Trench nephritis

Before the First World War, kidney diseases had been described in medical textbooks by physicians including Sir William Osler in 1909 and Marcus Seymour Pembrey in 1913. In November 1914, in the early months of the First World War, there were four million men living in of trenches, with which three diseases came to be closely associated: trench fever, trench foot, and trench nephritis. File:Indian soldiers in trench, Gallipoli,1915.jpg|Indian soldiers in trenches, Gallipoli (1915) File:Cheshire Regiment trench Somme 1916.jpg|British soldier in trenches, Somme (1916) File:Dressing wounded in trench during the battle of Courcelette. Sept. 15, 1916.jpg|Canadian soldiers in trenches, Somme (1916) File:Italian Soldiers in Trench World War 1.jpg|Italian soldiers in trenches (1918) ==First World War==

Trench nephritis, a term coined by Nathan Raw, Thereafter, the Medical Research Council began to investigate the new disease at St Bartholomew's Hospital, and the findings were discussed during the Royal Society of Medicine meeting in February 1916, with Osler as one of the four key speakers. Affected soldiers presented with sudden onset of albuminuria, high blood pressure, swelling of legs or face, headache, sore throat and difficulty breathing and bronchitis. Casts were seen in the urine. Pathology revealed narrowing of small blood vessels in the kidneys, capillary thrombi, and a proliferation of cells affecting the capillary lumen, suggesting an underlying inflammation of blood vessels. The cause was not established during the war and therefore preventative measures were not implemented. Trench nephritis was ineffectively treated in the same way that acute nephritis had been treated before the war. Research into the condition was stopped in 1918. ==Epidemiology==

Along with other trench diseases such as trench foot and trench fever, trench nephritis contributed to 25% of the British Expeditionary Force's triage bed occupancy and was the major kidney problem of the First World War. The condition led to 35,000 British and 2,000 American casualties, with deaths numbering in the hundreds. The mortality rate of the condition was low, but men took a long time to recover. ==Significance==

Trench warfare was significant in subsequent wars such as the Second World War, the Falklands War and the Gulf War. Trench fever has also been detected during peacetime in homeless alcoholic people and people with HIV. A similar kidney disease was reported in epidemic proportions in 1934 in Sweden. == References ==