The common causes of refractory nephrotic syndrome include: 1. Misdiagnosis of some secondary nephropathies such as amyloid nephropathy, diabetic nephropathy and special kidney diseases such as lipoprotein nephropathy and fibrous glomerulopathy as primary nephrotic syndrome with “hormone” treatment, which of course cannot achieve satisfactory results. The main drugs used in the treatment of nephrotic syndrome are the hormones and the hormones. The main drug for the treatment of nephrotic syndrome is “hormone”, and the general treatment principle of this drug is “adequate amount, slow reduction and appropriate”. In the case of prednisone, for example, the starting dose should be taken early in the morning for 8 to 12 weeks; in effective cases, the original dosage can be reduced by 10% to 20% every 2 to 3 weeks, to be reduced to the appropriate maintenance treatment, for a total duration of six months to one year. The starting amount is sufficient to help the disease remission, and the slow reduction and proper maintenance can prevent recurrence of the disease. However, in clinical practice, for various reasons, some patients may have received irregular treatment such as insufficient dose of “hormone” and too fast reduction, which turned the originally effective type of “hormone” nephrotic syndrome into frequently recurring type of nephrotic syndrome. 3.The improper use of “hormone” affects the efficacy of “hormone”. The improper use of hormones affects the absorption, bioavailability and excretion of hormones, thus affecting the effectiveness of hormones. (1) For patients with severe nephrotic syndrome with severe clinical swelling, oral prednisone is used, which may affect the absorption of the drug due to severe edema of the gastrointestinal mucosa. (2) Prednisone should be administered to patients with poor hepatic function. Since prednisone needs to be converted to prednisolone by the liver in the body, this conversion function may be impaired when the liver is not functioning well, which may affect the bioavailability of the drug. (3) Ignore the drug interactions, we all know that patients with nephrotic syndrome often combine a variety of complications and need to use several drugs at the same time. However, some drugs, such as carbamazepine and rifampin, can increase the excretion rate of prednisolone in the body by 60% and 143%, respectively, thus reducing the blood concentration of prednisolone. At this time, if the doctor ignores the interaction between these drugs, the therapeutic effect of the “hormone” can be affected. 4.The presence of comorbidities affects the therapeutic effect