Chronic Renal Failure

Chronic renal failure refers to a decline in the glomerular filtration rate, with resultant increases in urea blood nitrogen (azotemia) and serum creatinine. It is an end stage disease that results from any major cause of renal dysfunction including diabetic nephropathy, polycystic kidney disease and prostatic hypertrophy. CRF can manifest with numerous signs and symptoms, including hypertension, muscular spasm and convulsion, peripheral neuropathies, poor appetite, nausea and vomiting, GI ulceration, malnutrition, and asthenia. Very frequently the skin has a yellowish brown cast and is pruritic, and the mouth has an ammonia-like taste because of excess urates in the saliva. In very rare cases the skin excretes excess urates in the sweat, forming a whitish crystalline excretion called a uremic frost. (Verrelli 2005; Berkow 1992)

Medical treatment

The medical management of CRF is largely focused on delaying or halting progression of CRF, and addressing specific abnormalities in the blood chemistry and pressure caused by CRF, as well the underlying etiology. Hypotensive agents such as ACE inhibitors and loop diuretics are used to control blood pressure and edema. Hyperlipidemia is treated with hypolipidemic agents such as HMG-CoA reductase inhibitors. Hyperphosphatemia is treated with dietary phosphate binders and dietary phosphate restriction, whereas hypocalcemia and hyperparathyroidism is treated with calcium supplements and/or calcitriol. Metabolic acidosis is treated with oral alkali supplementation. Hyperglycemia in diabetics is controlled by hypoglycemics such as metformin or insulin. As CRF progresses and uremia begins to manifest the treatment is then supplemented with dialysis, and if possible, renal transplantation. (Verrelli 2005; Berkow 1992)

Holistic treatment

It is unlikely that holistic treatments will often be considered in CRF, but can be seen to support renal function increase the quality of the life. These therapies will attempt to compliment rather than replace medical treatment, although in CRI holistic therapies may be sufficient to delay or halt the progression of the disease. The holistic treatment of CRI and CRF is orientated towards treating the underlying etiology as well as the endstage condition itself, whether it is diabetes, autoimmune diseases such as SLE and glomerulonephritis, or benign prostatic hypertrophy.

Protein restriction is a subject of considerable debate and concern, due to the formation of urea as a breakdown product, and the resultant stress upon kidney function. In diabetic conditions however such a restriction could speed the progression of the disease. In his book Dr. Bernstein's Diabetes Solution, Richard Bernstein suggests that increasing dietary fat intake (e.g. olive oil) is one possible solution, and is a technique being used many dialysis centers to replace the lost calories (1997, 318).

In Ayurvedic medicine CRI/CRF is treated as vata condition, and treatments are given to decrease vata and restore ojas (rasayana). In Chinese medicine CRI/CRF is recognized as Kidney weakness, and treatments are orientated towards strengthening the Kidney Yin/Yang and Jing. In Western herbal medicine kidney trophorestoratives are used.

• Vatahara, rasayana: Amalaki (Phyllanthus emblica), Shatavari (Asparagus racemosa), Ashwagandha (Withania somnifera), Gokshura (Tribulus terrestris), Amalaki (Emblica officinalis), Brahmi (Bacopa monniera), Guggulu (Commiphora mukul), Arjuna (Terminalia arjuna), Tila (Sesamum indica), Yashtimadhu (Glycyrrhiza glabra), Bala (Sida spp.), Punarnava (Boerhavia diffusa), Shilajit
• Kidney yang/jing restoratives: Lu Rong (Deer or Elk velvet), Dong Chong Xia Cao (Cordyceps sinensis), Yin Yang Huo (Epimedium grandiflorum), Bai Ji Tian (Morinda officinalis), Bu Gu Zhi (Psoralea coryfolia), Du Zhong (Eucommia ulmoides), Xi Yang Shen (Panax quinquefolium), Tian Men Dong (Asparagus cochinchinensis), Shi Hu (Dendrobium nobile), Han Lian Cao (Eclipta prostata), Shu Di Huang (Rehmannia glutinosa)
• Kidney trophorestoratives: Nettle seed (Urtica dioica), Horsetail (Equisetum arvense), Parsley Piert (Aphanes arvensis), Pellitory-of-the-wall (Parietaria diffusa), Hydrangea (Hydrangea arborescens), Cornsilk (Zea mays), Couchgrass (Agropyrion repens), Hawthorn (Crataegus oxycanthoides)