Wars, disasters and kidneys

Abstract

This paper summarizes the impact that wars had on the history of nephrology, both worldwide and in the Ghent Medical Faculty notably on the definition, research and clinical aspects of acute kidney injury. The paper briefly describes the role of 'trench nephritis' as observed both during World War I and II, supporting the hypothesis that many of the clinical cases could have been due to Hantavirus nephropathy. The lessons learned from the experience with crush syndrome first observed in World War II and subsequently investigated over many decades form the basis for the creation of the Renal Disaster Relief Task Force of the International Society of Nephrology. Over the last 15 years, this Task Force has successfully intervened both in the prevention and management of crush syndrome in numerous disaster situations like major earthquakes.

Biodefense Implications of New-World Hantaviruses

“…Puumala virus causes a milder form of HFRS called Nephropathia Epidemica (NE) and is spread by the bank vole in Europe (Vapalahti et al, 2003). It is suspected that hantaviruses, specifically PUUV, spread across Europe during WWI in the form of Trench Nephritis which can be attributed to the congestion of soldiers and rodents in tight places, including trench lines that destroyed farmland and undermined infrastructure (Johnson, 2001;Schmaljohn, 2009;Lameire, 2014). Trench diseases, including Trench Foot, Trench Fever, and Trench Nephritis, constituted 25% of the British Expeditionary Force's triage bed occupancy, and when the US entered the war in 1917, 0.54% of their 370,000 military personnel were affected by NE (Lameire, 2014).…”

Nephrology in Bosnia and Herzegovina: impact of the 1992–95 war

“…During wars, the care of wounded and acutely ill patients marginalizes that of residents with chronic diseases dependent on expensive forms of treatment like dialysis [ 1 ]. In this regard, the major difficulties in dialysis treatment we encountered during the war (1992–95) were lack of dialysis supplies, medications, diagnostics and food, lack of processed water for dialysis (using of untreated water), electricity blackouts, lack of fuel for patient transportation, military attacks and the added burden by refugees (31% of the total number of dialysis cases).…”

“…This may well be the proper time to provide the nephrology community with an appraisal of the care of patients with chronic kidney disease (CKD) in the pre-war, war and post-war periods in the European transitional country. Each of the periods described, even during war, had its specificities as well as its good and bad sides, as articulated by Norbert Lameire that ‘in many cases war moves medical practices and innovation forward’ [ 1 ]. In today’s world, it is hard to find a peaceful nook without wars, socio-political turmoil, upheavals or natural catastrophes that affect human health and the ability to care for the needy.…”

A historical perspective on crush syndrome: the clinical application of its pathogenesis, established by the study of wartime crush injuries

“…It is for this reason that the International Society of Nephrology founded the Renal Disaster Relief Task Force in 1989, initially as a relief effort for the Armenian earthquake (1988). Lameire12 discusses the fact that this body, which works closely with Médecins Sans Frontières (doctors without borders), was set up on the basis of discoveries by Minami and Bywater, and the research for the treatment and management of crush syndrome that has been carried out since then.…”

“…Lameire12 describes how in comparison to the London Blitz of 1940–1941, when crush syndrome was almost certainly fatal, by 1999, the mortality rate for crush syndrome was reduced to only 20%. This statistic on the mortality rate of crush syndrome capitulates the significance of contributions by Minami and Bywaters to our current knowledge of crush syndrome.…”