**Question:** A patient of nephrotic syndrome taking steroids for 6 years presented with a limping gait and of limitation of abduction and internal rotation. He most probably has -

A. Osteonecrosis
B. Osteoporosis
C. Osteogenesis imperfecta
D. Scoliosis

**Core Concept:** Nephrotic syndrome is a clinical condition characterized by severe proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Steroids are the primary treatment for nephrotic syndrome, and their long-term use may lead to various side effects.

**Why the Correct Answer is Right:** The correct answer is A. Osteonecrosis, also known as avascular necrosis or dead bone, is a condition characterized by the death of bone tissue due to reduced blood supply. In this case, the long-term steroid therapy can lead to osteonecrosis as it suppresses the immune system, which in turn reduces the blood supply to bone marrow and causes avascular necrosis.

**Why Each Wrong Option is Incorrect:**

B. Osteoporosis (Option B) is a condition characterized by low bone mass and increased bone fragility, not the same as the described clinical picture.

C. Osteogenesis imperfecta (Option C) is a genetic disorder causing fragile bones, not a consequence of steroid therapy.

D. Scoliosis (Option D) is a spinal curvature disorder, not related to steroid therapy or the described clinical picture.

**Clinical Pearl:**

Long-term steroid therapy in nephrotic syndrome patients should be carefully monitored, as side effects like osteonecrosis may occur. Early diagnosis and intervention are crucial to prevent severe complications and improve patient outcomes.