Cystone (Renalka) Syrup in the treatment of Urinary Tract by ida17629

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									                      [Indian Journal of Clinical Practice (2001): (12), 4, 63-66]

          Renalka Syrup in the Treatment of Urinary Tract Infection
                                 Jai Prakash, MD, DM, FISH, DNB,
                        Professor of Nephrology, Institute of Medical Sciences,
                       Banaras Hindu University, Varanasi, Uttar Pradesh, India.

                [Correspondence to: Dr. Kala Suhas Kulkarni, M.D., Medical Advisor,
                 R&D Center, The Himalaya Drug Company, Makali, Bangalore, India]



SUMMARY
Forty patients with clinical diagnosis of urinary tract infection (UTI) were selected for the
study. The X-ray for kidney ureter and bladder regions/ultrasonography were done in all
cases and prostate gland was examined in elderly subject for evidence of benign prostatic
hyperplasia. Antibiotics were withdrawn in all the patients. All the patients received Renalka
syrup at a dose of 2 teaspoonfuls, twice daily (i.e. before breakfast and after dinner) for 2-4
weeks depending upon the clinical response. The patients with complicated UTI not
responding to Renalka syrup in a week’s time were given appropriate antibiotics depending
upon urinary pathogens and their sensitivity pattern. The factors responsible for complicated
UTI were noted in each patient. The urine was culture positive in 32 (80%) patients. E. coli
was the commonest organism. Proteus and Staphylococcus saprophyticus were seen in 1 and
3 patients respectively. However, urine was sterile in 8 (20%) patients. The combination of
Renalka and antimicrobial was given in 9 (22.5%) patients with complicated UTI as they did
not respond to Renalka alone in a week’s time. Twenty eight (70%) patients had a good
clinical response to Renalka. The favourable clinical response was observed when Renalka
syrup was combined with antibiotics in patients with complicated UTI. No adverse effects
were seen in Renalka syrup therapy.

INTRODUCTION
Urinary tract infections are common bacterial infections treated in general practice and are
responsible for considerable morbidity in certain groups. Urinary tract infection can be
defined as a condition in which bacteria multiply within the urinary tract, regardless of
bacterial count. Numerous antimicrobial agents are used to treat UTIs with mixed clinical
response. Recurrent UTI, despite treatment with antimicrobial agents is a cause of clinical
concern among patients. Hence alternative agents, other than antimicrobial drugs, that are
beneficial in treating UTIs are required.

MATERIAL AND METHODS
The study was carried out at the Department of Nephrology, University Hospital, Banaras
Hindu University, Varanasi, in forty patients of either sex. Urinary tract infection was
diagnosed using standard criteria for (1) Symptomatic UTI (dysuria, increased frequency,
fever), (2) Urinalysis with pus cells >5-10/hpf, (3) Growth of organism on MSU culture and
(4) covert UTI with positive urine culture.

All the patients included in the study were subjected to a detailed clinical examination,
urinalysis, urine culture, haemoglobin, total and differential leucocyte count, urea, creatinine
and blood glucose estimation. The ultrasonography/X-ray KUB region was done in all the
cases. Prostate was examined in cases aged 60 or above. Paracetamol was used where fever
was above 1010F. Antibiotics were withdrawn in all the patients included in this study.
Renalka syrup was given orally at a dose of 2 teaspoonfuls, twice a day before breakfast and
after dinner for 2-4 weeks depending upon clinical response. The efficacy of treatment was
assessed weekly using clinical/or bacteriological criteria. The patients with complicated UTI
not responding to Renalka syrup in a week’s time were given appropriate antibiotics
depending upon urinary pathogens and their sensitivity pattern. The factors responsible for
complicated UTI were noted in each patient.
                                                             Table 1: Renalka syrup in UTI (n=40)
RESULTS                                                  Study period            April 99 – July 2000
 This study included (male 31; female 9) 40              Total patients          40 (Male 31: female 9)
patients in the age group of 22-82. All patients had     Age range (years)       22-82
documented UTIs; symptomatic UTI in 30 (75%)             Mean age (years)        46 ± 2.8
and asymptomatic UTI in 10 (25%). Asymptomatic           Symptomatic UTI         30 (75%)
UTI (covert bacteriuria) was diagnosed on the basis      Asymptomatic UTI        10 (25%)
of routine urinalysis and culture positive urine in      Uncomplicated UTI       26 (65%)
diabetics, and patients with obstructed urinary tract,   Complicated UTI         14 (35%)
who otherwise had no clinical symptoms of UTI.
Uncomplicated UTI (normal urinary tract and              Table 2: Factors responsible for complicated
                                                                         UTI (n=14)
normal renal function) and complicated UTI were
                                                                                         No. of patients
noted in 26 (65%) and 14 (35%) cases respectively                  Factors
                                                                                              (%)
(Table 1). The factors responsible for complicated       Diabetes mellitus                   6 (42)
UTI were diabetes 6 (42%), prostatic enlargement -       Prostatic enlargement              4 (28.5)
4 (28.5%), and renal stone - 2 (14/2%) patients.         Renal stone                        2 (14.2)
Hydronephrosis and solitary kidney were seen in          Bilateral hydronephrosis             1 (7)
one case each (Table 2). The majority (47.5%) of         Single kidney                        1 (7)
patients with symptomatic UTI had symptoms of
less than a week’s duration. The clinical symptoms           Table 3: Renalka syrup in UTI (n=40)
were of 1-2 weeks duration in 7 (17.5%) and more                                               No. of
                                                                   Parameters
than 2 weeks duration in 4(10%) cases. The                                                  patients (%)
varying grades of renal failure (S. cri. 2.0-3.6                          (<week)            19 (47.5)
                                                         Duration of
mg%) were noted in 6 (15%). The urine was                                 (1-2 week)          7 (17.5)
                                                         symptoms
culture positive in 32 (80%) patients. The                                (>2 week)            4 (10)
commonest organism grown on culture was E. coli          Renal failure
                                                                                               6 (15)
                                                         (S. cri. 2.0-3.6 mg%)
in 28 (70%) patients. Proteus and Staphylococcus
                                                         Culture positive                     32 (80)
saprophyticus were seen in 1 and 3 patients
                                                         Culture negative                      8 (20)
respectively. However, urine was sterile in 8 (20%)
                                                         Renalka alone                       31 (77.5)
patients (Table 3).
                                                         Renalka + Antibiotics                9 (22.5)
 Renalka syrup was used for 2-4 weeks in
                                                   Table 4: Treatment outcome with Renalka syrup
31 (77.5%) patients. The combination of                                (n=40)
Renalka and antimicrobial was given in 9                                             No. of patients
                                                            Parameters
(22.5%) patients with complicated UTI as                                                  (%)
they did not respond to Renalka alone in a Clinical             Renalka alone            28 (70)
                                                response:       Renalka + antibiotic    9 (22.5)
week’s time. Twenty eight (70%) patients
had a good clinical response to Renalka and Drop out                                     3 (75.)
3 patients were lost for follow-up (Table 4). Adverse effect                               Nil
The drug was given for a period of two weeks in a majority of cases and 3 cases continued
the treatment for 4 weeks. The clinical efficacy was assessed by the absence of symptoms of
UTI and negative urine culture. One pregnant woman with UTI (E. coli positive) showed
excellent response to Renalka syrup with respect to clinical symptom of UTI and
subsequently, urine became free of pus cells and was culture negative. She was treated with
various antibiotics prior to Renalka therapy without clinical response. The favourable clinical
response was observed when Renalka syrup was combined with antibiotics in patients with
complicated UTI. No adverse effects were seen in Renalka syrup therapy.

DISCUSSION
A definite diagnosis of UTI can only be made by culturing the urine1,2. Bacterial culture was
positive in 80% patients. Antibacterial agents are a major part of the treatment for UTI,
supplemented with plenty of fluid. Even if symptoms regress in an untreated patient, the
bacteriuria invariably persists. A major error in the management of UTI has been that most
clinicians give too many drugs for too long a period. The aim of treating UTI should be to use
the shortest course of the simplest, safest, and most economical antimicrobial agents that will
eradicate the offending pathogens3-5. The side effects of the chosen drugs should be weighed
against the severity of the illness. The emergence of drug resistance (e.g. E. coli now resistant
to amoxycillin) is another difficult situation in the management of UTI. Due to the side
effects associated with antibiotics and drug resistance, a need for an alternative therapy is
emphasised. Thus an open trial of Renalka syrup in the treatment of UTI in adults was
conducted. Renalka syrup was taken orally by forty patients with UTI. Symptomatic
improvement and urine free from pus cells were noted in 28 (70%) cases, suggesting a good
clinical response. Antibiotics were used in combination with Renalka syrup in 9 cases with
complicated UTI. Such combinations provide better cure of UTI then Renalka alone in
patients with complicated UTI. No side effects were found and only three patients were lost
to follow up.

Renalka syrup contains several ingredients that have a beneficial effect in the management of
UTI like Varuna, Trinapanchmoole (Sariva, Musta and Ushira) and Gokshura6,7. Varuna,
Kulatha, and Gokshura have been used either as single drug or in compound formulations to
manage urinary disorders in ancient classical texts of Ayurveda8. The anti-inflammatory and
antilithiatic effects of Varuna have been proved in experimental animals9. It is proposed that
the anti-inflammatory action of Varuna (an ingredient of Renalka) might have clinical
efficacy in the treatment of UTI.
CONCLUSION
In treating uncomplicated UTI, Renalka syrup is an effective herbal formulation, which is
safe and free from side effects. The patients with complicated UTI who do not respond well
with Renalka alone need antimicrobial agents. Renalka syrup has been used in one pregnant
woman with UTI and has given excellent results. Thus, Renalka syrup is an economical, safe
and effective herbal preparation in the management of uncomplicated UTI in adults.

ACKNOWLEDGEMENT
We are thankful to Dr. S.K. Mitra, MD, Research and Technical Assistants, R&D Center, The
Himalaya Drug Company, Bangalore, India, for arranging the drug Renalka syrup for clinical
trials.

REFERENCES

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6.   Chopra KK. Role of Varuna in Urinary disorders D. Ay. M. Thesis 1970, Banaras
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7.   Sharma M. Urinary Tract Infections and effect of Trinapanchamoola on them. D. Ay.
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     drugs (Varuna Kulattha and Gokshuru), CSRAS Publication, Government of India,
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9.   Chopra RN. Glossary of Indian Medicinal Plants, Council of Scientific and Industrial
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