Trench Nephritis - Causes, Symptoms, Diagnosis, and Management

Introduction:

A trench is a long and narrow excavation in the ground with mounds of dirt at the edge to protect against enemy fire or attack. Long, narrow trenches, usually occupied by infantry for several weeks, were dug into the frontline to protect World War I soldiers from machine gun fire and aerial bombardment. The soldiers were exposed to terrible conditions like fevers, parasites, and infections rampant on the war front, killing thousands of troops living in the trenches. The most common diseases and viruses include influenza, typhoid fever, trench foot, and trench fever.

What Is Trench Nephritis?

Nephritis is a condition in which the tissue of the kidneys becomes inflamed, making it difficult for them to filter waste products from the blood. Nephritis can be caused by infections, inflammatory conditions (such as lupus), certain genetic conditions, and other diseases or conditions. During World War I, nephritis was prevalent among soldiers, especially in the trenches. Unlike post-streptococcal glomerulonephritis, it was characterized by atypical features such as proteinuria, hypertension, edema, sudden onset of dyspnea, bronchitis, early mortality, and frequent relapse.

What Are the Causes of Trench Nephritis?

There was a debate as to whether it was a new condition or strep nephritis, and the research has shown that it was a new condition. Studies have suggested that the origin of the disease is infectious rather than toxic, but no clear cause has been found till now. Causes that could have led to trench nephritis in soldiers are:

• Infections or toxins.

• Autoimmune diseases induced by the stress of the war.

• Strenuous work without water.

• Poor diet.

• Unhygienic conditions.

• Urinating less frequently.

What Are the Risk Factors of Trench Nephritis?

Certain people are at elevated risk of trench nephritis. Risk factors for trench nephritis include:

• Family history of kidney disease and infections.

• Have an immune system disorder such as lupus.

• Excessive use of antibiotics or painkillers.

• Recent urinary surgery.

What Are the Symptoms of Trench Nephritis?

The symptoms of trench nephritis that world war I soldiers presented with were:

• Albuminuria. (excess albumin in the urine).

• High blood pressure.

• Casts in urine.

• Difficulty breathing.

• Bronchitis.

• Pain in the pelvis.

• Pain or a burning sensation while urinating.

• A frequent need to urinate.

• Cloudy urine.

• Blood or pus in the urine.

• Pain in the kidney area or abdomen.

• Swelling of the body, commonly in the face, legs, and feet.

• Vomiting.

• Fever.

What Are the Possible Complications of Trench Nephritis?

The possible complications of trench nephritis are:

• Accumulation of waste products or toxins in the bloodstream.

• Misregulation of essential minerals and nutrients.

• Loss of red blood cells.

• Loss of blood protein.

The following conditions can arise with uncontrolled trench nephritis:

• Acute Renal Failure - Acute renal failure is a sudden, rapid decline in renal function and is often associated with infectious causes of trench nephritis. Accumulation of waste products and fluids can be life-threatening if not treated quickly with an artificial filter (dialysis). Kidneys often restore normal function after recovery.

• Chronic Kidney Disease - Persistent inflammation leads to long-term kidney damage and decreased function. Chronic kidney disease is described as kidney damage or loss of function lasting more than three months. Chronic kidney disease can progress to renal failure, requiring dialysis or a kidney transplant.

• Hypertension - Glomerular damage due to inflammation and scarring can lead to increased blood pressure.

• Nephrotic Syndrome - Nephrotic syndrome is a condition wherein excess blood protein is found in the urine and too little in the bloodstream. These proteins play a role in regulating fluid and cholesterol levels.

When to Get Help for Trench Nephritis?

Urine that contains blood appears brown or pink. People with this sign should see a doctor as soon as possible.

It is recommended to see a doctor for other urine-related symptoms, like painful and frequent urination. Early treatment can prevent permanent kidney damage and more serious complications of trench nephritis.

How Is Trench Nephritis Diagnosed?

Doctors can sometimes diagnose trench nephritis with routine blood or urine tests. Detection of protein in the urine may indicate that the kidneys are not working properly. A blood test measuring the waste product in the blood called creatinine can also provide information about kidney health. However, a biopsy is the best way to confirm the presence of trench nephritis. In this procedure, a doctor removes part of the kidney with a needle and sends it to a laboratory for analysis.

How Is Trench Nephritis Treated?

Treatment of nephritis depends on the cause and type of nephritis:

• Acute nephritis may go away without treatment. However, it usually requires medications and special treatments to remove excess water and dangerous proteins.

• Treatment of chronic nephritis usually includes regular kidney tests and blood pressure monitoring. The doctor may prescribe water pills to control blood pressure and reduce swelling.

• Drugs that prevent the immune system from attacking the kidneys are also sometimes beneficial.

• Doctors can also refer people with kidney infections to a nutritionist to advise them on what to eat to protect their kidneys. A proper diet is usually low in protein, salt, and potassium.

How to Prevent Trench Nephritis?

Although it is not always possible to prevent trench nephritis, certain lifestyle practices can reduce the risk for many people. These practices include:

• Drinking plenty of water regularly.

• Urinating frequently.

• Maintaining proper hygiene and sanitation.

• Maintaining a healthy body weight.

• Cessation of smoking.

• Maintaining a check on blood pressure.

• Regularly exercising.

• Eating a balanced diet can also help protect renal health.

Conclusion:

Trench nephritis is an inflammation of the kidneys along with respiratory symptoms. Causes are varied and can be acute or chronic. Early symptoms include a change in urine color, swelling of the limbs, and breathlessness. People who notice changes in their urine should see a doctor to check for kidney damage. If left untreated, it can also lead to renal failure. Acute episodes of trench nephritis often respond well to treatment, but chronic glomerulonephritis can develop years later. A cure for trench nephritis may not always be available, but proper treatment can control the condition and protect the kidneys. Following the physician’s instructions are important to prevent and limit kidney damage. If kidney failure develops, dialysis or a kidney transplant may be required. Dialysis is a medical procedure that regulates safe levels of blood chemicals by mimicking how healthy kidneys remove waste products and excess water.