Eighty patients with non-insulin-dependent diabetes mellitus being treated in a south Indian hospital were biopsied to confirm suspected nondiabetic renal disease (NDRD). The positive predictive value of the standard clinical indicators for NDRD in the presence or absence of diabetic retinopathy was 54 and 87%, respectively. These values are higher than those given by comparable studies in Western populations. This is probably due to a higher prevalence of NDRD in the population of south India, and especially of proliferative glomerulonephritis, which was found in 21.5% of the patients studied. Standard clinical predictors of NDRD in diabetics have a high predictive value in the tropics where there is a high prevalence of proliferative glomerulonephritis.

A randomized, controlled trial was conducted in a pediatric unit in a teaching hospital in India to assess the efficacy of levamisole in maintaining remission in children with steroid-sensitive nephrotic syndrome. Sixty-one children with steroid-sensitive nephrotic syndrome, who had achieved remission with corticosteroids, were allocated to a treatment group (33 patients) receiving levamisole (2-3 mg/kg/day) twice a week for 12 months or to a control group (28 patients) receiving no treatment. The main outcome measure was duration of remission. Thirty months later, in the levamisole group, 21 of 33 patients were in remission as against 12 of 28 patients in the control group (χ² = 2.54, p = 0.11, NS). The median duration of remission maintenance was 12 months in the levamisole group as compared with 10.5 months in the control group. On survival analysis, the difference in duration of remission maintenance between the two groups was not significant (p = 0.10), though there was a trend in favor of the treatment group. On stratified survival analysis, multiple relapsers in the levamisole group had longer remission maintenance than the control group though this did not reach statistical significance (p = 0.08). The clinically significant trend towards increased duration of remission maintenance in steroid-sensitive nephrotic syndrome observed with levamisole therapy, especially in patients with multiple relapses, may require a larger study with a longer follow-up for definitive confirmation.

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The infants of mothers with skinfold thicknesses less than 7 mm (less than 25th percentile for the whole group) had significantly smaller anthropometric measurements than those of mothers with skinfold thicknesses greater than 12-1 mm (greater than 75th percentile) (see table II).There were significant differences between the paying and nonpaying groups in infant weight and length and maternal height and triceps skinfold thickness (see table III). Infants weighing under 2500 g constituted 24 % of the whole group, 15 % of the paying group, and 30 % of the non-paying group. DiscussionThe positive correlation we found between maternal triceps skinfold thickness and infant anthropometric measurements is further evidence that the nutrition of the mother affects the nutrition of her baby. The social class differences in these measurements confirm this point, as many of our mothers were appreciably malnourished. Indeed, the mean maternal triceps skinfold thickness in our non-paying group was only 8-7 mm compared with the 16 mm found by Turner and Whitehouse8 in British young women. Furthermore, the fetal growth retarding factor of maternal smoking was absent in our mothers.Perinatal mortality in south India is as high as 68-8 per 1000rural population and 62-8 per 1000 urban population."0 This high rate is due partly to problems of intrauterine growth retardation. Our results emphasise the need to pay attention to maternal nutrition in developing countries. Indeed, at least two studies" 12 have shown that dietary supplementation during pregnancy benefits the growth of the infants. In Britain Trussell" and Smalley and Bissenden14 have also emphasised the importance of an adequate diet during pregnancy, particularly among immigrants. Furthermore, Davies et all5 have suggested that the growth-retarding effect of maternal smoking is due to poor food intake during pregnancy. Our work has added to the evidence that an adequate maternal diet is necessary for adequate fetal growth-a fact that is important for the West as well as developing countries.We thank the British Paediatric Association and H J Heinz company for funding the fellowship of JRS.

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