Seven renal abnormalities were diagnosed that had not been detected antenatally. Only one of the seven mothers had not attended for any scans; in the others the abnormality had not been found in appropriate scans. Four of these patients had vesicoureteric reflux, which is known to be difficult to diagnose antenatally. 4 The impact that early diagnosis of abnormalities of the fetal renal tract and subsequent intervention may have on the incidence of symptomatic renal disease later in life-for example, acute pyelonephritis and recurrent urinary tract infection-remains unknown. We also do not know what proportion of those in whom a renal abnormality was diagnosed antenatally would have suffered renal scarring or deterioration of renal function had the diagnosis been delayed until after a urinary tract infection. To obtain this information would require an untreated control group, which would not be ethical. We intend, however, to reassess this cohort of children at age 5 years to determine the incidence of renal disease.We found a high incidence of renal abnormalities in this study and conclude that antenatal ultrasonography at 28 weeks' gestation is an effective method of screening for structural renal abnormality.We thank Dr S A Price and the staff of the ultrasonography department for their help in collecting data.
AbstractArthritis associated with leprosy is underreported. In Egypt 66 patients from a leprosy colony were studied, 20 of whom had arthropathy. This was characterised by an inflammatory symmetrical peripheral polyarthritis. The wrist, metacarpal and proximal interphalangeal joints of the hands, the knees, and the metatarsophalangeal joints of the feet were affected with associated morning stiffness. The arthritis was erosive in 11 out of 20 patients, had no features of the arthritis associated with erythema nodosum leprosum reactions, but symptomatically responded to antileprosy treatment.This arthritis would seem to be a previously unrecognised feature of leprosy.