The medical response to trench nephritis in World War One

Abstract

Around the 90-year anniversary of the Battle of the Somme, it is important to remember the international effort that went into responding to the new diseases, which appeared during the First World War, such as trench nephritis. This condition arose among soldiers in spring 1915, characterized by breathlessness, swelling of the face or legs, headache, sore throat, and the presence of albumin and renal casts in urine. It was speedily investigated by the military-medical authorities. There was debate over whether it was new condition or streptococcal nephritis, and the experts agreed that it was a new condition. The major etiologies proposed were infection, exposure, and diet (including poisons). Research pointed to the origin of the disease as being infective rather than toxic, but no definite cause was discovered. A number of labels were given to the disease, including war nephritis. However, trench nephritis was the one used most widely. Trench nephritis was a serious problem for the Allies, leading to 35 000 casualties in the British and 2000 in the American forces. There were also hundreds of deaths. The condition was treated in line with pre-war regimens designed for acute nephritis. No significant preventative methods were implemented for trench nephritis, as there was no consensus regarding causation. The medical response to trench nephritis was largely ineffective, with medical commentators recognizing that there had been a lack of medical progress.

Undifferentiated Febrile Illnesses Amongst British Troops in Helmand, Afghanistan

“…Hantavirus was probably the cause of more than 35 000 cases of "trench nephritis" in British troops on the Western Front during World War I [46], it caused more than 3000 military cases of "epidemic haemorrhagic fever" during the Korean War [47] and also affected British troops during the last Balkans Conflict [48]. More recently there have been cases of Lassa fever in military peacekeepers working in Sierra Leone [49].…”

“…Dengue fever [20,[34][35][36] Sandfly fever [37,38,39,40] Chikungunya [41] Japanese encephalitis [20,42] West Nile fever [43] Yellow Hantavirus infection [46][47][48] Lassa fever [49] Other viruses Infectious mononucleosis [50] [1] and in May to July 2007 there were 14 cases that presented at the British field hospital there. Several of these patients had leukopenia, thrombocytopenia or raised liver transaminases, but no diagnoses were possible using the investigations available, which included blood films, malaria antigen tests, chest radiographs and cultures of blood, faeces and urine.…”

Undifferentiated febrile illnesses in military personnel

“…Although the names of these syndromes suggest quite specific clinical features, many cases will initially present with a UFI. Hantavirus, probably the cause of trench nephritis in World War 1,39 was first identified following outbreaks throughout the Korean War40 and occurred in British troops during the Balkans conflict 41. Even when characteristic features are present, it is difficult to distinguish hantavirus infection from leptospirosis.…”

Wars, disasters and kidneys

“…A neglected area of research is the group of diseases that bear the name of the trenches, namely trench fever, trench nephritis and trench foot. [14][15][16] Trench fever was a short-duration relapsing fever spread by lice; trench foot involved pain and swelling of the feet due to exposure to cold and damp, which could lead to gangrene. Trench nephritis occurred secondary to an unknown cause but there are arguments to believe that at least many cases of trench nephritis were caused by Hanta virus disease (see below).…”

“…acute myopia and localized oedema) and with repeatedly negative findings for leptospirosis in the patients, a new field-like fever disease ('Kriegsnephritis') was suspected. 24 Extensive investigations on both sides of the front during and after World War I yielded no clear aetiology, but a viral cause (a filter-passer) was already suspected early 15,21 (Dr Jan Clement, personal communication). Although a combination of several conditions could have been responsible for these epidemies (acute tubular necrosis, acute interstitial nephritis, glomeronephritides) there is more and more, be it indirect and retrospect evidence, that Hantaan virus infection and Hanta virus nephropathy could have been a major cause (see below).…”