Risk factors for steroid-induced osteonecrosis of the femoral head in children with immune kidney disease.

Objective: To investigate the risk factors for steroid-induced osteonecrosis of the femoral head (SONFH) after glucocorticoid (GC) therapy in children with immune kidney diseases.

Methods: This retrospective study included patients (1-18 years) diagnosed with immune kidney disease treated with GCs from January 2012 to July 2022 in our hospital. Data, such as sex, age and body weight at the first GC treatment, and the GC dose, were collected. Patients were divided into SONFH and non-SONFH groups based on the occurrence of SONFH. According to the International Classification of Diseases, Tenth Revision, the disease diagnosis was searched on the clinical data webpage of our hospital. The descriptive statistics and binary logistic regression analyses were performed. A nomogram was constructed to predict the risk of SONFH in children with immune kidney disease after GC treatment. The predictive ability of the nomogram was evaluated using the concordance index and calibration plots.

Results: The SONFH and non-SONFH groups included 18 and 90 patients, respectively. Age at first GC treatment, 6-month cumulative [oral (po) plus intravenous (iv)] GC dose, total cumulative prednisone (po) dose, total cumulative methylprednisolone (iv) dose for pulse therapy and total cumulative GC (po plus iv) dose significantly differed between the two groups. Age at the initial GC treatment, total cumulative prednisone (po) dose and total cumulative methylprednisolone (iv) dose for pulse therapy were independent risk factors for SONFH in the multivariate analysis.

Conclusions: This study identified specific risk factors for developing SONFH during GC treatment. Thus, children with immune kidney disease undergoing GC treatment should be monitored closely based on these risk factors, with the aim to avoid irreversible damage to the femoral head.