Nephrotic syndrome is a group of diseases characterized by large amounts of proteinuria (>3.5 g/day in adults and >50 mg/kg body weight/day in children), hypoalbuminemia (≤30 g/l), edema, hyperlipidemia and lipiduria. All of these manifestations are directly or indirectly related to increased permeability of the glomerular filtration membrane (as if the holes of the “sieve” had become larger), resulting in leakage of plasma proteins and loss of large amounts of protein from the urine. Therefore, a large amount of proteinuria and hypoalbuminemia are necessary for the diagnosis of nephrotic syndrome. Edema can be severe or mild or insignificant. In some patients, lipids can be non-hyperlipidemic, especially secondary to nephrotic syndrome. Therefore, hyperlipidemia and edema are not necessary for the diagnosis of nephrotic syndrome. According to the etiology, they can be divided into two main categories: primary and secondary. Secondary nephrotic syndrome has many etiologies, with hereditary diseases, infections (post-streptococcal nephritis), and allergic purpura being common in children; systemic lupus erythematosus (especially in women), infections, and drug factors in young and middle-aged people; and diabetic nephropathy, renal amyloidosis, and multiple myeloma in the elderly. At least half of the patients with nephrotic syndrome have a clear secondary etiology. Primary, is a disease in which the original lesion occurs in the glomerulus. Various types of primary glomerular diseases, such as acute nephritis, acute progressive nephritis, chronic nephritis and glomerulonephritis can present with nephrotic syndrome during the course of the disease. In terms of pathological classification, it mainly includes microscopic lesion nephropathy, tegumentary proliferative nephritis, membranous nephropathy, membranoproliferative nephritis and glomerular focal segmental sclerosis. In children, about 80% are caused by microscopic nephropathy; in adults, membranous nephropathy is more common in foreign reports, but tegumentary proliferative nephritis is most common in China. What are the clinical manifestations of nephrotic syndrome 1, proteinuria Some patients may be asymptomatic and found due to routine urine examination. Urine protein is to ＋＋＋＋, 24-hour urine protein quantification > 3.5 grams, some cases can be combined with hematuria. 2, hypoalbuminemia In nephrotic syndrome, it is usually manifested as hypoproteinemia with serum albumin ≤ 30 g/l. However, massive proteinuria and hypoalbuminemia do not exactly parallel each other. In addition, there can be changes in globulin, transferrin, and coagulation fibrinolytic-related proteins. 3. Hyperlipidemia and lipiduria Most patients with nephrotic syndrome have elevated total cholesterol, phospholipids, and triglycerides in the blood, and lipiduria may be present in the urine. 4. Edema Oedema often appears gradually, mostly at the ankle initially, and is depressed when pressed; swelling of the face and lids in the morning, gradually spreading to the whole body; in severe cases, ascites, pleural fluid or pericardial effusion. When edema is not serious, it only shows weight gain. 5. Hypertension About 1/3 of patients with nephrotic syndrome may develop hypertension, and about half of those with significant edema have hypertension, with blood pressure often in the range of 140-170/95-110 mmHg. 6. Major comorbidities Easily secondary infections, most commonly respiratory tract infections, urinary tract infections, skin infections and peritonitis. Postural hypotension may occur in patients with insufficient blood volume. Pediatric patients are prone to heart failure due to obvious edema, and elderly patients are prone to acute renal failure. Most patients with nephrotic syndrome are in a hypercoagulable state and have a tendency to form thrombosis and embolism. What is the progress of research on nephrotic syndrome? The treatment of nephrotic syndrome is firstly to treat the cause, secondly to treat the complications (such as edema and hyperlipidemia), and thirdly to treat proteinuria, but not simply to eliminate or reduce proteinuria as the sole purpose. In some cases, proteinuria cannot be controlled despite strict regular treatment, and renal function is significantly reduced. The aim of treatment for these refractory nephrotic syndromes should be shifted to the protection of renal function. The treatment of this disease, in recent years, more emphasis on low protein diet, because high protein diet is prone to glomerulosclerosis. It is advocated that 0.7 to 1 g/kg/day, with animal protein and soy protein as the mainstay. Corticosteroids (such as prednisone) are still preferred for medication. For cases with severe renal pathological changes, poor effect of prednisone treatment, or recurrent attacks, immunosuppressant-cyclophosphamide can be added. The phenomenon of hypercoagulation can be added with anti-platelet aggregation drugs and anticoagulants, which is generally known as “quadruple therapy” in clinical practice. In recent years, angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists have been added to reduce urinary protein, protect renal function and lower blood pressure. For refractory nephrotic syndrome, hormones plus the new immunosuppressant primaquine (MMF) are used; intravenous immunoglobulin is used; immunostimulants or serine protease inhibitors are applied, etc. The characteristics of TCM treatment for nephrotic syndrome are evidence-based treatment and holistic treatment. It can improve the body’s sensitivity to hormones, help reduce the toxic side effects of hormones (and cytotoxic drugs), prevent hormones from “rebounding”, consolidate the efficacy of hormones, and adjust the balance of qi, blood, yin and yang in the body. In addition, we can add the Chinese herbal medicine Leigongtang Polysaccharide Tablets or Torch Flower Root Tablets at the same time, which can help hormones lower urine protein, as well as prevent hormone dependence and hormone rebound in patients. Since different patients have different constitutions, different types of pathology and different clinical manifestations, treatment measures should not be uniform, but should emphasize individualized treatment, so as to give full play to the respective strengths of Chinese and Western medicine and improve the efficacy. Although the nephrotic syndrome is aggressive and heavy, but as long as we adhere to the integrated Chinese and Western medicine treatment for a longer period of time, most of the prognosis is good and can be cured.