In traditional Chinese medicine, "kidney deficiency" or "shen xu" is a common concept. However, when we try to understand it from the perspective of Western medicine, we need to delve into various physiological and pathological aspects. This article aims to explore the English expression of kidney deficiency and its related medical knowledge.
I. The Concept of "Kidney" in Western Medicine
In Western medicine, the kidneys are vital organs responsible for filtering blood, regulating water, electrolyte, and acid-base balance, as well as producing hormones such as erythropoietin. Unlike TCM, which views the kidneys as encompassing a broader range of functions including reproductive, growth, and development, Western medicine focuses more on their specific anatomical and physiological roles.
II. Symptoms and Manifestations Corresponding to "Kidney Deficiency"
- Fatigue
In Western medicine, chronic fatigue can be associated with many conditions, and one possible cause is kidney dysfunction. When the kidneys fail to effectively remove waste products from the body, these substances can accumulate, leading to feelings of tiredness and lethargy. For example, uremic patients often experience severe fatigue due to the buildup of toxins.
- Edema
The kidneys play a crucial role in regulating fluid balance. If there is kidney damage, such as nephrotic syndrome, it can lead to proteinuria, causing a decrease in plasma albumin levels. This results in reduced plasma colloid osmotic pressure, allowing fluid to leak into the interstitial spaces and causing edema, typically starting in the eyelids and lower limbs.
- Changes in Urination
Frequent urination, especially at night (nocturia), may indicate impaired kidney function. In conditions like chronic pyelonephritis or renal tuberculosis, the kidney's ability to concentrate urine is compromised, leading to increased nocturnal urine output. Additionally, hematuria (blood in urine) or proteinuria (protein in urine) can also be signs of kidney problems, suggesting possible inflammation, stones, or other diseases affecting the kidneys.
- Bone Problems
The kidneys are involved in vitamin D activation. When kidney function declines, active vitamin D synthesis is reduced, impairing calcium absorption in the intestines. Over time, this can lead to osteoporosis, bone pain, and even fractures. Children may develop rickets, while adults may experience symptoms similar to those described in TCM as "kidney governing bones."
III. Causes of Kidney Disease from a Western Medical Perspective
- Infections
Bacterial infections, such as acute glomerulonephritis caused by streptococcal infection, occur when bacteria invade the kidneys, triggering an immune response that damages kidney tissue. Recurrent urinary tract infections can also spread upward to the kidneys, causing pyelonephritis.
- Metabolic Disorders
Diabetes is a major risk factor for diabetic nephropathy. Prolonged high blood sugar levels damage the small blood vessels in the kidneys, particularly the glomeruli, leading to proteinuria and progressive loss of kidney function. Similarly, hypertension can cause renal arteriosclerosis, reducing blood flow to the kidneys and resulting in ischemic damage.
- Autoimmune Diseases
Conditions like systemic lupus erythematosus (SLE) can affect multiple organs, including the kidneys. In SLE, autoantibodies attack the body's own tissues, including the kidneys, causing lupus nephritis. This condition presents with proteinuria, hematuria, and potentially progresses to renal failure if not managed properly.
- Drug Toxicity
Some medications, such as certain antibiotics (e.g., aminoglycosides) and nonsteroidal anti-inflammatory drugs (NSAIDs), can have nephrotoxic effects. Long-term use or improper dosing can damage kidney cells, impairing kidney function. Additionally, contrast agents used in imaging studies can sometimes induce contrast-induced nephropathy, especially in patients with pre-existing kidney disease.
IV. Diagnosis Methods for Kidney Diseases in Western Medicine
- Laboratory Tests
Blood tests measure creatinine, urea nitrogen, and other indicators to assess kidney function. Elevated levels suggest impaired filtration. Urinalysis detects abnormalities like proteinuria, hematuria, leukocyturia, etc. Microscopic examination of urine sediment can reveal casts, crystals, and other elements indicative of specific kidney diseases.
- Imaging Studies
Ultrasound is commonly used to visualize kidney size, shape, structure, and presence of stones or cysts. CT scans provide more detailed images, useful for identifying tumors, obstructions, or complex congenital abnormalities. Radionuclide scans help evaluate renal blood flow and function.
- Biopsy
Renal biopsy involves taking a small sample of kidney tissue for microscopic examination. It is essential for diagnosing many primary and secondary kidney diseases, determining the type and severity of lesions, and guiding treatment decisions. Although it is an invasive procedure, it offers valuable diagnostic information.
V. Treatment Approaches for Kidney Diseases in Western Medicine
- Medications
For different types of kidney diseases, various medications are employed. Antibiotics treat bacterial infections; immunosuppressants manage autoimmune-related kidney issues; antihypertensives control blood pressure and reduce proteinuria; diuretics alleviate edema; and phosphate binders manage mineral imbalances in advanced stages. Erythropoiesis-stimulating agents (ESAs) address anemia associated with chronic kidney disease.
- Dietary Management
Patients with kidney disease require tailored diets. Those with chronic kidney disease should limit protein intake to减轻肾脏负担，同时保证足够的热量供应，对于水肿明显的患者，要严格控制盐的摄入量，避免加重水钠潴留，根据血钾水平调整钾的摄入，高钾血症时要限制含钾高的食物如香蕉、橙子等。
- Dialysis and Transplantation
When kidney function deteriorates severely, reaching end-stage renal disease, dialysis becomes necessary. Hemodialysis uses an artificial machine to filter blood outside the body, while peritoneal dialysis employs the peritoneum as a semipermeable membrane within the abdomen. Kidney transplantation offers a potential cure but requires finding a suitable donor and lifelong immunosuppression post-transplant.
VI. Prevention Strategies for Kidney Diseases
- Maintaining Good Lifestyle Habits
Adequate hydration promotes urine production, helping flush out toxins. A balanced diet low in salt, fat, and moderate in protein reduces the risk of hypertension, obesity, and metabolic disorders, all of which contribute to kidney health. Regular exercise strengthens the body's resistance, preventing infections. Avoiding smoking and excessive alcohol consumption also protects the kidneys.
- Timely Treatment of Underlying Conditions
Managing diabetes, hypertension, and other chronic diseases effectively prevents complications involving the kidneys. Routine check-ups allow early detection and intervention for potential problems. Seeking prompt medical attention for symptoms like frequent urination, urgency, dysuria, flank pain, etc., enables early diagnosis and treatment of urinary tract infections and other kidney disorders.
- Caution with Nephrotoxic Substances
Minimize unnecessary exposure to nephrotoxic drugs. When using medications known to affect the kidneys, follow dosage instructions strictly and monitor kidney function regularly. Occupational workers handling chemicals or heavy metals should take protective measures to prevent accidental ingestion or absorption.
In conclusion, although there are differences between the concepts of "kidney deficiency" in traditional Chinese medicine and the understanding of kidney diseases in Western medicine, both emphasize the importance of kidney health. By learning about the relevant knowledge of kidney diseases from a Western medical perspective, we can better prevent, diagnose, and treat kidney problems, thereby
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