In my clinical work, I am often asked by parents whether they should add hormones when their child’s proteinuria recurs or worsens. In fact, there is no standard answer to this question, we should analyze the specific problem. First of all, I will analyze the reasons for the recurrence or aggravation of proteinuria in nephropathy, if we find the right reason, we can do the right thing. The causes of recurrence or aggravation of urinary protein are mainly related to infection, allergy, fatigue, mental stress, minor surgery, vaccination, inappropriate diet, inappropriate Chinese medicine treatment, hormone reduction, etc. 1, infection: children’s infections are generally respiratory tract infections, such as red throat, runny nose, cough, some children are gastrointestinal tract infections, such as vomiting and diarrhea, some children are urinary tract infections, such as frequent and painful urination, urine with white blood cells, so once there is a recurrence or aggravation of urine protein, the first choice is to check whether there is an infection in these parts, sometimes also check the blood routine and CRP to help determine whether there is an infection, if If it is determined to be caused by an infection, the urine protein can usually be reduced or disappeared after 3-7 days of antibiotics. Should the hormone dosage be increased in this case? My experience is that if the hormones are taken every other day, it is still recommended that they be taken daily. If the hormone is taken every day, at this time, if the urine protein is repeatedly within 2+, you can observe without adding hormone. The observation period is usually 2 weeks, and if the proteinuria does not turn negative or decrease after two weeks, it is recommended to add hormone to the last dose, for example, if the child is reduced from 3 tablets to 2 tablets now, then it can be restored to 3 tablets. When the child’s urine protein repeatedly reaches above 3+, if the child does not show obvious symptoms of urine volume reduction, swelling, or abdominal pain and vomiting, it can still be observed for a few days. If any of the above symptoms appear, it is necessary to add hormone, which can generally be added to the last dose, but if the disease develops quickly, it can be added directly to more than half amount or even the full amount of hormone. In TCM, if your child has a wind-heat cold, you can take Pu Di Lan, Jian’er Qing Jie Liquid, Jin Lian Qing Fever Infusion, etc. It can be taken together with antibacterial agents, such as third-generation cephalosporin or azithromycin. 2, allergies: some children’s urine protein recurrence is related to allergies, such as allergic rhinitis, the child is always sneezing; allergic skin disease, the child’s body scratching and itching and wind groups. If left untreated, it may cause urine protein recurrence when the hormone is in small doses. This can be treated with additional anti-allergy treatment such as paracetamol, keratan, cyproheptadine, ketotifen, etc. For children with allergic rhinitis, montelukast (cisplatin) can also be added. 3, fatigue, mental tension: these two factors cause proteinuria aggravation, or even recurrence is actually not uncommon in clinical practice. The relapse of the child after strenuous exercise is actually caused by fatigue. In addition, some children have a small degree of urine protein at home, but as soon as they return to the clinic, there is urine protein or even aggravation, which is actually related to fatigue and the child’s mental tension. In this case, it is usually not necessary to add hormones, and a few days of rest can make the urine protein turn negative. If the urine protein is repeatedly above 3+ and cannot be reduced even with rest, you may consider adding hormones. Chinese medicine believes that recurrence after fatigue is related to qi deficiency, and by increasing the dose of astragalus and ginseng, this condition can generally be better treated. 4, minor surgery: children’s stitches after trauma, tooth extraction, circumcision, etc., may cause recurrence of urine protein due to inflammation of the wound, and generally do not need to add hormones, or add to the last dose, it can make urine protein reduce or disappear. 5, vaccination: parents are generally cautious about taking hormones when vaccination, but some vaccines are non-vaccination, such as dog bites when rabies vaccine must be played, at this time, if proteinuria recurrence or aggravation, hormone add or not add dose, can be handled according to the infection. 6, inappropriate diet: cases of relapse after eating seafood, chicken, pigeon and other hairy products are seen in the clinic from time to time, this inappropriate diet may cause allergies or infections, generally need anti-allergy treatment or antibacterial treatment, whether to add hormones can be dealt with in accordance with the above related to infection or allergy. Chinese medicine considers wind or damp-heat, consider dispelling wind and clearing heat to benefit dampness treatment. 7, inappropriate Chinese medicine treatment: kidney disease requires a combination of Chinese and Western medicine, but at present there are relatively few pediatric nephrologists with experience in Chinese medicine treatment, most children in adult nephrology to see, some are in Western hospitals by Western doctors to prescribe Chinese medicine, which results in inaccurate Chinese medicine treatment, or even the wrong situation, which seriously leads to frequent recurrence or aggravation of kidney disease, such as a large number of hormone period, the child is not suitable for supplementation of qi Such as astragalus, ginseng or wormwood are generally not used during the full amount of hormones. But clinically I often see children using astragalus at the beginning of treatment, which is obviously not appropriate. 8. Hormone reduction: If the relapse is caused by hormone reduction, some relapses after a few days of reduction, and some relapses after several months, it is generally necessary to exclude the relapse caused by the above-mentioned conditions, and if it is indeed excluded, then the hormone should be added, just to the last dose. If the hormone keeps on decreasing, TCM believes that it belongs to qi deficiency, so you can use tonic drugs such as Astragalus, Ginseng, Atractylodes, and Gorgonzola to help the hormone decrease smoothly. The reasons for recurrence or worsening of proteinuria in clinical children are complex, many of them are a combination of factors, while some of them cannot be found. Therefore, parents need to cooperate with doctors to identify them carefully. Because prolonged application of hormones can bring more side effects, it is not recommended to add hormones first as soon as a relapse occurs.