|Year : 2022 | Volume
| Issue : 3 | Page : 263-266
Ayurvedic management of renal cyst – A case study
Ritesh Singhal1, Manjry Anshumala Barla2, Rakesh Roushan1
1 Department of Kriya Sharir, Ch. Brahm Prakash Ayurved Charak Sasnthan, Government of NCT Delhi, New Delhi, India
2 Chief Medical Officer, Directorate of AYUSH, Government of NCT of Delhi, New Delhi, India
|Date of Submission||24-Feb-2022|
|Date of Decision||18-May-2022|
|Date of Acceptance||03-Jul-2022|
|Date of Web Publication||28-Sep-2022|
Department of Kriya Sharir, Ch. Brahm Prakash Ayurved Charak Sasnthan, Government of NCT Delhi, Khera Dabar, Najafgarh, New Delhi
Source of Support: None, Conflict of Interest: None
Introduction: Renal cysts are detected more easily in elderly people due to the widespread use of abdominal computed tomography (CT), abdominal ultrasonography (USG), and magnetic resonance imaging. The importance of renal cysts arises from their augmented detection in elderly populations with the pervasive use of CT and abdominal USG. In Ayurveda, renal cyst has been interpreted with the name of Granthi where Vata-Kapha dominant Tridosha is involved. Very less scientific data is available depicting the effect of Ayurvedic intervention in such cases. Main Clinical Finding: A confirmed case of renal cyst of size 15 mm × 16 mm was seen in the lower calyx of the left kidney, a calculus of size 2.3 mm with mild upper hydroureteronephrosis, increased parenchymal echogenicity suggestive of Grade 1 fatty liver and gallbladder is distended with multiple hyperechogenic foci suggestive of calculus largest measuring of 13mm. Diagnosis: The patient was a diagnosed case of a renal cyst of size 15 mm × 16 mm in the lower calyx of the left kidney with a calculus of size 2.3 mm with mild upper hydroureteronephrosis with Grade 1 fatty liver and calculus largest measuring of 13 mm in the gallbladder based on USG findings. Interventions: The patient was treated with Ayurvedic medicines such as Chandraprabha Vati, Kanchnara Guggulu, Lavan Bhaskara Churna, Samsamani Vati, Kumaryasava, and Gokshuradi Guggulu. Outcome: Complete remission of the renal cyst with calculi along with Grade 1 fatty liver was observed after 6 months of treatment. Conclusion: This case study demonstrates the potential and usefulness of Ayurveda in the management of renal cysts.
Keywords: Ayurveda, fatty liver, Granthi roga, renal calculi, renal cyst
|How to cite this article:|
Singhal R, Barla MA, Roushan R. Ayurvedic management of renal cyst – A case study. J Ayurveda 2022;16:263-6
| Introduction|| |
Renal cysts are encapsulated semisolid or liquid fluid commonly identified during an abdominal scan. Simple renal cysts are very common, and the incidence increases with age. The prevalence of renal cysts was 27% and higher in men (34%) than in women 21%. Renal cyst prevalence increased from 14% in the youngest age group (20–29 years) to 55% in the oldest age group (≥ 70 years) for men and from 7% to 43% for women. Renal cystic lesions are found very frequently to come upon the face at computed tomography (CT), abdominal ultrasonography (USG), and magnetic resonance imaging. Abdominal USG is usually the first-line imaging examination of the abdominal viscera and organs like the kidney. Renal cysts are easily recognized with a well-defined border; homogeneous anechoic content marked posterior enhancement. Large population-based data for the history, nature, and prevalence of renal cysts are still lacking. Based on the Bosniak classification, long-term follow-up of the simple renal cysts are not available. Often, insufficient information or even misapprehension was the basis for making treatment decisions. Insidious interventions such as surgical delaminating or marsupialization and percutaneous aspiration were commonly performed for the renal cyst, even for asymptomatic simple renal cysts.
In Ayurveda, renal cyst can be compared with Granthi, which occurs due to the accumulation of morbid dosha in the body tissues. Ayurvedic literature identified nine different forms of Granthi, depending on the pathological factor and the body tissue affected. Pathogenesis of Granthi is defined as when aggravated Tridoshas, vitiate Meda (fat/adipose tissue), Mamsa (fleshy/muscles), and Rakta (blood), with Kapha they generate a knotty, rounded protuberant, hard swelling called Granthi.
For Granthi, Vata dosha is the main pathogenic factor and its natural site is Kati Pradesha (lumbar region). As per the classical texts of Ayurveda, cyst can be compared to Granthi. Granthi can be treated by breaking the pathogenesis (Samprapti Vighatana). Here, we are presenting a case of renal cyst, which was successfully treated on the basis of Ayurvedic management of Granthi. Ethical standards were followed as per the “CARE” Case Report Guidelines.
| Case Report|| |
A 60-year-old married, nonsmoking, nonalcoholic Hindu female, registered vide outpatient department number 2678 on July 14, 2021, presented with complaints of abdominal pain, burning micturition, and burning in the epigastric region. Her ultrasound report clearly revealed the finding of a renal cyst of size 15 mm × 16 mm seen in the lower calyx of the left kidney, a calculus of size 2.3 mm is seen in the middle calyx with mild upper hydroureteronephrosis, Grade 1 fatty liver and the gallbladder are distended and showing multiple hyperechogenic foci with acoustic shadowing suggestive of calculus largest measuring of 13 mm, increased parenchymal echogenicity suggestive of the right kidney was normal in size and without cyst [Figure 1]. The patient was advised to go for surgical intervention but the patient was not willing for surgical intervention.
Renal cysts are similar to Granthiroga of Ayurveda. It is Vata-Kapha dominant Tridoshaja vyadhi; therefore, Vata-Kaphahara Ayurvedic medications are required for the breakdown of the pathogenesis of Granthi Roga [Table 1].
Follow-up and outcomes
The patient's treatment was continued with Ayurvedic medications for about 6 months. Criteria on which improvement was observed were the findings of USG. Some oral Ayurvedic medications were added and withdrawn during treatment. This is mentioned in the timeline of the case [Table 1].
| Discussion|| |
The present case was treated as per the management of Granthiroga. Chandraprabha Vati, Kanchnara Guggulu, Lavana Bhaskara Churna, Samsamani Vati, Kumaryasava, and Gokshuradi Guggulu were advised to the patient during the treatment. The renal cyst was completely cured along with renal calculi and Grade 1 fatty liver as no sign of renal cyst, renal calculi, and Grade 1 fatty liver was seen in subsequent USG [Figure 2]. There is no recurrence of any signs or symptoms in the patient till now. Chandraprabha Vati is the drug of choice for the treatment of diseases of the lower abdomen such as kidney stones, difficulty in urination, urinary incontinence, and frequent urination. Chandraprabha Vati is Tridoshahara in nature; therefore, it is used in several Tridoshaja Vyadhi like Granthi.
Kanchanara Guggulu was advised to the patient due to its Shothahara (anti-inflammatory), Lekhana (scraping), and Vata-Kaphahara properties, which shows its significant effect in Granthi. Lavana Bhaskara Churna is a very effective Ayurvedic formulation for gastritis. Its main ingredient is salt. It is a traditional Ayurvedic medicine for balancing all three doshas. Samsamani Vati is an Ayurvedic herbal formulation used for fever with different etiology. It has mild antipyretic and anti-inflammatory actions. Kumaryasava was also given to the patient as Aloe vera is the main ingredient of it. Kumaryasava has therapeutic use in Ashmari, Mutra Kricchra, and Amlapitta (gastritis). Vata-Kapha is the main body humor involved in the pathogenesis of Granthi. A dose of three teaspoonfuls with equal water twice daily was advised. Gokshuradi Guggulu is an effective medicine used for Mutra Kricchra, Ashmari, and disorders related to the urinary tract. It was prescribed in a dose of two tablets twice a day with warm water. For gallstone treatment purpose, she was advised to go for surgical intervention.
| Conclusion|| |
The present case was presented with the USG finding of renal cyst, renal calculi, and Grade 1 fatty liver. The case was successfully treated with oral Ayurvedic medications without surgical intervention. The patient was free from all the signs and symptoms after completion of the treatment except gallbladder stone which was advised for surgical intervention before starting the treatment. This approach of treatment can be taken into consideration for further research work and treatment of renal cysts, renal calculi, and Grade1 fatty liver.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the consent form, the patient has given her consent for her images and other clinical information to be reported in the journal for the betterment of humankind. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Whelan TF. Guidelines on the management of renal cyst disease. Can Urol Assoc J 2010;4:98-9.
Mensel B, Kühn JP, Kracht F, Völzke H, Lieb W, Dabers T, et al.
Prevalence of renal cysts and association with risk factors in a general population: An MRI-based study. Abdom Radiol (NY) 2018;43:3068-74.
Hartman DS, Choyke PL, Hartman MS. From the RSNA refresher courses: A practical approach to the cystic renal mass. Radiographics 2004;24 Suppl 1:S101-15.
Smith AD, Carson JD, Sirous R, Sanyal R, Remer EM, Allen BC, et al.
Active surveillance versus nephron-sparing surgery for a Bosniak IIF or III renal cyst: A cost-effectiveness analysis. AJR Am J Roentgenol 2019;212:830-8.
Lai S, Jiao B, Wang X, Xu X, Zhang M, Diao T, et al.
Renal cell carcinoma originating in the free wall of simple renal cyst: Two unusual case reports with literature review. Medicine (Baltimore) 2019;98:e15249.
Rawat N, Roushan R. Guduchi; A potential drug in Ayurveda. World Journal of Pharmaceutical Research 2018;7:355-61.
Rawat N, Barla MA, Roushan R. Ayurvedic approach for management of ovarian cyst: A case report. Int J Res Ayurveda Pharm 2020;11:9-12.
Shastri SN, editor. Arshorogadhikara. Bhaishajya Ratnavali. Ch. 9, Ver. 223-33. Varanasi: Chaukamba Publications; 2005. p. 321-2.
Shastri SN, editor. Agnimadhyarogadhikara. In: Bhaishajya Ratnavali. Ch. 10, Ver. 79-87. Varanasi: Chaukamba Publications; 2005. p. 830.
Srikantha Murthy KR. Sharangdhar Samhita. Reprint Edition 2012. Ch. 10, Ver. 19-27. Varanasi: Chaukamba Publications; 2012. p. 139.
Srikantha Murthy KR. Sharangdhar Samhita. Reprint Edition 2012. Ch. 07, Ver. 84-7. Varanasi: Chaukamba Publications; 2012. p. 109.
[Figure 1], [Figure 2]