Prevalence and Predictors of Bone and Ocular Complications in Children With Steroid-Sensitive Nephrotic Syndrome: A Cross-Sectional Study

Objective The main objective of this study is to assess bone mineral density (BMD) and ocular complications in children with steroid-sensitive nephrotic syndrome (SSNS) receiving prolonged corticosteroid therapy and to identify factors associated with these complications. Methods This cross-sectional observational study was conducted at a tertiary care center over 18 months. Children aged 1-18 years with SSNS who had received corticosteroids for more than six months were enrolled. Clinical details, including cumulative steroid dose and duration of therapy, were recorded. All participants underwent ophthalmologic evaluation, biochemical assessment, and lumbar spine dual-energy X-ray absorptiometry (DEXA) to determine BMD Z-scores. Associations between steroid exposure and bone and ocular outcomes were analyzed. Results Fifty children were included, 66% were boys, and the mean age was 6.08 ± 2.84 years. Osteopenia was found in 25 children (50%), and osteoporosis in nine (6%). Longer steroid duration was significantly associated with lower BMD (p = 0.025). Children with osteoporosis had significantly higher parathormone (PTH) and alkaline phosphatase (ALP) levels and lower vitamin D levels (p < 0.001). Ocular complications were identified in nine children (18%), most commonly refractive errors (16%). Refractive errors were significantly associated with longer steroid duration (p = 0.013) and higher cumulative steroid dose (p = 0.012). Posterior subcapsular cataract and raised intraocular pressure were observed in one child each. Conclusion Prolonged corticosteroid therapy in children with SSNS is associated with reduced BMD and ocular complications. Regular monitoring of bone health, vitamin D status, and ophthalmologic evaluation should be part of long-term care.