Abstract: Objective　To investigate the value of the ratio of neutrophils to lymphocytes (NLR) in the prediction of glucocorticoid induced osteonecrosis in patients with minimal change disease (MCD). Methods　A total of 329 MCD patients diagnosed by percutaneous renal biopsy were retrospectively analyzed. According to receiver operating characteristic(ROC) curve, the best cutoff value of NLR for diagnosing steroid induced osteonecrosis in MCD was determined. The subjects were divided into low NLR group (NLR ≤ 3.321, n=262) and high NLR group (NLR > 3.321, n=67). The baseline clinical indicators, hormone dosage and time, combined use of calcium and active vitamin D3 were compared between the two groups. The correlation between NLR and steroid induced osteonecrosis in MCD patients was analyzed. The joint survival rate was compared by Kaplan Meier survival curve between the two groups. Multivariate Cox regression model was used to analyze the risk factors of steroid induced osteonecrosis in patients with MCD. Results　 The median follow-up time for all the patients was 38 months. The age, white blood cell count, monocyte count, C-reactive protein, erythrocyte sedimentation rate, fibrinogen, osteocalcin, β-CTX, blood urea nitrogen, serum creatinine and the proportion of osteonecrosis were significantly higher in the high NLR group than those in the low NLR group (P＜0.05). The eGFR was significantly lower in the high NLR group than that in the low NLR group (P＜0.05). Kaplan-Meier survival curve showed that the joint survival rate was significantly higher in the low NLR group than that of high NLR group (c2=10.130, P＜0.01). The 1-year, 3-year and 5-year joint survival rates were 82.9% vs. 93.5%, 76.3% vs. 88.9% and 65.2% vs. 85.6% in the high NLR group and the low NLR group, respectively. Multivariate Cox regression analysis demonstrated that the high NLR level was an independent risk factor for glucocorticoid induced osteonecrosis in MCD patients (HR=2.155, 95%CI=1.136-4.089, P＜0.05). Conclusion　There is a positive correlation between blood NLR level and the risk of glucocorticoid induced osteonecrosis in MCD patients, and NLR could be used as a valuable indicator to evaluate the risk of steroid induced osteonecrosis in MCD patients.

Key words: nephrotic syndrome, nephrosis, lipoid, osteonecrosis, glucocorticoids, minimal change nephrosis, glucocorticoid induced osteonecrosis, neutrophil lymphocyte ratio, inflammation