A root long used in Indian traditional medicine to shed excess fluid and support the kidneys and liver. Its root compounds calm inflammation and protect kidney and liver tissue in animals, consistently. No properly designed human study of the herb on its own has been published. The largest practical uncertainty is what is actually in the bottle. (Full Review)
| Marker | Target | Why |
|---|---|---|
| eGFR | ≥ 90 mL/min/1.73 m² | Core outcome the herb is taken for |
| Serum creatinine | 0.6–1.0 mg/dL (women), 0.8–1.2 (men) | Detects both benefit and injury |
| BUN | 10–16 mg/dL | Sensitive to volume depletion from diuresis |
| Serum sodium | 137–142 mmol/L | Primary safety marker for excess diuresis |
| Serum potassium | 4.0–4.5 mmol/L | Distinguishes punarnava from loop diuretics |
| uACR | < 10 mg/g | Earliest signal of filtration-barrier change |
| ALT | ≤ 20 U/L (women), ≤ 25 (men) | Detects the documented liver-injury signal |
| AST | ≤ 25 U/L | Pairs with ALT to localise injury |
| HbA1c | 4.8–5.4% | Tracks the animal-derived glucose claim |
| Fasting glucose | 75–90 mg/dL | Catches additive hypoglycaemia with drugs |
| Blood pressure (seated and standing) | 110–125 / 70–80 mmHg | Detects excessive volume loss |
| Blood lead | < 1.0 µg/dL | Addresses the highest-evidence product risk |
| Serum ferritin | 50–150 ng/mL | Only for mandura-type iron formulations |
| Body weight | No fall greater than 1.5 kg in a week | Moves earlier than sodium on excess diuresis |
Cadence: Baseline, then electrolytes and weight at two weeks, the full panel at eight weeks, then every six months, with blood lead annually for continuous users.