Urology with Yarnell: Chronic Kidney Disease – Part 1

Urology with Yarnell: Chronic Kidney Disease – Part 1

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1 Presentation | 2 hours
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This is the first part of an entire series of Urology with Yarnell: Chronic Kidney Disease. Part 1 (this course) will address the early stages of Chronic Kidney Disease (Stages 1-3). Part 2 will address treating late stage Chronic Kidney Disease (Stages 3-5). Part 3 will address dialysis and kidney transplants. Part 4 will address glomerulonephritides and vasculitis. Lastly, Part 5 will address Polycystic Kidney Disease (PKD).

Chronic Kidney Disease: Screening and Diagnosis (60 mins)

In the beginning of this course, Dr. Yarnell will review the western medical criteria for the diagnosis and staging of chronic kidney disease (CKD). Did you know that the GFR diagnosis criteria for Stage 1 chronic kidney disease (CKD) actually meets the criteria for totally normal and healthy kidney function? Did you know that for Stage 2 you won’t be able to detect chronic kidney disease (CKD) with simply estimated GFR and serum creatinine? You’ll learn these details and so much more in this course. In addition to GFR staging, you’ll also learn how to assess the health of the kidney via the albumin staging criteria.

Dr. Yarnell will overview appropriate screening for and steps toward prevention of chronic kidney disease (CKD). The earlier that CKD can be diagnosed, the more of a chance you’ll have for finding the cause and offering treatment that will completely resolve the problem. Which, of course, is our ultimate goal for our patients. If chronic kidney disease (CKD) can be prevented altogether, this will provide for the best outcome.

Did you know that most people with end stage renal failure (ESRF) ultimately die of cardiovascular disease? Did you know that only testing for serum creatinine and eGFR (estimated GFR) for kidney screening is not enough? By the time the eGFR is <60, your patient has potentially lost half of their kidney function! Learn the tests you need to order to truly screen for early stage chronic kidney disease (CKD).

Don’t be the doctor who doesn’t know or who ignores the signs! Dr. Yarnell shares about a young, 41 year old patient who had persistent proteinuria for 2 years, but because of her age and otherwise apparent health, it was ignored by her PCP. She ended up being diagnosed with IG nephropathy and focal segmental glomerulosclerosis, but had lost 2 years of potential diagnosis and treatment since the signs were ignored.

On that note, do you know what to do if your patient has a one-off elevated protein in their urine? You’ll learn exactly what to do in this course.

You’ll learn the two primary reasons for proteinuria (protein in the urine). You’ll also learn that elevated urine protein or albumin is a HUGE risk factor for cardiovascular disease. (And later on in this course, botanical interventions to help treat it).

Have you heard of Cystatin C (a laboratory test)? You’ll learn about why you might want to order this for your patients!

Do you know what the difference is between GFR and eGFR? It’s important and could mean a really big difference for your patients! Do you know the average normal loss of Glomerular Filtration Rate (GFR) that occurs per year after age 30? This calculation will help you predict where your patient should be at for their particular age and stage.

The beginning portion of this course will support you thoroughly in screening and diagnosing the cause of chronic kidney disease (CKD).

Chronic Kidney Disease: Botanical Interventions (60 mins)

Then, we get to the juicy stuff. Dr. Yarnell shares his experience in using nutritional and botanical interventions in urology. Do you think chronic kidney disease (CKD) patients should be on the kidney failure diet? At what point in their staging and diagnosis? Dr. Yarnell shares that there are times where this diet could be contraindicated and detrimental for their health.

Dr. Yarnell covers general nephroprotective herbs that will strengthen the kidneys – improving filtration and decreasing the leaking of protein. For clinical purposes, Dr. Yarnell breaks up the herbs into two categories: non-immunomodulating and immunomodulating herbs.

The following herbs will be covered in this course. Dr. Yarnell will cover dosing and safety/contraindications for each herb discussed:

  • Parietaria judaica (pellitory[-of-the-wall]) aerial parts
  • Urtica dioica (nettle) seed
  • Rheum palmatum (rhubarb) processed root
  • Lespedeza capitata (lespedeza) aerial parts
  • Crataegus spp (hawthorn) leaf, flower
  • Silybum marianum (milk thistle) fruit
  • Ophiocordyceps sinensis (cordyceps) mycelium
  • Astragalus propinquus (astragalus) root
  • Codonopsis pilosula (dang shen) root
  • Glycyrrhiza spp (licorice) root

Did you know that for Rheum palmatum (rhubarb), you want to use the processed root in chronic kidney disease (CKD) (as the unprocessed root is a cathartic laxative due to its anthroquinone content)? Did you know that the name for Rheum palmatum (rhubarb) in Mandarin is 大簧dà huáng, which means “big yellow” referring to the color of the raw, unprocessed root? How about that for a fun fact?!

Are you familiar with the health benefits of stinging nettle (Urtica dioica) seed? You might be surprised at how clinically useful this part of the plant can be!

Dr. Yarnell will also share two botanical formulations that he uses in his clinical practice to support his patients with chronic kidney disease (CKD). For each formulation, he includes relative percentage of each herb, dosing of the total formulation, as well as rationale for each ingredient. Dr. Yarnell closes the presentation with two case studies of idiopathic chronic kidney disease (CKD).

What You’ll Learn

  • The diagnostic criteria for chronic kidney disease (CKD), including ICD-10 diagnosis codes
  • How to properly medically abbreviate chronic kidney disease (CKD) staging, including medical abbreviation modifications for things like a patient being on dialysis or having a kidney transplant
  • How to appropriately screen for early chronic kidney disease (CKD) (which Dr. Yarnell recommends you do with all of your patients starting at age 40)
  • How to properly apply ICD-10 diagnosis codes for chronic kidney disease (CKD), nephrotic syndrome, proteinuria, amongst other diagnoses
  • Which eGFR to use in North America based on which ethnicity
  • The diagnostic criteria for microalbuminuria and macroalbuminuria
  • The problems with the eGFR lab test – and why!
  • How to properly counsel patients in preventing CKD, particularly when due to diabetic and hypertensive nephropathies
  • How to develop effective and safe nephroprotective formulas for patients with CKD stage G3
  • What is normal renal aging versus actual CKD
  • How to appropriately counsel patients with early-stage CKD on diets that treat the causes (and when to avoid the renal failure diet)

This Course is for You if

  • You are in primary care, work in a general practice, or have patients with kidney disease, or
  • You want to know how to help prevent, screen, and treat chronic kidney disease (stages 1-3) in your patients using naturopathic interventions

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