1. Do patients with lupus nephritis need to take hormones for life? This depends on the question of which immunosuppressant is chosen to control the lupus activity during the maintenance period of the patient. In the past, when only hormone therapy was available, most advocated long-term maintenance treatment with small doses of hormones, unless the lupus is stationary for more than 5 years (some views think 2 years), try to stop the drug, and if there is no relapse, you can continue to observe urinalysis and immunological changes, and if the GFR continues to be stable, there is no proteinuria and hematuria, and the immunological indicators are normal, you can continue to stop the drug for observation. In recent years, with the use of new immunosuppressants, some patients can control lupus activities without hormones, so the selection of immunosuppressants with small side effects and sure efficacy is the difficulty and focus of physicians’ treatment. 2. How to use hormones during the development of lupus nephritis and which anti-rheumatic drugs should be combined with them? Except for mild lupus nephritis (type I), hormone therapy is generally required, and the treatment process is divided into two phases: early (induction phase) and maintenance phase. In the early stage (induction phase), the treatment course is 3-6 months, and different doses of hormone therapy are usually selected according to the patient’s renal pathology, ranging from 0.5-1 mg/kg/d orally or by intravenous infusion. Low-dose glucocorticoids (≤10 mg/d prednisone or other equivalent glucocorticoids) are recommended in combination with mycophenolate (MMF 1-3 g/d) or azathioprine [(1.5-2.5 mg/(kg-d))] or cyclosporine or tacrolimus (when AZA and MMF are not tolerated) during the maintenance period. Hydroxychloroquine can be added during hormone therapy to prevent lupus recurrence. 3. What is hormone shock therapy and under what circumstances is it needed? For severe proliferative glomerulonephritis [rapid progression to renal insufficiency, often with diffuse (>50%) glomerular crescent formation or vascular loop necrosis], hormone shock therapy is considered, such as methylprednisolone 0.5-1.0 g, intravenous drip, for 3 consecutive days as a course of treatment. Followed by prednisone 0.5-1mg/kg/d orally or by intravenous infusion, and gradually reduce the dosage after 4 weeks depending on the changes of the disease. 4. How to reduce the dosage of hormone during the stable period of lupus nephritis? After the condition of lupus nephritis is stabilized, the dose should be reduced by 5-10mg/d every 2 weeks until it is ≤10 mg/d prednisone or other equivalent glucocorticoid maintenance therapy every month. 5. How often should I have a follow-up examination during hormone therapy? Monthly check-ups are recommended during the induction phase, and once every 1-3 months during the maintenance phase. Depending on the changes in the condition (e.g. cold, fever, diarrhea, etc.), you should visit the doctor at any time. 6.What is the harm of intermittent hormone use or independent discontinuation? Hormones can be taken every other day, but they must be used under the guidance of a doctor. Not taking hormones for more than 2 days may cause hormone withdrawal syndrome and symptoms of adrenocortical insufficiency, and adrenal crisis may occur in a few patients under severe stress. The clinical manifestations are high fever, gastrointestinal disorder, circulatory deficiency, indifference, depression or restlessness, delirium or even coma, which is called adrenal crisis. 7.What are the side effects of hormone on the body, and is the side effect of shock treatment stronger? The main side effects of hormone therapy are: induced or aggravated infection, peptic ulcer bleeding or perforation, osteoporosis, femoral head necrosis, Cushing’s syndrome (full moon face), neurological symptoms (agitation, insomnia, muscle tremors, individual patients may induce psychosis, epileptic patients may induce seizures), menstrual disorders, elevated blood sugar, local acne-like skin rash and folliculitis. Hormone shock therapy is generally used to treat with short-acting methylprednisolone and sparingly with long-acting hormones (such as dexamethasone), which will not last longer than 5 days and will not have stronger side effects. After all, it is a high-dose hormone therapy, the incidence of side effects is still higher than the conventional dose, so we should strictly grasp the indications, such as severe proliferative glomerulonephritis [rapid progression to renal insufficiency, often with diffuse (>50%) glomerular crescent formation or vascular loop necrosis], consider using hormone shock therapy, such as methylprednisolone 0.5-1.0 g, intravenous drip, for 3 consecutive days as a course of treatment. 8.If the patient has diabetes mellitus, femoral head necrosis and other diseases, can he still use hormone therapy? This situation requires a comprehensive analysis of which disease will lead to greater risk to life and weigh the pros and cons. Whether high-dose hormone therapy is necessary in case of complications (when lupus is life-threatening), and whether there are other immunosuppressive drugs that can replace hormones and which can control the activity of lupus. If there are other immunosuppressive drugs that can replace hormones, we believe that hormone therapy can be suspended. Even if they must be applied, we advocate the use of low-dose hormones as much as possible, but they must be accompanied by glucose-lowering drugs or insulin, calcium supplementation and active vitamin D to prevent aggravation of complications.