy : red blood cells, white blood cells and cast. • Proteinuria and albuminuria analysis – - The most appropriate, practical and precise method for estimation of proteinuria in children is to calculate the protein-to-creatinine ratio in spot urine specimen. - Patient with positive dipstick test finding (1+ or greater ) should undergo quantitative measurement within 3 months to confirm proteinuria . Urine studies
  • 55.
    • Blood ureaand creatinine • Serum cholesterol • Serum protein – Total protein and albumin / globulin ratio • Antistreptococcal antibody titre Blood Examination
  • 56.
    • Plain X-rays: Renal size , shape and presence of radiopaque calculi • Ultrasonography : Initial assessment of the genitourinary system • Intravenous Pyelogram : To provide detail anatomical images of renal calyces, pelvis, and ureter • Micturating cysto-urethrogram (MCUG) : - Anatomy of the lower urinary tract , vesicoureteric reflux and posterior urethral valves - We recommend MCU for infant with antenatally detected hydronephrosis who develop a UTI • CT Scan and MRI : Renal and abdominal masses, CT guided biopsy, spinal imaging for neuropathic bladder Imaging Studies
  • 57.
    • Renal biopsyis helpful in pathological diagnosis • Chronic glomerulonephritis • IgA nephropathy • Alport syndrome , etc Renal biopsy
  • 58.
    First attack offebrile UTI Imaging Evaluation on after the first urinary tract infection • USG • MCU Age < 1 yr. • USG Age 1-5 yr. • If USG abnormal then MCU Age > 5 yr.
  • 59.
    • We recommendthat antenatal hydronephrosis be diagnosed and its severity graded based on antero-posterior diameter (APD ) of the renal pelvis Classification of antenatal hydronephrosis based on APD :- ANTENATAL EVALUATION AND MONITORING classification Second trimester Third trimester Mild 4-6 mm 7-9 mm Mod 7-10 mm 10-15 mm Severe >10 mm >15 mm
  • 60.
    • USG adviseduring 18-20 weeks of gestation-congenital anomaly scan • Amniotic fluid analysis • Creatinine level during pregnancy • In cong. anomaly scan found unilateral renal agenesis so, we advice to continue the pregnancy and if both kidneys absent then advice abortion.
  • 61.
    • Timing ofInitial Ultrasound - a) All newborn with antenatal hydronephrosis : 1 st wk of life b) In neonate with suspected post. urethral valve, oligohydramnios or severe bil. hydronephrosis : within 24-48 hr. of birth c) In all other cases : within 3-7 days or before hospital discharge Postnatal evaluation
  • 62.
    MCU - performedin patient with unilateral or bilateral hydronephrosis with renal pelvic APD > 10 mm. a) MCU be performed early within 24-72 hrs of life , in patient suspected lower urinary tract obstruction . b) In other cases , the procedure should be done at 4-6 weeks of age. Micturating cystourethrogram
  • 63.
  • 65.
    • A methodof sterile urine sample collection in which mid-stream urine collection is difficult. The procedure is most applicable in children < 2 years in whom distended bladder is situated in the abdomen. • If phimosis in male children and if vaginitis in female children. Indication of suprapubic catheterization
  • 66.
  • 67.
    विशेषतो वृक्क रोगोरक्तस्य परिवर्तनात। नराणां जायते देहे भिषजामिति निर्णय: ॥ (भै. र. ९३/२) मुत्रपरिक्षा
  • 68.
    “MANAGEMENT OF PAEDIATRICNEPHROTIC SYNDROME (Sandrameha) THROUGH AN INTEGRATED APPROACH ” Case - 1
  • 69.
    Case Presentation 1 yr.9 Months Female patient ( wt. 8.3 kg) presenting with following C / O - 1) Peri - orbital Swelling - 1 Month 2) Pitting Pedal Oedema - 15 Days 3) Abdominal Oedema - 15 Days 4) Oedema Over labia Majora - 15 Days 5) Anasarca - Generalized Oedema - 07 days 6) Fever & Irritability - 1 day 7) Loose motions - 1 day 8) O/E = Pulse – 120 / min , B.P – 120/ 90 mm of hg. Hepatomegaly and Fluid thrill was present. Treatment taken in private hospital and Civil Hospital , but had no relief so was referred to Higher Tertiary Center because of bad prognosis. For further management parents admitted baby in G. A. Hospital Osmanabad.
  • 70.
    15/12/2025 Pallava-2019 70 Sr. No. CBC31/12/18 on admission 05/01/19 11/01/19 14/01/19 23/01/19 on discharge 22/11/19 0n last Follow up 1. HB 9.9 ↓ 7 ↓ 15.8 ( B.T on 7/01/19 & 9/01/19) 15.4 12.5 12.7 2. WBC 14400↑ 11400 10800 10400 10200 9.8 3. Neutrophils/ Granulocytes 50-75 31 29 41 53 66 54 4. Lymphocytes 20-50 63 ↑ 66 ↑ 52↑ 36 26 38 5. Eosinophils 0-6 04 - - - 02 02 6. Monocytes 02 04 03 06 06 04 7. Basophils 0-1 00 00 00 00 00 01 8. Platalet 1.5-4.5 lakhs 623000 ↑ 521000 ↑ 256000 234000 263000 398000
  • 71.
    15/12/2025 Pallava-2019 71 Sr. No. Urine01/01/2019 13/01/2019 19/01/2019 23/01/2019 On discharge 22/11/19 0n last Follow up 1. Colour Pale Yellow Pale Yellow Pale Yellow Pale Yellow Pale Yellow 2. Appearance Slightly Turbid Clear Clear Clear clear 3. Specific Gravity 1.010 1.025 1.010 1.000 1.025 4. PH 6.0 6.5 7 8 6.5 5. Proteins 500 (4+)↑ 300 (4+) ↑ 60 ↑ ( 2+) Negative Negative 6. Sugar 100 50 Absent Absent Negative 7. Ketone Bodies Trace↑ Negative Negative Negative Negative 8. Leucocytes Absent 5 Negative Negative Negative 9. RBC 8 6 Negative Negative Negative 10. Pus Cells 2-4 Nil Nil Nil 01 11. Epithelial Cells 8-10 Nil Nil Nil 02 12. Casts Granular Nil Nil Nil Nil
  • 72.
    15/12/2025 Pallava-2019 72 Sr. No. Investigation31/12/18 05/01/19 11/01/19 14/01/19 22/11/19 0n last Follow up 1. Serum creatinine 0.7 0.7 0.39 0.40 0.36 2. S. Albumin 2.4 ↓ 2.2 ↓ 3.9 4.25 4.1 3. Blood Urea 26 22 20 - 28 4. Serum cholesterol 294 ↑ 274 ↑ 236 ↑ 172 156 5. Serum HDL Cholesterol 52 - 36.9 43.3 38 6. Serum Triglyceride 145↓ - 185 168 152 7. Serum LDL Cholesterol 215.40↑ - 149 120.1 114 8. Serum VLDL 26.60 - 65 93.6 62 9. Cholesterol / HDL Ratio 5.65 - 3.43 - - 10. LDL / HDL Ratio 4.14 - 1.046 - -
  • 73.
    Sr. no Investi gation 04/01/2019 12/01/2019 1 USG-Mild Hepatomegaly - Echogenic Kidneys & -Mild Ascites with dilated -sluggish bowel loops -Rt. Kidney – 6.8* 2.9 cm - Lt. Kidney – 8.1*2.8 cm - Free fluid in abdomen & pelvis - Ascites - Increased ecotexture of Kidney
  • 74.
    Pragati - 201774 DIAGNOSIS • Modern diagnosis – NEPHROTIC SYNDROME. • Ayurved diagnosis - 1) SANDRA PRAMEHA- Nephrotic syndrome have features like Albuminuria, Hyperlipidemia along with Oedema so it can be correlated with Prameha. • Albuminuria makes urine concentrated , viscid or dense,hence comparable to Sandrameha ( type of kaphaj prameha). 2) SARVANGA SHOTHA- Generalised swelling due to sodium retention. 3) KAPHAJ MUTRAKRUCHA – viscous or dense urine. “ बहुलं कुरुते मूत्रमल्पबाधं सितं घनम्। बस्तिगौरवशोथौ ” च मुत्रघाते कफ़ात्मके ॥ 23-12-2017
  • 75.
    Pragati - 201775 TREATMENT PLAN • In nephrotic syndrome there is immunlogical disorder , T lymphocyte disregulation , decreased antioxidant defense & renal damage. • Ayurvedic medicines having Immunomodulator , nephroprotective and anti-oxidative properties can be used. 23-12-2017
  • 76.
    Pragati - 201776  ON ADMISSION TREATMENT (31/12/19) 1. Punarnavashtak kwatha 2.5 ml tds . 2. Panchavalkal kwatha 2.5 ml tds . 3. Syp Amyron 2.5 ml bd . 4. Sanjivani vati 2 tds with curd for 5 Days. 5.Tab. Prednisolone – 10 mg bd. ( 31/12/18 -17/01/2019) Tab. Methyl Prednisolone 8 mg bd. ( from18/01/19) 6. Tab. Lasix - 10 mg bd . ( 31/12/19 to 11/01/2019 bd then od upto 22/01/19 ). 7. Inj. Cefoparazone with sulbactum 500 mg BD for 7 days 8. Inj. Amikacin 75 mg BD for 7 Days. 23-12-2017
  • 77.
    15/12/2025 Pallava-2019 77 TREATMENT MODIFICATIONS - 1. Syp Neeri 2.5 ml bd since 11/ 01/ 19. 2. Tab. Sarpagandha (reserpine) by 0.01 mg/ kg. ( 02/01/19 – 06/ 01/19.) 3. Blood transfusion on 07/01/2019 & 09/01/2019 (150 ml over 6 hr.)  Advice - 1. Salt restriction - < 1500 mg daily 2. Fluid restriction. 3. Diet protein intake of 1.5 - 2 gm / kg / day.
  • 78.
    15/12/2025 Pallava-2019 78 ON DISCHARGE MEDICATIONS (23/01/19)- 1) Punarnavashtak kwatha 2.5 ml BD 2) Panchavalkal kwatha 2.5 ml BD. 3) Syrup Neeri 2.5 ml BD. 4) Syrup Amyron 2.5 ml BD. 5) Tab. Methyl prednisolone 8 mg bd.
  • 79.
    Pragati - 201779 BT AT Comparison BEFORERX DURING RX AFTERRXA
  • 80.
    15/12/2025 Pallava-2019 80 4yrs ( 14.6 kg ), Female c/o – • Fever with chill–2 days • Burning Micturition- 2 days Rx – • Cefixime ( 8 mg/ kg) • Chandraprabha vati 125 mg bd • Syp Renalka 5 ml bd • Syp Paracetamol ( 15 mg /kg ) * 7 days. • If no response to cefixime - Culture report CASE 2 – Urinary Tract Infection
  • 81.
    15/12/2025 Pallava-2019 81 CASE3 – Urinary Bladdar STONE
  • 82.
    15/12/2025 Pallava-2019 82 8yrs ( 21 kg ) , Male child with C / o – • Abdominal pain – 3 days. ( Rt. Lumbar and Hypogastric ) • Fever with headache - 1 day Rx – • Gokshuradi guggul 1 bd. • Punarnavashtak kwath 10ml bd • Tb. Cystone - ½ tab bd • Syp Cefixime ( 8 mg / kg ) • Syp Paracetamol ( 15 mg / kg) * 7 days . Cont…
  • 83.
    AFTER Rx USG ABDOMEN Name Age/ Sex 14 YRS / male Date 12 / 07 / 19 Ref By Dr. A YURV EDIC HOSPITAL USG ABDOMEN PELV IS Liver Normal in size shows normal echotexture. . No e/o focal lesion. No e/o dilated IHBR. CBD and portal vein appears Normal in course and caliber . Gall bladder is distended with normal caliber walls. No e/o pericho lic co llect ion. Spleen Normal in size and shows no rmal homogenous echotexture. No e/o focal lesion. Splenic veins Normal Pancreas: - head & part of body visualized Normal in size with Normal in echotexure .No e/o peripancreat ic collection noted . Excessive bowel gas. Right Kidney Normal in size, shape and posit ion. It show normal corticomedullary differentiation with Normal in echotexture . No e/o hydronephrosis and hydroureter No E/o calculus noted. Left Kidney Normal in size, shape and position. It show normal corticomedullary differentiation with Normal in echotexture . No e/o hydronephrosis and hydroureter No E/o calculus noted. Aorta & IVC shows normal appearance . Dilated Edematous Bowell loops noted in abdomen & pelvis with gases and mid Normal peristalsis noted . No e/o free fluid in abdomen and pelvis at present Urinary bladder is distended . No E/o calculus noted Prostate appear normal in size and echotexture . IMPRESSION: Normal USG Findings. Dr . DESHMUKH ANAND. Consultant Radiologist.
  • 84.
    15/12/2025 Pallava-2019 84 CASE4 – DENGUE Kidney FAILURE
  • 85.
    Rx- • 10 yrsmale child , Wt – 26 kg :- • IVF 0.45 % DNS – 5 ml / kg / hr • Inj Ceftriaxone – 75 mg / kg / day • Inj Amikacin – 15 mg / kg / day • Syrup Platboost 5 ml tds • Sanshamani vati 1 tab tds • Bhunimadi Kadha 10 ml tds • Oligouria – urine output < 1 ml / kg / hr. 3 rd space fluid loss . Renal imperfusion leading to kidney failure. • Intravenous Fluid under Jugular venous pressure measurement.
  • 86.
    वृक्क रोग निदान: प्रायेणशैत्यस्य विशेषयोगाद्वृक्कद्व्ये वृक्कगदोऽभिजायते। मसूरिकायां च विसूचिकायां किंवाऽऽमवाते चिरजे ज्वरे अपि वा॥ उपद्र्वत्वेन गृहीतजन्मा भवेदसौ चेति मतं बुधानाम। (भै. र. ९३/१) वृक्क रोग में उपद्रव: मूर्च्छा कास: फु फ्फु सभित्तौ श्वयथुस्तथा हि उरस्तोय:। सलिलोदरश्च तद्वन्मूत्रविषस्य संक्रमणमध्य्स्त्रम॥ अधिवृक्करोगमेते ननु भवन्त्युपद्रवा विशेषेण॥ (भै. र. ९३/११,१२)
  • 87.
    15/12/2025 Pallava-2019 87 Case5 – Congenital Hydronephrosis
  • 88.
    Antenatal U.S.G- • Antenatalhydronephrosis with APD > 15 mm requires very close repeated follow up . • Termination of pregnancy is not recommended in foetuses with unilateral or bilateral antenatal hydronephrosis , except in presence of extrarenal life threatening abnormality.
  • 89.
    Post Natal U.S.G:- • Look for Urine pass within first 48 hours. • Watch for abdomonal distension ,irritability , Fever , Dehydration. • Ensure Breastfeeding / Intravenous fluid. • Post natal USG – 3rd day of life . • < 10 mm renal pelvis AP diameter - Repeat USG after 4-6 weeks • > 10 mm - Diuretic Renography . • Plan surgery if bilateral hydroneprosis / functioning deteriorates.
  • 90.