Kidney diseases do not usually give us sufficiently distinctive signs or symptoms to tell us what is causing them. Sometimes, it is obvious, such as in someone who has long-untreated diabetes mellitus or high blood pressure (if they are well treated, these conditions don't or minimally hurt the kidneys, by the way). But even in some patients like this, they have kidney disease that seems too extreme to be explained just by these conditions, or treating the diabetes or blood pressure doesn't seem to help their kidneys. At least 10% of everyone with kidney disease has an autoimmune condition, and usually we can only diagnose this with a biopsy.

In all cases, if we don't know the disease(s) damaging the kidneys, the treatment we choose could easily be wrong. This is one of the worst outcomes, as it wastes time, potentially letting the kidney disease get worse due to using the wrong treatments (besides wasting the patient's money!).

Here is a good example. A consulted with a 54-year-old man who had high blood pressure for about three years. He took a medication at first, but stopped due to side effects and unfortunately didn't implement any other treatment (and wasn't really offered any choices by his conventional provider). Unfortunately, he then collapsed one day in church, and it was found his blood pressure was through the roof. In the emergency room, it was found he was in serious kidney failure, and it was assumed he had chronic high blood pressure causing kidney damage. He ultimately had to be put on six different medications at the same time to control his blood pressure. He still felt terrible from the kidney failure, but now also had new side effects from all the drugs.

Right way this did not sound right to me. Usually it takes more than 10 years for chronically high blood pressure to hurt the kidneys. He only had a problem for three years. And when it was first diagnosed, it just wasn't that bad. While he should have continued treating the high blood pressure, it seemed highly unlikely the problem was coming from hypertension. It is critical to remember the kidneys are the primary controllers of blood pressure, and that high blood pressure is in fact a common symptom of kidney disease, and not always the cause of it.

So I suggested he get a kidney biopsy. At first he and his wife were skeptical, but they quickly realized this was the only way to figure out what was really going on. His convention provider at first resisted, but the patient ultimately was able to convince him, and get a kidney biopsy. It turned out he has a disease called IgA nephropathy that was attacking his kidneys. This was the cuase of the high blood pressure. Now that I had the correct diagnosis, I could recommend the most effective herbs and diet for him, and we were able to move him out of stage 5 kidney failure back up to stage 4. This is critical as it stops all discussion of implementing dialysis. We were able to get him off half his blood pressure medicines within a few months while keeping his blood pressure under control. He has done much better. Unfortunately, he hasn't been able to improve much beyond this, as so much damage was done to his kidneys. If he had gotten a diagnosis sooner, things could have turned out better, but this was still a better result than dialysis or transplant!

Conventional providers are often hesitant to do biopsies because they don't have that many specific treatments for individual kidney diseases, or at least they think so. But more and more drug options are even becoming available (for example, for IgA nephropathy, several new drugs have been approved to treat this condition in the last 10 years). And of course they don't really know anything about natural medicine approaches. But these can be very different depending on the diagnosis, which often only a biopsy can tell us.

Another crucial point is that there are naturopathic treatments to reverse scar tissue in the kidneys. This is considered largely impossible in conventional medicine, so determining the degree and severity of kidney scarring is often overlooked. But I have found it helpful in guiding treatment as well as getting a diagnosis. I hate to put people through an invasive procedure, but the rewards have always been so high it has been worth it in every case.

Not everyone needs a biopsy. Often if there is a clear cause, usually when someone has a clear history of long un- or poorly-treated diabetes or hypertension, and now had kidney disease, we can initiate treatment on this basis. If we see good results, there is no need for a biopsy. If there isn't improvement, I will start to push for one so we can figure out if we're missing something else. Most often though, it is patients without a clear cause for their kidney disease who will almost always profit from a biopsy.

If you have questions, don't hesitate to schedule and I can talk through whether a kidney biopsy makes sense from my perspective, and help support you through the process of getting one if that is what you decide to do. It really is a minimally traumatic procedure with modern ultrasound-guided procedures. In 30 years, I've only had one patient develop bleeding afterward, and that stopped without treatment in just a couple of hours! Given how safe it almost always is, and how much we can learn from the process, I have found myself in the paradoxical position of being the naturopathic doctor pushing for more of these than conventional nephrologists.

First, it is becoming more and more clear that a prostate MRI should be done before any biopsy. There are several reasons why:
    1. Many MRIs show there is no cancer, and thus a biopsy would be a waste of time.
    2. If an MRI does show a spot that might have cancer, the biopsy can be targeted to that area instead of being somewhat random.
    3. Almost always, this means a biopsy can be limited to just 1–3 samples being taken, instead of the standard of 12 more more.
    4. The MRI can also show other important information such as the size of the prostate, if the seminal vesicles, urinary bladder, lymph nodes, or bones in the area are being affected.

Overall, prostate MRIs help reduce the number of prostate biopsies, which is a very good thing, while providing lots of other information ultrasound-guided biopsies can’t deliver, or aren’t as good at assessing.

It is crucial that the MRI is done on a 3 Tesla strength machine (older MRI machines had 1.5 Tesla magnetic fields and are not sufficient for seeing the prostate). If you have concerns about the contrast material used in MRIs, we have natural options to help counter the low risk of side effects they may cause.

A proper MRI will give what is known as PI-RADs score. This is a standardized assessment of how likely it is that serious prostate cancer would be found on a biopsy. Generally speaking only PI-RADS 4 or 5 lesions should be biopsied, and sometime even these prove not to be cancer. If there is only a PI-RADS 3 lesion, then usually it means no biopsy is needed and a repeat MRI should be done in a year (almost always without contrast on this follow-up imaging). PI-RADS 1 and 2 lesions never need to be biopsies.
There are other tests Dr. Yarnell can discuss with you as well to help determine if a biopsy is necessary in the first place.

Second, if the MRI shows an issue or a prostate biopsy is going to happen, it is imperative that it be a transperineal, not a transrectal biopsy. Currently over 90% of prostate biopsies are done through the rectal wall, which does provide good and fairly easy access to the prostate. However, this brings with it a quite high risk of infection, including potentially deadly sepsis. This risk is so high, that the entire country of Norway has essentially abandoned transrectal prostate biopsies, and in 2021 the European Association of Urology agreed, saying only transperineal biopsies should be done. In this type, the needle or needles are placed through the skin between the base of the penis and the anus. While a bit more challenging for the urologist, it provides just as good information and is dramatically safer.

Dr. Yarnell can help explain all these options to you, and help advocate with your urologist to make sure you get an MRI when appropriate. If it appears a biopsy is recommended, Dr. Yarnell will help support you getting a transperineal biopsy focusing only on problem lesions, and not a transrectal biopsy or a fishing expedition all over your prostate. Furthermore, he can provide natural treatments to go with the biopsy to reduce the already very low risk of side effects even further.

Some patients are concerned that a biopsy will spread cancer. Two studies have looked into this concern with prostate biopsies. One found that while very rarely you could find evidence of prostate cancer cells in the blood after a biopsy (just 4 cases out of 42 studied). This supports the long-held naturopathic notion that the immune system can take out a few errant cells that might escape during a biopsy. Another study found that in just 2% of prostate biopsies was there any evidence of cancer cells being pushed around inside the prostate by the needle. Given that the rate of prostate cancer mortality has gone down despite the near tripling of the number of prostate cancer biopsies being performed, it is highly unlikely that prostate biopsies cause any significant amount of cancer spread. Again, Dr. Yarnell can recommend some supplements to help reduce this already extremely low risk if you wish.
If you want a forward-thinking doctor who really puts patients first, stays up-to-date on the latest findings, and can implement a science-informed natural approach to prostate problems of all kinds, then call and make an appointment to see Dr. Yarnell.

Bastacky SS, Walsh PC, Epstein JI (1991) “Needle biopsy associated tumor tracking of adenocarcinoma of the prostate” J Urol 145(5):1003–7. 

Midiri F, Vernuccio F, Purpura P, et al. (2021) “Multiparametric MRI and radiomics in prostate cancer: A review of the current literature” Diagnostics (Basel) 11(10):1829.
​
Moreno JG, O'Hara SM, Long JP, et al. (1997) “Transrectal ultrasound-guided biopsy causes hematogenous dissemination of prostate cells as determined by RT-PCR” Urology 49(4):515–20.

Wolinsky H (2023) “Death Spurs Country's Shift to Safer Prostate Biopsies” Medscape Medical News, March 15

These tainted products are dangerous for many reasons. First, you don't know the drugs are there in most cases, so you might falsely attribute the benefits of the supplement to the supplement and not the hidden drugs, leading you to take more and risking greater harms. Second, you have no idea what dose of the drugs you are taking. Third, some of these drugs are seriously dangerous at any dose. For instance, sibutramine, an appetite-suppressant, is not legally for sale in most countries due to its dangerous effects on the cardiovascular system. Anabolic steroids are associated with infertility, a three-fold increased risk of dying as well as higher rates of acne, gynecomastia (breast enlargement), and erectile dysfunction. Fourth, there is no way to know if you might have drug-drug interactions, depending on what else you are already taking. Finally, these adulterated products make it seem like all or most natural products for sale are dangerous, when in fact it is only some bad actors selling dangerous garbage. There are plenty of ethical, high-quality companies that would never sell adulterated products.

So if you are having problems with erectile function or want to lose weight, consult with knowledgeable health professionals, and do not trust anything you can buy online for these problems without a practitioner referral. Properly-trained professionals know which brands and products are not adulterated and can help steer you in the right direction.

The FDA's post about this problem can be read in its entirety here (as of 1 Jan 2021).

The FDA's tainted dietary supplements database can be accessed here.

Large trials of screening for prostate cancer have failed to include black men at levels commensurate to their representation in the population, and arguably not mirroring the known fact  that they are at higher risk. This may well stem from prior episodes of racism in medicine, such as the infamous Tuskegee experiments in which African-American men with syphilis were denied treatment (or given placebos and told they were actually drugs) to observe the effects of the disease. These and many other terrible experiences have led to low levels of trust in the black community for medical research. The medical community is reaping as they have sown.

Antwi S, Tucker TC, Coker AL, Fleming ST. Racial disparities in survival after diagnosis of prostate cancer in Kentucky, 2001-2010. Am J Mens Health 2013;7(4):306-316.

Dess RT, Hartman HE, Mahal BA, et al. Association of black race with prostate cancer-specific and other-cause mortality. JAMA Oncol 2019;5(7):975-983.

Krishna S, Fan Y, Jarosek S, Adejoro O, Chamie K, Konety B. Racial disparities in active surveillance for prostate cancer. J Urol 2017;197(2):342-349.

Pinsky PF, Ford M, Gamito E, et al. Enrollment of racial and ethnic minorities in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. J Natl Med Assoc 2008;100(3):291-298.

Research shows that doctors at the top of the list in terms of payoffs from drug and device companies do not reveal such payments a shockingly large amount of the time when writing journal articles (62% of the time in the study cited below!). The system of publishing research about medicine relies on self-disclosure of potential conflicts of interest by authors. Unfortunately, these data show the system is broken. Medical journals need to mandate such reporting, and actually double-check whether authors are telling the truth using these readily available public sources of information.

You might think getting a free meal or two from a drug company wouldn't have a major impact on doctors' medical behavior. Unfortunately, the evidence is clear that such bribes do have an impact. Doctors who get the most meals prescribe the fewest generic (i.e. cheaper, usually) drugs and change their behavior in other ways that favors the drug companies.

Doctors also frequently receive free samples from drug companies. While this seems obviously beneficial to patients, the reality is that such practices also influence doctors to then prescribe those drugs more often, and they are usually expensive, patented drugs and not cheaper or generic alternatives.

Basically all major pharmaceutical companies engage in illegal marketing practices, and have paid large fines as a result of them over the years. Arguably though, these fines are a pittance compared to the massive profits these companies make. So it shouldn't surprise us when drug and device companies are trying to influence and corrupt doctors. Though pharmaceutical and medical device marketing has been steadily rising every year, enforcement of rules against deceptive marketing and other malfeasance is on the decline. You can read a detailed reporting of these crimes here:

Final note: Dr. Yarnell is president and part owner of Heron Botanicals and does make money off the sale of herbal products produced and marketed by this company. He is also CEO of Red Root Pharmaceuticals which currently has no products but is trying to get a botanical formula approved by the FDA to treated polycystic kidney disease.

–Ziai K, Pigazzi A, Smith BR, et al. Association of compensation from the surgical and medical device industry to physicians and self-declared conflict of interest. JAMA Surg 2018;153(11):997-1002.
DeJong C, Aguilar T, Tseng CW, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical industry-sponsored meals and physician prescribing patterns for Medicare beneficiaries [published correction appears in JAMA Intern Med. 2016 Sep 1;176(9):1411-2]. JAMA Intern Med 2016;176(8):1114-1122.
Morgan MA, Dana J, Loewenstein G, Zinberg S, Schulkin J. Interactions of doctors with the pharmaceutical industry. J Med Ethics 2006;32(10):559-563.
Schwartz LM, Woloshin S. Medical marketing in the United States, 1997–2016. JAMA 2019;321(1):80-96. 

First, if you have symptoms, it is more likely that you have an enlarged prostate (BPH) or prostatitis causing the elevation. Find out first if this is the case, treat these problems (there are effective naturopathic approaches for both, or else using drugs or surgery if necessary) and repeat the PSA test only after they have been resolved. If they cannot be resolved, then the PSA test is probably useless as a cancer screening test for you. Getting a prostate biopsy in such circumstances does not appear warranted without some other evidence besides PSA that there might be cancer present.

If you don’t have symptoms, then either wait and retest in 1–3 months or get a urine PCA-3 urine test. Up to 50% of repeat PSA levels come back normal without any treatment. The PCA-3 urine test requires a prostate exam, and has the great benefit of not being affected by BPH or prostatitis. It is more expensive than PSA, but this should change as more of them are done. If the PCA-3 comes back <35, then no biopsy should be done. If it comes back >35, then a prostate biopsy is warranted along with either an endorectal MRI or color Doppler ultrasound of the prostate, two imaging tests that give a broader, more holistic view of the prostate than just a biopsy.

There is growing reason to think that urine PCA-3 testing might be a better option than serum PSA testing over all, and that perhaps the PSA test shouldn’t even be used anymore for screening. See other posts for discussions of the many, many problems with the PSA test. Additionally now we can also include a test (the dauntingly named TMPRSS2:ERG gene fusion) that looks at the severity of any cancer that is detected; combined with the PCA-3 test this is known as the Michigan Prostate Score (developed at and run by the University of Michigan).

Before getting a biopsy, be sure to take modified citrus pectin and to have a plan of what you will do depending on the results. Waiting to see what happens and then deciding on a course of action usually leads to poor choices based on fear rather than good choices based on knowledge without emotions clouding the issues. As much as possible, your entire family should be involved in such decision making. Come in for a consultation with Dr. Yarnell if you would like help in making pre-biopsy decisions, for a PCA-3 test/Michigan Prostate Score, or to get help with any aspect of prostate cancer screening
Summary

• If PSA is elevated and you have symptoms, treat the cause first and don’t get a biopsy without some other reason.
• Retest any PSA result that is elevated in 1–3 months (up to half of them come back normal).
• Get a PCA-3 test (and probably do this instead of PSA in the first place).
• If a biopsy is indicated, make choices on what treatment to do before having the biopsy for all possible scenarios.

References​
Hessels D, Schalken JA (2009) “The use of PCA3 in the diagnosis of prostate cancer” Nature Rev Urol 6:255-61.
Singh R, Cahill D, Popert R, O’Brien TS (2003) “Repeating the measurement of prostate-specific antigen in symptomatic men can avoid unnecessary prostatic biopsy” BJU Int 92(9):932-5.
Stamey TA, Caldwell M, McNeal JE, et al. (2004) “The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?” J Urol 172(4 Pt 1):1297-301.
​Tomlins SA, Day JR, Lonigro RJ, et al. (2016) "Urine TMPRSS2:ERG plus PCA3 for individualized prostate cancer risk assessment" Eur Urol 70(1):45-53.

Most often, IgA nephropathy is detected incidentally in a routine urine test when blood or protein is found. Sometimes it is first noted after a cold or flu episode that leads to blood in the urine. Very rarely the condition starts out as acute failure of the kidneys.

Naturopathic medicine offers a unique ability to work with the totality of your situation. We can help you assess and monitor your condition, help figure out some of the possible underlying causes and treat those, as well as offering natural supportive and corrective treatments. We can work with and even prescribe most of your medications if necessary. We can work with your other providers to determine if some medications might not be needed or doses reduced.


What Causes IgA Nephropathy?
IgA nephropathy is a classic example of a condition in which someone with a genetic predisposition only develops a problem when exposed to one of several potential environmental triggers (thus a “two-hit” condition). It is now known that people who develop IgA nephropathy have a genetic problem with attaching certain sugars to their A type immunoglobulins (antibodies), or IgA, subtype 1. IgA1 antibodies are very unusual in humans for being blood proteins that have so-called O-linked sugars. The enzymes that control which sugars are attached to the IgA1 are mutated in such a way that not very many galactose sugars are attached. The results if the IgA1 don’t work very well. This is only an issue if the body calls out for production of a lot of IgA1: the environmental trigger.

Many studies point to the fact that people with IgA nephropathy have allergic reactions to food (Kovacs, et al. 1996; Coppo, et al. 1991). A particular problem is a reaction to wheat, which is different than celiac disease (Almroth, et al. 2006; Laurent, et al. 1987). These reactions are one of the potential environmental triggers that stimulates lots of IgA1 to be made. They stick onto food proteins but don’t do anything useful. The resulting immune complex (IgA1-antigen complex) then floats through the blood and ends up sticking in the kidneys, provoking inflammation and damage.

Not all patients with IgA nephropathy have food allergies. As noted above, infections are also a common trigger of IgA1 production and thus provoking IgA nephropathy. Getting blood in the urine during an acute infection is known technically as “synpharyngitic hematuria” and is a major hallmark of this condition not seen in most other diseases. Anyhow, it is critically important that the possibility of food reactions be investigated and any problem foods removed to prevent the condition from progressing. The process of determining the foods that we use at Northwest Naturopathic Urology is called an elimination-challenge diet, but if for some reason that can’t be done then there are some much less reliable tests that can be done. Testing for antibodies to gliadin, the compound in wheat that most often triggers an allergic reaction damaging the kidneys, is usually done to help decide whether to remove wheat from the diet.

The way the elimination-challenge diet is done is very important. It is critical to realize that many food reactions are delayed, and also there is no predicting for any single patient what food or foods will be a problem, so just avoiding common antigens (like wheat, gluten, or dairy) is not sufficient. Short eliminations without challenges are also a problem because many reactions are delayed, and there may be no noticeable symptoms (so using urine protein testing is critical to monitor the process). Speaking with Dr. Yarnell about how to properly do an elimination/challenge diet is advised.

Another part of the problem that often underlies IgA nephropathy is known as leaky gut syndrome. In this case, food molecules are absorbed that shouldn’t be, which can trigger the reactions that damage the kidney. A simple urine test is done to determine if this is a problem and whether natural treatments such as glutamine are indicated to help fix the leakiness.

Other Natural Treatments
Several studies have shown that high-doses of fish oil can help decrease the severity of the disease (Hogg, et al. 2006). Most people who treat themselves use far too little to make a difference. We can help you figure out the optimal dose for your body size.

A number of herbal medicines have been used effectively in our practice to help prevent and even reverse some of the kidney damage that occurs in people with IgA nephropathy. Some of the most important herbs of this type include Lespedeza capitata (round-head lespedeza) leaf and flower, Rheum palmatum (rhubarb) root (used at a low-dose to prevent diarrhea), and Parietaria judaica (pellitory-of-the-wall) herb. These herbs are extremely safe. We generally develop an individualized herbal formula to address your condition and help protect your kidneys.

There are several natural therapies, including magnesium and the powerful herb Rauvolfia serpentina (Indian snakeroot), that can help us manage any high blood pressure you may have naturally, Sometimes this allows patients to avoid medications for blood pressure, and sometimes they are used in combination for optimal effects.

Some vitamins may also be helpful for your situation, though this requires analysis of your symptoms and how long you have had the condition to determine.

Does It Work?
We have had four IgA nephropathy patient in 2009. Three of them had relatively mild or early disease, without symptoms other than protein or blood in the urine. Urine protein levels declined or became normal in all three after elimination-challenge diet and with high-dose fish oil and herbal medicines (and occasionally a couple of other supplements). No one has developed any complications attributable to treatment or IgA nephropathy.

One patient seen initially in 2006 has been followed up for years. She had severe disease (present for over 20 years, with high blood pressure and significantly reduce kidney function). She was able to maintain at a functional level for those entire three years until finally she had to go on dialysis. Conventional doctors all said there was nothing she could do but wait until she had to go on dialysis, then get a transplant. Though ultimately in her case this was not prevented, it was at least delayed significantly. Who knows what might have happened if she had seen a naturopathic doctor before the condition got completely out of control.

As of 2004, Dr. Yarnell has worked with 37 patients with a definitive diagnosis of IgA nephropathy, ranging from teenagers to adults. A compilation of their results is still ongoing. Nine with food follow-up definitely had significant improvement; one (described above) improved despite having advanced disease but ultimately had to go on dialysis and then get a transplant. Four did not undertake treatment and did not follow-up, so their outcomes are unknown. At least one patient already on dialysis did not have much improvement, not surprisingly. One patient who already had a transplant due to IgA nephropathy and was showing some signs of rejection has stabilized and stayed stable working with Dr. Yarnell for the past three years.

References
Almroth G, Axelsson T, Müssener E, et al. (2006) “Increased prevalence of anti-gliadin IgA-antibodies with aberrant duodenal histopathological findings in patients with IgA-nephropathy and related disorders” Uppsala J Med Sci 111(3):339–52.
Coppo R, Amore A, Roccatello D, et al. (1991) “Role of food antigens and alcohol in idiopathic nephritis with IgA deposits” Minerva Urol Nefrol 43(3):171-4 [in Italian].
Hogg RJ, Fitzgibbons L, Atkins C, et al. (2006) “Efficacy of omega-3 fatty acids in children and adults with IgA Nephropathy is dosage- and size-dependent” Clin J Am Soc Nephrol 1: 1167–72.
Jenkins DA, Bell GM, Ferguson A, Lambie AT (1988) "Intestinal permeability in IgA nephropathy" Nephron 50(4):390. 
Kovács T, Kun L, Schmelczer M, et al. (1996) "Do intestinal hyperpermeability and the related food antigens play a role in the progression of IgA nephropathy? I. Study of intestinal permeability" Am J Nephrol 16(6):500–5.
Kovács T, Mette H, Per B, et al. (1996) “Relationship between intestinal permeability and antibodies against food antigens in IgA nephropathy” Orv Hetil 137(2):65-9 [in Hungarian].
Laurent J, Branellec A, Heslan JM, et al. (1987) “An increase in circulating IgA antibodies to gliadin in IgA mesangial glomerulonephritis” Am J Nephrol 7(3):178-83.

Standard diagnostic tests for CKD include urinalysis and blood work. If no symptoms are present, oftentimes no more than this cursory work-up is conducted before the patient is basically told to just wait until dialysis is needed. If the patient doesn’t have diabetes, hypertension or heart disease, then the shoulders are shrugged and the patient is counseled to wait and see. This is a travesty, as there is much that can be done during these early stages to aid and even reverse the process with the use of naturopathic and herbal medicine. The need for dialysis can be prevented. The key is finding out what is really going on, and for this, additional tests are often needed.

At Naturopathic Northwest Urology, we usually recommend that at least a kidney ultrasound be performed, and in many cases a kidney biopsy as well, for patients diagnosed with CKD. These additional tests can help determine the underlying causes of disease, particularly autoimmune diseases (glomerulonephritis of various types), polycystic kidney disease, kidney tumors, or chronic/recurrent infections. Even patients with known, long-standing diabetes or hypertension (both well-established and common causes of CKD) are not simply assumed to have CKD due to these conditions, but proven so by ruling out other possible causes and assessing the features of the kidney damage going on. Other testing is often undertaken, depending on what is found, to find the causes of the causes (for example, many patients with IgA nephropathy and other types of glomerulonephritis have a problem called leaky gut which needs to be addressed if the CKD has any hope of being slowed or reversed).

Once a more accurate picture has been obtained, then herbal and nutritional medicine has much to offer in terms of slowing the disease process, providing tissue support, and decreasing or halting the rate of decline. Of course everyone’s case is different and there is no perfect guarantee of results. Herbal protocols are personalized and fine-tuned according to the specific clinical picture and every effort is made to achieve success. We have had numerous patients avoid the need for dialysis by following a customized naturopathic treatment plan.

References
Desruelles J, Delmon A. Clinical trial of treatment of azotemic conditions with an injectable extract of Lespedeza capitata. Lille Med 1969;14(2):83–87 [in French].
Moreillon JJ, Bowden RG, Deike E, et al. The use of an anti-inflammatory supplement in patients with chronic kidney disease. J Complement Integr Med 2013; 10(1): 1–10.
Singh RG, Rajak M, Ghosh B, et al. Comparative evaluation of fosinopril and herbal drug Dioscorea bulbifera in patients of diabetic nephropathy. Saudi J Kidney Dis Transpl 2013;24(4):737–742.
Treasure J. Urtica semen [stinging nettle seed] reduces serum creatinine levels. J Amer Herbalists Guild 2003;4(2):22–25.
Yarnell EL. Botanical medicines used for kidney disease in the United States. Iran J Kidney Dis 2012;6(6):407-418.
Yarnell E. Naturopathic Urology and Men’s Health (Wenatchee, WA: Healing Mountain Publishing), 2001. (Naturopathic Approach to Kidney Disease​ 2nd ed, by Dr. Yarnell, is expected to come out in 2022)