Understanding of Vrikka Vidradhi w.s.r. to Renal Abscess

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ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 141 Understanding of Vrikka Vidradhi w.s.r. to Renal Abscess Dr. Mamatha TS, 1 Dr. Shankar S. Swamy, 2 Dr. S. V. Shailaja 3 1 Post Graduate Scholar, 2 Assistant Professor, 3 Professor & HOD, Department of Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital & Research Centre, Bangalore, Karnataka, INDIA. I NTRODUCTION Vidradhi [1] is a Rakta Dushti Vikara which undergoes rapid suppuration followed by Pooya formation. Antarvidradhi [2] is a Vidradhi Bheda which develops in relation with Koshta . Ahitakara Nidana Sevana leads to Dosha Prakopa in the Kostha which takes Sthanasamshya in Rakta Mamsa Dhatus of different Adhistana that leads to Shopha and Sheegra Vidahitwa, then Rakta and Mamsa gets Paka where Pooya Sanchaya forming Address for correspondence: Dr. Mamatha TS Post Graduate Scholar, Department of Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital & Research Centre, Bangalore, Karnataka, INDIA. E-mail: mamathamanjunath 555@gmail.com Submission Date : 18/08/2018 Accepted Date: 20/09/2018 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 3 i 5.13832 Pakwa Shopha and leads to Vidradhi. Vrikka (Kidney) is derived from the root " Vikkadane " means to take. No direct reference of Vrikka's relation to urine formation is found in either of the Ayurvedic classics. Vrikka are two in numbers and are situated in the lumbar regions on either side in the posterior abdominal wall in Kostha [3] Vrikka is also a maternal contribution derived from essence of Rakta and Meda [4] Sushruta has explained ten different sites [5] of Antarvidradhi , among that Vrikk a Vidradhi is also mentioned and reflect the symptom of Parshva Sankocha , and it can be correlated with Renal abscess. Renal and perirenal abscesses are uncommon disease entities resulting from infections in or around the kidneys. Further more, it is a diagnostic challenge for physicians. A delay in diagnosis may lead to higher morbidity and mortality [6] R ENAL ABSCESS Renal Abscess is a collection of pus around kidney [7] Pus is formed following infection of soft tissue around A B S T R A C T Acharya Sushruta and Charaka , described Vrikka Vidradhi under Abhyantara Vidradhi, Vrikka Vidradhi is also mentioned and reflect the symptom of Parshva Sankocha , and it can be correlated with Renal abscess. Renal Abscess is a collection of pus around kidney. Renal abscess is an uncommon disease caused by trauma and infection associated with kidney stone. Renal abscess is caused by infection with enteric gram-negative bacilli, Staphylococcus aureus is the etiologic agent in 90% of cortical abscess cases. Renal abscesses most commonly occur in individuals with diabetes mellitus with or without urinary tract obstruction Common symptoms in patients with renal corticomedullary abscess include fever, chills, nausea / vomiting and flank or abdominal pain. Percutaneous drainage plus parenteral antibiotics is indicated as the initial treatment for abscesses 3-5 cm in size. In cases that involve perirenal abscess or infected urinoma, also place a percutaneous perirenal drain. Hence an attempt is made to understand Vrikka Vidhradi in relation to renal abscess. Key words: Renal Abscess, Stapylococcus Aureus, Percutaneous Drainage, Vrikka Vidradhi.

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Dr. Mamatha TS et.al. Understanding of Vrikka Vidradhi w.s.r. to Renal Abscess ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 142 kidney or infection of peripheral kidney tissue. Renal abscess is an uncommon disease caused by trauma and infection associated with kidney stone. Renal abscess is caused by infection with enteric gramnegative bacilli, Staphylococcus aureus is the etiologic agent in 90% of cortical abscess cases, often coupled with urinary tract abnormalities Although kidney and perinephric space infections are uncommon, they can cause significant morbidity and carry a risk of mortality. Causes of Perinephric abscess [8] It refers to the collection of pus in the perirenal area. Infection in a perirenal haematoma. Pyonephrosis when it ruptures. Tubercular perinephric abscess. Pus from retrocaecal appendicitis can extend into loin, perinephric area and may present as abscess. The predisposing factors for renal abscesses includes diabetes mellitus (DM), [9] renal calculi, ureteral obstruction, vesico ureteral reflux (VUR). Intravenous drug abuse (IVDA), chronic debilitating disease and immuno-compromised status are other less common causes. Pathophysiology Renal cortical abscess results from hematogenous spread of bacteria from a primary extra - renal focus of infection [10] The source is not apparent in up to one third of cases at the time of diagnosis. In contrast, renal corticomedullary abscess develops as an ascending infection by organisms already isolated from the urine. Severe renal parenchymal involvement in combination with corticomedullary abscess is more likely to extend to the renal capsule and perforate, thus forming a perinephric abscess. Renal corticomedullary infections include the below acute and chronic infectious processes of the kidney. Cold perinephric abscess from tuberculosis may occur from tuberculous kidney or tuberculosis of a nearby vertebra. Intrarenal abscesses develop within the renal capsule and the perirenal fascia of Gerota. Untreated and fulminant infections can rupture through the capsule and can involve the perinephric space and retroperitoneum. Because the kidneys are positioned retroperitoneally, 3 areas are of considerable importance when discussing infections in this area; Anterior perirenal space - Contains portions of the pancreas, intestine, and colon Perinephric space - Contains Gerota fascia and the adrenals Intrarenal space - Contains renal parenchymal tissue. Spread of infection can adversely affect these vital structures. Once infection spreads to the perinephric spaces, percutaneous or open surgical drainage is required. Identifying and treating an intrarenal abscess before capsular invasion occurs can prevent perinephric and retroperitoneal spread of infection to avoid further complications. C LINICAL FEATURES Sympotoms [11] 1 Patients usually present with persistent pyrexia, chills and renal pain. 2 sympotoms of vesical irritability are almost unknown. 3 A few cases may give previous history of renal calculus. Physical Signs a Extreme tenderness over the affected kidney is the main physical sign available. b The kidney may be palpable and tender, though adequate muscle spasm may stand in the way of better palpation. Diagnosis of this condition depends entirely on the clinical examinations Patient’s back is inspected in sitting posture. Slight fullness may be detected just below the last rib and lateral to sacrospinalis muscle on comparing with the opposite side the abscess is

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Dr. Mamatha TS et.al. Understanding of Vrikka Vidradhi w.s.r. to Renal Abscess ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 143 often related to the upper pole where no swelling can be detected but less frequently such abscess may be related to the lower pole of the kidney when a swelling in the renal area can be seen. The patient is now instructed to lie prone on examining table while doing renal angle test muscular rigidity is felt on the affected side. In straight X-ray psoas shadow is obscured, there may be reactionary scoliosis with concavity towards the abscess. The daiphragam is raised and immobile on the affected side. Definite diagnosis is made by CT and Ultrsonography. Renal ultrasonography [12] is a rapid and relatively inexpensive initial screening tool for detecting parenchymal lesions and anatomic abnormalities. The presence of an ill-defined renal mass with lowamplitude internal echoes and disruption of the corticomedullary junction is suggestive of an intrarenal abscess. Computed tomography scanning is by far the study of choice in evaluating intrarenal abscesses and helps in characterizing infections as diffuse or focal, for detecting the presence of gas and to determine perinephric extension Magnetic resonance imaging usually offers no additional information. Plain radiography may show radio-opaque stones in the case of calculus induced obstruction or intraparenchymal gas in patients with emphysematous pyelonephritis. In the past, surgical debridement, drainage and nephrectomy were widely used to treat corticomedullary abscesses. With the advent of effective antibiotics along with percutaneous techniques, the open surgical approach is now reserved for only more severe, refractory cases. Treatment Acharya Sushruta practised Bhedana Karma and Siravyadha [13] in Antarvidradhi as emergency management in order to save the life of the patient which highlightens the importance of Shalya Chikitsa as Pradhanatama Samanya Chikitsa Apakwavastha - Rakta Shodhana, Rakta Prasadana Pakwavastha - Bedhana, Shodhana and Ropana Samanya Chikitsa in Apakwa Avastha [14] Varunadi Gana Aushadhas with Ushakadi Gana Churna as Kashaya Pana Virechana with Ghrita preparation Asthapana and Anuvasana Madhu Shigru with suitable Sahapana o Vatika - Dhanyamla o Paittika - Jala o Kaphaja - Gomutra Guggulu, Shilajatu, Shunti, Suradaru Prayoga. Samanya Chikitsa in Pakvavastha Bhedana or enhance the spontaneous Visravana. Intake of Madhusigru and Varunadi Gana Aushadhas with Sahapanas like Maireya, Surasava, Amla Kanchika. Virechana with Trivruta ,Tilwaka Ghrita daily in the morning. All the treatments should be followed by Pathya Ahara Seva Successful treatment of renal abscess requires the use of approximate antibiotics along with percutaneous drainage. Early diagnosis and treatment of renal and perinephric abscess is important to prevent complications of septicemia or even death. Percutaneous drainage is as effective as open surgery for large and medium renal abscesses. Small abscesses may be effectively treated with a course of intravenous antibiotic therapy [15] DISCUSSION Renal cortical abscess results from hematogenous spread of bacteria from a primary extrarenal focus of infection. The source is not apparent in up to one third of cases at the time of diagnosis. Antar Vidradhi

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Dr. Mamatha TS et.al. Understanding of Vrikka Vidradhi w.s.r. to Renal Abscess ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 144 is a Darunatara Roga which needs an early diagnosis and early management. Sushruta has explained ten different sites of Antarvidradhi , among that Vrikka Vidradhi is also mentioned and reflect the symptom of Parshva Sankocha and it can be correlated with Renal abscess Even though Vrikka Vidradhi is one among Abhyanthara Vidradhi , it can be managed with Abhyanthara Chikitsa along with the Shastra Karma. Immunity is highly related with the onset of Antarvidradhi in relation with abscess. So Balyakara Ahara, Balya Vihara and Rasayana Aushadhis can be adviced to the patients to get complete relief from such conditions and also to prevent the reoccurance. Advanced technology for diagnosis of renal abscess like USG, X-ray, MRI, Complete Blood Count, Urine, Pus culture etc., are practiced. With the help of these tools diagnosis of Vrikka Vidradhi can be made precisely on evidence based on investigations which may be helpful to correlate with renal abscess CONCLUSION Vrikka Vidradhi is a condition where in there is Parshwa Prusta Kati Graha, Vedana, Jwara, Parshwa Sankocha, Pooya Mutrata and Rakta Mutrata are the common Lakshanas seen in Vrikka Vidradi. Antar Vidradhi is a life threatening condition which needs Chikitsa in the Apakwavatha itself, so prevention is better than cure. Follow Bala Vridhikara Bhavas , try to hold on Sadvritha so that a healthy life is awaiting for all and also for the coming generation. REFERENCES 1 Susruta Samhita of Susruta with the Nibandha Sangraha Commentary of Sri Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya: 2014, Published by Chaukhamba Surbharati Prakashan, Varanasi, Nidanastana, 9 th chapter, pp-824, pg no:301. 2 Susruta Samhita of Susruta with the Nibandha Sangraha Commentary of Sri Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya:2014, Published by Chaukhamba Surbharati Prakashan, Varanasi, Nidanastana, 9 th chapter, pp-824, 15 th shloka pg no:303. 3 Sushruta, Sushruta Samhita, with Nibandha Samgraha commentary of Dalhana edited by Vaidya Yadavaji Trikamji Aacharya, Chaukhamba Surbharati Prakashana, Varanasi, Nidaana Sthaana 9/18 reprint edition 2010. pp-824, pg no:304 4 Sushruta, Sushruta Samhitaa, with Nibandha Samgraha commentary of Dalhana edited by Vaidya Yadavaji Trikamji Aachaarya, Chaukhamba Surbharati Prakashana, Varanasi, Shareera Sthana 4/30 reprint edition 2010, Page 357. pp-824, 15 th shloka pg no:303 5 Susruta Samhita of Susruta with the Nibandha Sangraha Commentary of Sri Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya: 2014, Published by Chaukhamba Surbharati Prakashan, Varanasi, Nidanastana, 9 th chapter, pp-824, 18 th shloka pg no:303. 6 Yen DH, Hu SC, Tsai J, Kao WF, Chern CH, Wang LM, et al. Renal abscess: early diagnosis and treatment. Am J Emerg Med. 1999;17:192–197. [PubMed]. 7 e-pain Assit, Pramod Kerkar, MD,FFARCSI, Pain Assist Inc.Last Modified On:February 2018 8 Manipal Manual of Surgery, 4 th edition, chief editor: K Rajgopal shenoy, Anitha Shenoy (Nileshwar), CBS Publishers and Distributors Pvt Ltd, pp-1193, pg no:952 9 NP Jaik,et al., Renal Abscess. JAPI . VOL. 54 .MARCH 2006 pg.No-241-243 10 Aaron Benson, MD Staff Physician, Department of Urology, Southern Illinois University School of Medicine, Renal corticomedullary abscess, Medscape. Updated:Jun 28, 2018 11 A Concise Text Book of Surgery, 9 th edition Somen Das, Published by Dr. S Das, Kolkata, Pp-1374, pg No- 1197 12 Acute pyelonephritis complicated with renal abscesses. Lal A, Singhal M. Indian J Nephrol 2007;17:87-8. 13 Sushruta Samhita of Sushruta with the Nibandha Sangraha Commentary of Sri Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya: 2014, Published by Chaukhamba Surbharati Prakashan, Varanasi, Sharirasthana, 8 th chapter, pp-824, pg no:381. 14 Sushruta Samhita of Sushruta with the Nibandha Sangraha Commentary of Sri Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya: 2014, Published by

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Dr. Mamatha TS et.al. Understanding of Vrikka Vidradhi w.s.r. to Renal Abscess ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 145 Chaukhamba Surbharati Prakashan, Varanasi, Chikitsasthana, 16 th chapter pp-824, pg no:465. 15 Percutaneous drainage of renal and perinephric abscess. Gerz of S G Urol. Radiol, 1981;2(3):171-9. ******************************* How to cite this article: Dr. Mamatha TS, Dr. Shankar S. Swamy, Dr. S. V. Shailaja. Understanding of Vrikka Vidradhi w.s.r. to Renal Abscess. J Ayurveda Integr Med Sci 2018;5:141-145. http://dx.doi.org/10.21760/jaims.v 3 i 5.13832 Source of Support: Nil, Conflict of Interest: None declared.

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