Acute Kidney Injury: Treatment with Unani Medicine—Case Report

1. Acute Kidney Injury: Treatment with Unani Medicine—Case Report Muhammad Shakil Ahmad Siddiqui* , Khan Usmanghani Rafah-e-Aam Dawakhana Ajmali (Clinics) and Rafah-e-Aam Herbal Laboratories, Karachi, Pakistan

2. Definition of AKI • Impairment of kidneys functions over a period of hours and days. • Results in retention of toxins, fluids and end products of metabolism • A diagnose of AKI is made on the basis of presence of elevated serum creatinine and/or blood urea nitrogen (BUN) levels and/or decreased urine out put. • Sudden reduction in kidney function and are associated with morbidity and mortality. • May progress to Chronic Renal failure or End Stage Renal Disease(ESRD).

3. Acute Kidney Injury: Treatment with Unani Medicine—Case Report • Causes • PRERENAL • Hypovolemia, shock, blood loss, embolism, ascites or burns, cardiovascular disorders, sepsis • RENAL • Nephrotoxic agents, infections, ischemia and blockages, polycystic kidney disease • Postrenal • Stones, blood clots, BPH, urethral edema from invasive procedures

4. RIFLE criteria for diagnosis of AKI based on The “Acute Dialysis Quality Initiative” Am J Kidney Dis. 2005 Dec;46(6):1038-48

5. Acute Renal Failure • Diagnostic tests • BUN, • Serum creatinine, • Serum Electrolytes • Hgband Hct • Urine D/R • Urine C/S • US of kidneys • KUB • Retrograde pyloegram • Renal CT/MRI

6. A male named Anwer Jamal, age 45 years, married, visited Clinic Rafaheaam Dawakhana Ajmali on March 29, 2013, with history of glomerulonephritis, inherited renal diseases, hypertension and previously hooked on voltaren 50 (Diclofenic Sodium, 50 mg) and was not on dialysis. Different diagnostic parameters showed the patient was suffering from acute renal failure according to the RIFLE criteria. The patient was treated and managed with herbal medicines according to Unani system of medicine. Reversal of the parameter such as serum creatinine from 7.90 mg/dl (6.58 fold high) to 0.81mg/dl within two weeks clearly shows the remarkable recovery in a short period of time. During this period the other related parameters e.g. blood urea nitrogen (BUN), serum albumin, albuminuria, blood pressure were also normalized whereas clinical sign and symptom exhibited improvement. . Research Presentation _Abstract

7. Pateient Kidney Function Test

8. Unani (Herbal) Medicine • MajunMussafiKhasChob Chini (Smilax chinensi Linn), SennaMakki (Cassia senna Linn), Turbud (IpomeaturpenthumR.Br.),NigandBabri (Vitexnegundo Linn). • QursRasoot: Rasoot (Berberisaristata D.C.) HaleelaZard (Terminaliachebula Retz half ripe fruit) • QursPodina: Zinjabeel (ZingiberofficinaleRosc), Kala Zeera (Carumcarvi Linn), Podina (Menthapiperita Linn), Ajwain (Trachyspermum ammi (L.) Sprague), Filfil Daraz (Piper longum Linn) at noon after lunch; • Habb e Sibr(Aloe vera L. Burm f.) or constipation, • ItrifalKishnizi: HaleelaZard (Terminaliachebula Retz) , and Haleela Siyah (Termineliachebula Retz. uripe fruit) and Kashneez (Coriandrumsativum Linn) , • Hab-e-Fishar (Rauwolfiaserpentina (L.) Benth ex Kurz) for blood pressure) at night after meal.

9. Unani Medicine priscription 2 &3 • MajunMussafiKhasChob Chini (Smilax chinensi Linn), SennaMakki (Cassia senna Linn), Turbud (IpomeaturpenthumR.Br.),NigandBabri (Vitexnegundo Linn). • Sherbet Bazoori: Kasni (Cichoriumintybus Linn), Kharpazza (Cucumis melo Linn), Badyan (Foeniculum vulgare Mill) • Sodium bicarbonate Tablet after meal; • ItrifalKishnizi: HaleelaZard (Terminaliachebula Retz) 0.43 mg, and Haleela Siyah (Termineliachebula Retz. uripe fruit) 0.21 mg and Kashneez (Coriandrumsativum Linn) 0.21 mg. • Unani Prescription 3. JawarishZarooniSaida

10. Follow up • On 08 May, 2013, serum creatinine 0.87 mg/dl. urine specific gravity 1020, pH 6.0, Protein, Blood, Pus cells, Cast, Bacteria was reported NIL Blood pressure was 120/80 mm∙Hg, no lumber pain, no edema, urine output was normal. • On June 12, 2013, the serum creatinine 0.76 mg/dl. urine D/R specific gravity 1.030, pH 6.0, Urine albumin negative, blood nil, pus cell 4 - 6/HPF, RBC, casts, crystals were nil, bacteria reported few and 24 hrs. creatinine clearance(Cr.Cl.) was 64.4 ml/min. (60 - 170 mg dL).

11. Conclusion • Unani herbal preparations have resolved acute kidney injury within 20 days. BUN, serum creatinine and 24 hour serum creatinine clearance levels become in normal ranges. • After 35 days showed sustained improvement. Monitoring for another 15 days showed sustained improvement. Serum creatinine does not rise to abnormal levels until a large proportion of the renal mass is damaged, because the relationship between the glomerular filtration rate (GFR) and the serum creatinine level is not linear, especially early in disease. • The data presented clearly represent where in creatinine level on March 29, 2013 at 7.90 mg dL and on April 15, 2013 it decrease to 0.81 mg dL.

12. Thank you!