Indian Journal of Traditional Knowledge

Vol. 17(4), October 2018, pp. 807-810

Effect of herbal Unani formulation on Nephrotic syndrome: A case study

Misbahuddin Azhar
Regional Research Institute of Unani Medicine, Post Box No 70, Near Head Post Office, Aligarh-202 001, Uttar Pradesh, India
E-mail: [email protected]

Received 20 March 2018, revised 24 July 2018

According to Philosophy of Unani medicine, Du’f al-Kulya is a condition in which the kidneys do not perform their
normal function because of impairment in their temperament or alteration in their humoral status or anomalies in their
structure. Du’f al-Kulya Barid is caused by the impairment of the temperament of kidneys specially cold impaired
temperament leading to swelling, white coloured urine, decreased thirst, feeling of coldness at the site of kidney. These
symptoms are very much closer to the condition of ‘Nephrotic syndrome’. That’s the real logic to use traditional herbal
Unani formulation for the treatment of nephritic syndrome. The present case report is based on traditional use of herbal
Unani formulation for the treatment of nephrotic syndrome. The evidence-based data is provided to support the traditional
use of this valuable herbal Unani Formulation (HUF). To generate the biochemical and clinical data from a patient treated
with HUF for nephrotic syndrome. A 57-year-old female from Punjabi Sikh community from capital Delhi was diagnosed
nephrotic syndrome and treated for four months with a combination of Unani herbal drugs. The patient was advised to take
10 g of powder of HUF twice with Arq Mako and Arq Kasni 20 mL each diluted with equal amount of plain water in the
morning and evening. The treatment was continued for four months and investigations for renal functions were carried out
and patient was clinically examined at each visit. Laboratory reports and clinical sign and symptoms revealed that HUF
reduces serum creatinine, urea and swelling on face and body. Increased blood pressure was declined compared to base line
reading. In the present case study, the HUF has shown promising nephroprotective activity by significantly reducing serum
creatinine, urea and protein leakage in urine.

Keywords: Nephrotic syndrome, Polyherbal, Unani, Nephroprotection, Du’f al-Kulya

IPC Int. Cl.8: A61K 38/00, A61K 39/395, A61P 13/12, A61M 1/14, A61K 35/22, A61K 36/00, A61K 38/26, A61K 45/06,
A61K 31/198

Nephrotic syndrome (NS) comprises signs of day due to increased permeability of glomerular
nephrosis, large proteinuria, hypo-albuminemia and membrane. Hypoproteinemia leads to low colloidal
hyper-lipidemia1. It resembles to Du’f al-Kulya Barid osmotic pressure that in turn allow large amount of
in Unani medical literature. It is condition in which fluid to filter into the interstitial spaces and also into
kidneys do not perform their normal functions because potential spaces of the body casing edema. Hyper-
of impairment in their temperament or alteration in proteinuria causes increased permeability of
their humoral status or anomalies in their structure due the filtering membrane of the kidney leading to pass
to predominance of Barudat (coldness) in kidney. The red blood cells through the pores and causes hematuria.
accumulation of cold humours in kidney cause NS may be primary, include minimal change
alteration in structure and function of kidney especially nephropathy, focal glomerulosclerosis, membranous
in excretion and reabsorption of fluid through proximal nephropathy, hereditary nephropathies, while
tubules. The quantity and quality of urine in terms of secondary NS include diabetes mellitus, lupus
their normal colour and appearance is altered2-5. In all erythematosus, viral infections commonly hepatitis
cases of NS injury to glomeruli is an essential feature. B&C viruses and HIV, amyloidosis and para-
It may be primary, being a disease specific only to proteinemias. NS may be classified as steroid sensitive,
kidneys, or may be secondary, being a renal steroid resistant, steroid dependent, or frequently
manifestation of a systemic general illness. Nephrotic relapsing from a therapeutic point of view. The features
syndrome may affect adults and children of both sexes of nephrotic syndrome are morning sub orbital
but the causes are different in adults, infants and edema/face puffiness, pitting edema over the legs,
childhood nephrotic syndrome. It is a condition in sometimes anasarca, pericardial or pleural effusion,
which 3 g or more protein excreted through urine per ascites, hypertension, anemia, dyspnea along with
808 INDIAN J TRADIT KNOWLE, VOL 17, NO. 4, OCTOBER 2018

raised ESR due to increased fibrinogen and other mg/dL, total calcium 8.9 mg/dL, phosphorous 3.60
plasma contents. In some cases foamy or frothy urine, mg/dL, alkaline phosphatase 85 U/L, total protein 5.60
due to a lowering of the surface tension due to g/dL, albumin 3.13 g/dL, A:G ratio 1.27. In urine total
severe proteinuria. The treatment of nephrotic protein was 60.10 mg/dL, creatinine 118.21 mg/dL,
syndrome is usually symptomatic or it may directly protein and creatinine ratio 0.51. Urine Albumin +++
address the injuries caused to the kidneys. For and 24 h urinary proteins was 1528 mg/day. Patient
symptomatic treatment diuretics, statins or fibrates and was provisionally diagnosed with nephrotic
resinous sequesters of bile acids, anti-coagulant, syndrome/focal segmental glomerulosclerosis (FSGS).
antibacterial drugs, ACE inhibitors, vitamin D along Kidney biopsy showed renal parenchyma is
with correct energy intake, e.g., less than 1 g of represented by upto 6 glomeruli and tubule-
protein/kg body weight/ day have been advised to the interstitium, 2 glomeruli are globally sclerosed, 1
patients in the form of lean cuts of meat, fish, and obsolescent glomerulus shows segmental sclerotic
poultry, consumption of water not greater than the level lesion at one level. 10-15 % interstitial fibrosis with
of diuresis and restriction of salty diet like canned moderate acute tubular injury, mild focal nonspecific
soups, canned vegetables containing salt, luncheon chronic inflammation and mild to moderate
meats including prepared foods, fast foods, soy sauce, atherosclerosis. She came to CCRUM headquarters in
ketchup, and salad dressings are being prescribed. the last week of May 2017 for consultation for any role
While kidney damage is treated by prescribing of Unani System of Medicine in case of nephrotic
corticosteroids like prednisone at a dose of 60 mg/m² of syndrome.
body surface area/day for 4–8 weeks. After this period In review of Unani classical literature and scientific
the dose is reduced to 40 mg/m² for a further four studies conducted, many plants have shown
weeks. Frequent relapses are treated nephroprotective activities in different models6-8. After
by cyclophosphamide or nitrogen mustard or history, clinical examination and analysis of lab reports
1
cyclosporin or levamisole . In Unani medical system a HUF was prepared to treat the patient. Herbal Unani
the treatment of Du’f al-Kulya Barid is hot and wet formulation (HUF) comprising of four Unani herbs,
drugs and procedures5. The Unani Pharmacopoeia is viz. Revand Chini (Rheum emodi wall.), Khar-e-
very rich and uses three sources of medicine, i.e., Khasak-Khurd (Tribulus terrestris L.), Filfil Siyah
herbal, mineral and animal origin. The concept of (Piper nigrum L.) and Zanjabeel (Zingiber officinale
Muqawwiyat (tonics) and organo-therapy are unique in Rosc.) in a particular ratio. All the ingredients of the
Unani System of Medicine. Such drugs are used to plants are mentioned in Unani medical literature for the
tone-up the important organs and strengthen to save treatment of Du’f al-Kulya Barid. The therapeutic
them against the possible harmful substances. In actions of single drugs are resolvent, diuretics,
organo-therapy the same organ of goat and sheep have lithotriptic, deostuent, anodyne, analgesic, anti-
been specially prepared mixing with some specific inflammatory, antidote, antiseptic, blood purifier, tonic
herbal drugs for toning up the affected organ1. for kidney and liver9-12. Phyto-constituents and various
Aim of the study extracts of these plants have already showed
To treat nephrotic syndrome patients with Herbal nephroprotective activity in different experimental
Unani Formulation. models13-20.
Materials and methods The patient was advised to take 10 g powder of HUF
A female patient of age 57 yrs from Indian Punjabi with Arq Mako and Arq Kasni (distillate of Solanum
background diagnosed with rheumatoid arthritis in nigrum L. and Chichorium intybus L.) 20 mL each,
2015 in a reputed allopathic hospital of capital Delhi. diluted with equal amount of plain water in the
Physician put her on steroids and prescribed morning and evening empty stomach. Patient was
Prednisolone 80 mg alternate day, calcium carbonate advised to visit the physician at regular interval and
and Vitamin D3 once a day, Pantoprazole 40 mg twice also advised regarding the consumption of water not
a day, multivitamin once a day and Febuxostat 40 mg greater than the level of diuresis with restriction of
once a day. In the early week of May 2017 patient has salty diet like canned soups, canned vegetables
developed swelling on face and body, mild containing salt, luncheon meats including prepared
hypertension, and her lab investigations showed urea foods, fast foods, soy sauce, ketchup, and salad
84 mg/dL, creatinine 2.46 mg/dL, uric acid 12.4 dressings. The treatment continued for four months and
 AZHAR: EFFECT OF HERBAL UNANI FORMULATION ON NEPHROTIC SYNDROME: A CASE STUDY 809

regular clinical and biochemical investigations were Table 1 — Effect of HUF on biochemical parameters in blood and urine
carried out.
Parameters At base line After 4 month of
treatment
Results Blood
Swelling on face and body disappeared and patient Urea 84.0 48.00
felt quite normal and was performing her day to day Creatinine 2.46 1.35
activities independently after one and half month of Uric Acid 12.40 3.30
treatment. The kidney function report in the end of Total Calcium 8.9 8.85
Sept. 2017 significantly reduced the urea from 84 to 48 Phosphorous 4.00 3.50
mg/dL, creatinine from 2.46 to 1.35 mg/dL and uric Alkaline Phosphatase 110 89
Acid from 12.40 to 3.30 mg/dL in comparison to the Total Protein 5.80 5.85
report of May 2017 (baseline). Albumin 3.24 3.41
The patient witnessed an increase in her renal A:G ratio 1.27 1.40
function parameters in July 2017. The reported urea Sodium 138.0 134.00
was 106 mg/dL, creatinine 2.99 mg/dL, uric Acid 9.5 Potassium 4.18 4.46
mg/dL, total calcium 9.0 mg/dL, phosphorous 4.60 Chloride 105 101.00
mg/dL, alkaline phosphatase 81 U/L, total protein 6.0 Glucose (F) 58.90 79.0
g/dL, albumin 3.33 g/dL, A:G ratio 1.25, sodium 135.0 Glucose (PP) 93.36 106.0
Urine
mEq/L, potassium 4.48 mEq/L, chloride 108 mEq/L. In
Total Protein 58.90 49.90
urine total protein 60.10 mg/dL, creatinine 118.21
Creatinine 93.36 57.19
mg/dL protein and creatinine ratio 0.51 (Table 1).
P:C ratio 0.63 0.87
Analysis of investigations revealed that HUF
reduces serum creatinine, urea and uric acid level. Table 2 — Effect of HUF on clinical parameters
Clinical examination revealed reduction in swelling on Sign and symptoms Initial value After 4 month of
face and body and blood pressure in comparison to her treatment
base line reading by (Table 2). However, the leakage of Weakness +++ +
Loss of appetite +++ +
protein in urine is not significantly controlled.
Oedema ++ 0
Dyspnea on walking +++ +
Discussion
Blood pressure (mm Hg) 160/105 135/95
According to principles of diagnosis and treatment
of Unani medical literature for Du’f al-Kulya Barid, herbal Unani drug/formulations and their
the prescribed drugs are hot and dry temperament in pharmacodynamics and kinetics. The significant
nature, that helps the body to maintain the required reduction in serum creatinine, urea and uric acid level
temperature of the organs for performing their normal swelling of body and face, blood pressure after four
function5. Unani scholars have described various month of therapy showed that HUF is effective in a case
drugs for the treatment of kidney disorders. The of nephritic syndrome. This type of clinical and laboratory
ingredients of herbal Unani formulation have finding will be helpful for scientists, physicians,
resolvent, diuretics, anti-inflammatory, antiseptic, researchers working in the field of nephrology and
blood purifier, tonic for kidney and liver properties6-9. provide better and safe medicines to patients.
Apart from that actions mentioned in Unani classical
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