Abstract
Background: Clear data reflecting epidemiology of end-stage kidney disease (ESKD) in India and economic burden placed by it are not available due to absence of a registry. The scenario about pediatric ESKD is still worse as the data about etiologies that contribute to ESKD are also not available. Over 90% of patients requiring renal replacement therapy (RRT) succumb to their ESKD as only a few specialized medical centers providing nephrology care are available. Lack of universal access to RRT and financial inability to afford the medical care are also few of the reasons for this. Sixty percent of the patient stop RRT after starting it due to financial restrains1. Unexpected complications after kidney transplantation also put a lot of financial burden on the patient and his/her family. So, a cheaper and easily available treatment should be available to such needy patients.

Case presentation: Father of a 9year-9month-old boy, who had been diagnosed as ESKD patient, sought Ayurvedic treatment for his son. The boy’s serum creatinine was 8.2mg%, urea 154gm%, serum calcium 5.6gm% and phosphorous 7 mg/dl with very severe degree of growth restriction. His weight and height were far below 5 percentiles. His whole-abdomen body sonography revealed small right kidney with poorly maintained corticomedullary differentiation, left kidney not visualized and a couple of 4-5mm-stones in gall bladder. At the time of presentation to our hospital he had already started developing renal rickets with mild degree of knock-knees and difficulty in walking of 10-days duration. His eGFR was < 5.8, which place the patient in stage V of CKD {end-stage renal disease (ESRD)}.

Management and outcome: After clinical evaluation the ayurvedic treatment, which included niruha basti (recto colonic administration of drug) was started. His clinical condition was closely watched as he had come with much elevated serum creatinine; however, the boy responded well psychologically, physically and biochemically. The boy is being followed up till date regularly since his hospitalization here in September, 2015 and the results are very promising in all aspects including physical and biochemical ones.

Key words: End-Stage Renal Disease (ESKD), renal rickets, Gokshuradi guggulu, Niruha basti (recto colonic administration of the medicaments), Punarnavadi kvatha, Rasayana churna