This study provides values of renal length (mean ± 2SD) in normal Indian children. Renal length can be easily calculated by derived linear regression equation.

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Our objectives were to determine the accuracy of antenatal sonography for the detection of congenital renal malformations and to characterize the type of malformations, seen in a 3-year prospective study at a university-affiliated maternity hospital. Participants were 31,217 pregnant women, during the study period, and subjects were 65 fetuses in whom renal malformations were detected on antenatal ultrasound. Pelvic ultrasound scans were performed at least once between 20 and 37 weeks' gestation on all pregnant women attending the antenatal clinic of the hospital for the detection of renal malformations. Fetal urinary sampling, diversion procedures, or termination of pregnancy were carried out as required in those detected to have renal anomalies. Postnatal diagnosis was confirmed by sonography or autopsy. Diagnostic procedures and renal surgery were performed postnatally if indicated. Sixty-five fetuses (0.2 per cent) were diagnosed to have congenital renal malformation antenatally at a mean gestational age of 28.4 weeks. A dilated urinary system was seen in 39, cystic renal disease in 15, agenesis/hypoplasia in six, combined lesions in four, and a horseshoe kidney in one. Oligohydramnios was noted in 20 (31 per cent) pregnancies. Multiple congenital malformations associated with renal anomalies were detected in 12 pregnancies. Termination was carried out at 20 weeks in two pregnancies for lethal malformations; fetal urinary sampling was done in two fetuses with obstructed uropathy, and a vesicoamniotic shunt inserted in one. Postnatal ultrasound confirmed a dilated urinary system in 32, cystic renal dysplasia in 15, renal aplasia/hypoplasia in five, combined lesions in six, and a horseshoe and an ectopic kidney in one each. Five infants were found to be normal. There were seven stillbirths and seven neonatal deaths. Radionuclide scans showed obstruction in nine, decreased renal function in six, and absent renal functions in 10 infants. Micturating cystourethrography demonstrated reflux in 11 and a non-refluxing non-obstructive dilated renal system in five babies. Renal surgery was performed in nine infants. The conclusions drawn from this study were that antenatal detection of renal disease is fairly accurate, even in an extremely busy hospital and certain types of malformations reported in other studies were not observed, despite a large cohort.

SUMMARY Immunological studies were performed in 18 children with minimal change nephrotic syndrome proved by biopsy examination during relapse and in 15 age matched controls. All 18 children showed dysfunction of cell mediated immunity as evidenced by low absolute lymphocyte count, low blastogenesis index in response to phytohaemagglutinin stimulation, and reduced skin sensitivity to dinitrochlorobenzene when compared with controls. All 18 patients had low serum IgG concentrations, while the IgA, IgM, and C3 concentrations in the serum were within normal limits.Based on the evidence of depressed cell mediated immunity, 14 patients with nephrotic syndrome were treated with an immunoregulatory drug l-tetramisole (levamisole) for a period of 20-24 weeks. Six patients went into complete remission within 4-20 weeks of treatment, a further six patients went into partial remission, while two did not respond.On follow up (six to 24 months after stopping levamisole), of the six patients who achieved complete remission, four continued to maintain the state and two relapsed after roughly six months. Of the six patients who achieved partial remission, two went into complete remission, two continued to be in partial remission, and two relapsed.A variety of immunological alterations have been described in minimal change nephrotic syndrome. [1][2][3] Conventional treatment with steroids and immunosuppressants, although inducing a remission of the nephrotic state, increases the risk of severe life threatening infections in these children by further depressing the cell mediated immunity.This study was undertaken to evaluate the immunological state of children with minimal change nephrotic syndrome in relapse who were not being given any immunosuppressive treatment and to assess the role of levamisole, an immunoregulatory drug, in the management of this disease in those who showed evidence of dysfunction in cell mediated immunity. Patients and methodsEighteen patients with nephrotic syndrome and 15 controls, all aged between 1 and 12 years, were studied.All 18 patients had anasarca with proteinuria >40 mg/m2/24 hours, hypoalbuminaemia -2-5 g/dl and hypercholesterolaemia B200 mg/dl. Histology of the renal biopsy specimen obtained percutaneously showed a minimal lesion in all 18 cases on light microscopy; the immunofluorescence was negative in all except one, which had faint deposits of IgM in mesangium.The patients were further classified according to whether they had (a) single attacks, (b) infrequent relapses ( two in six months or > three a year). None of them were receiving any immunosuppressants at the time of the study. Only two had earlier received cyclophosphamide, and that was more than two years before the present study. Immunological studies were undertaken on all these patients.Tests for cell mediated immunity. These were (1) absolute T lymphocyte count by sheep red blood cell rosette formation; (2) blastogenesis by phytohaemagglutinin stimulation; and (3) skin testing for delaye...

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