Liu Jiao, Liu Shaoshan, Su Yuxi
Orthopedics Department, Children's Hospital of Chongqing Medical University.
Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders.
Clin Kidney J. 2025 Jan 13;18(3):sfaf011. doi: 10.1093/ckj/sfaf011. eCollection 2025 Mar.
To investigate the risk factors for steroid-induced osteonecrosis of the femoral head (SONFH) after glucocorticoid (GC) therapy in children with immune kidney diseases.
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.
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.
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.
探讨免疫性肾病患儿糖皮质激素（GC）治疗后发生类固醇性股骨头坏死（SONFH）的危险因素。
本回顾性研究纳入了2012年1月至2022年7月在我院接受GC治疗的1-18岁免疫性肾病患者。收集首次GC治疗时的性别、年龄、体重以及GC剂量等数据。根据是否发生SONFH将患者分为SONFH组和非SONFH组。根据国际疾病分类第十版，在我院临床数据网页上检索疾病诊断。进行描述性统计和二元逻辑回归分析。构建列线图以预测免疫性肾病患儿GC治疗后发生SONFH的风险。使用一致性指数和校准图评估列线图的预测能力。
SONFH组和非SONFH组分别有18例和90例患者。两组患者首次GC治疗时的年龄、6个月累积[口服（po）加静脉注射（iv）]GC剂量、泼尼松总累积（po）剂量、脉冲治疗的甲泼尼龙总累积（iv）剂量以及GC总累积（po加iv）剂量存在显著差异。多因素分析中，首次GC治疗时的年龄、泼尼松总累积（po）剂量和脉冲治疗的甲泼尼龙总累积（iv）剂量是SONFH的独立危险因素。
本研究确定了GC治疗期间发生SONFH的特定危险因素。因此，应基于这些危险因素对接受GC治疗的免疫性肾病患儿进行密切监测，以避免股骨头发生不可逆损伤。
