Nephroticsyndrome (NS) is a common clinical syndrome, and its diagnostic criteria are: 1) large amount of proteinuria (>3.5g/24hr); 2) plasma albumin <30g/L; 3) edema; and 4) hyperlipidemia. NS is divided into two categories: primary and secondary. The drug treatment in this article mainly focuses on primary NS. Symptomatic treatment: 1, low-salt diet, edema should be low salt (<3g/d). 2, diuretic and decongestive (1), diuretic and decongestive (1). (1) Thiazide diuretics For patients with mild edema, hydrochlorothiazide is commonly used 25mg once a day, 3 times a day, long-term use should prevent hypokalemia and hyponatremia. (2) Potassium retention diuretics For hypokalemia, commonly used spironolactone 20mg once, 1~2 times a day; or aminopterin 50mg once, 1~2 times a day. The diuretic effect is not significant when used alone, and can be combined with thiazide diuretics. Long-term use should prevent hyperkalemia, and should be used with caution in patients with renal insufficiency. (3) Collaterals diuretics are suitable for patients with moderate or severe edema, commonly used furosemide 20-120mg a day, or bumetanide 1-5mg a day, divided into oral or intravenous injection. When applying collaterals diuretics, beware of hyponatremia and hypokalemia, hypochloremic alkalosis. (4) Dextrose anhydride or plasma substitute Dextrose anhydride 40 (low molecular weight dextrose anhydride) or starch plasma substitute (706 plasma substitute, molecular weight 25,000-45,000), which does not contain sodium, should be injected intravenously at one time with 250-500 ml once a day, and once every other day.S. Addition of labeled diuretics after the injection can enhance the diuretic effect. However, it should be used with caution or avoided in patients with oliguria (one day urine volume <400ml).NS patients should avoid excessive diuresis and over-vigorance, so as not to cause blood volume insufficiency, aggravate the tendency of hyperviscosity of the blood, inducing thrombosis and embolism complications. 3, reduce urinary protein: ACEI or ARB has not depend on the reduction of systemic blood pressure to reduce the role of urinary protein, the application of its lower urinary protein, the dose should be generally larger than the conventional antihypertensive dose in order to obtain good efficacy. It should be used with caution after severe blood volume insufficiency or application of strong diuretics to avoid inducing acute renal insufficiency. Second, anti-inflammatory and immunosuppressive treatment: 1, glucocorticoids Hormones can inhibit the inflammatory response, inhibit the immune response, inhibit the secretion of aldosterone and antidiuretic hormone, affect the glomerular basement membrane permeability and other comprehensive effect to play its diuretic, eliminating the therapeutic effect of urinary protein. The principles and programs of use are as follows: (1) Starting full dosage of commonly used drugs for prednisone 1mg/kg a day, oral 8 weeks, if necessary, can be extended to 12 weeks; focal segmental glomerulosclerosis patients should be extended to 3~4 months. (2) Slowly reduce the dosage After adequate treatment, reduce the original dosage by 10% every 2~3 weeks; when reduced to about 20mg/day, the symptoms are easy to recur, and the dosage should be reduced more slowly. (3) Long-term maintenance Finally, the minimum effective dose (10mg/day) should be maintained for about half a year. It can be taken as a full daily dose or two daily doses every other day during the maintenance period, in order to reduce the side effects of hormones. In case of severe edema, hepatic impairment or poor efficacy of prednisone, it can be replaced by prednisolone (equal dose) or methylprednisolone (4mg methylprednisolone is equivalent to 5mg prednisone) orally or intravenously. Dexamethasone has a long half-life and high side effects and is now used sparingly. According to the patient's therapeutic response to glucocorticoids, it can be divided into "hormone-sensitive" (NS remission within 8 to 12 weeks of medication), "hormone-dependent" (hormone reduction to a certain extent, that is, relapse) and "hormone resistance" (hormone resistance), "hormone-dependent" (hormone reduction to a certain extent, that is, relapse). Hormone-dependent" (relapse after hormone dosage is reduced to a certain extent) and "hormone-resistant" (ineffective hormone therapy), and the further treatment for each of them is different. Long-term application of hormone patients can be infected, drug diabetes, osteoporosis and other side effects, a small number of cases may also occur in the femoral head aseptic ischemic necrosis, need to strengthen the monitoring, timely treatment. 2.Immunosuppressant drugs can be used for "hormone-dependent" or "hormone-resistant" patients, synergistic hormone therapy. If there is no contraindication to hormone, generally not as the first choice or separate treatment with drugs: (1) cyclophosphamide is the most commonly used cytotoxic drugs at home and abroad, in vivo by the hepatocyte microsomal hydroxylation, the production of metabolites with alkylation and has a strong immunosuppressive effect. The application dose is 2mg/kg a day, divided into 1~2 times orally; or 200mg a time, every other day intravenous injection. The drug is discontinued after the cumulative amount reaches 8~10g. The main side effects are bone marrow suppression and toxic liver damage, and gonadal suppression (especially in men), alopecia, gastrointestinal reactions and hemorrhagic cystitis can occur. (2) Cyclosporine selectively inhibits helper T cells and cytotoxic effector T cells, and has been used as a second-line drug for the treatment of refractory NS which is ineffective in the treatment of hormones and cytotoxic drugs. The usual dosage is 3~5mg/kg a day, taken orally on an empty stomach twice a day, and during the period of taking the drug, it is necessary to monitor and maintain the trough value of its blood concentration of 100~200ng/ml, and the dosage should be slowly reduced after taking the drug for 2~3 months, with a course of treatment of half a year to one year. Side effects include liver and kidney toxicity, hypertension, hyperuricemia, hirsutism and gingival hyperplasia. Easy relapse after stopping the drug is the shortcoming of this drug. (3) Mycophenolatemofetil (mycophenolatemofetil, MMF) metabolized to mycophenolic acid in vivo, the latter is a hypoxanthine mononucleotide dehydrogenase inhibitor, inhibiting the classical synthesis pathway of guanine nucleotides, and therefore selectively inhibit the proliferation of T and B lymphocytes and the formation of antibodies to achieve therapeutic purposes. The common dosage is 1.5~2g a day, divided into two oral, shared 3~6 months, reduce the dosage to maintain half a year. Some reports in recent years have shown that the drug is effective in some refractory NS with relatively few side effects. It has been emphasized despite the lack of findings from prospective controlled trials of large number of cases. Due to its high price, it is still used as a second-line drug. Occasional severe anemia and individual cases (mostly in renal impairment) of serious infections after application have been reported, which should cause marine crab (4) Tacrolimus, also known as FK506, is an immunosuppressive drug with a macrolide structure. The drug combines with FK506 binding proteins (FKBPs) in the body to form a complex, which inhibits calcineurin, thus inhibiting calcium-dependent information transmission in T cells and suppressing the generation of cytotoxic lymphocytes. This drug is used as a strong anti-rejection drug for liver, kidney and other organ transplant patients. It has been tried in refractory NS in China, and the commonly used induction dose is 4~6mg a day, divided into two fasting doses for six months; the commonly used maintenance dose is 2~4mg a day, divided into two fasting doses for six months. The blood concentration should be maintained at 5~10ng/ml. so far there is no evidence-based medical results of large-scale case treatment of NS, but the preliminary results have shown good efficacy in lowering urinary protein. Although its side effects are relatively mild, it can cause infections, gastrointestinal symptoms (such as diarrhea, nausea, vomiting), hepatic impairment, hyperglycemia, and neurotoxicity (such as headache, insomnia, tremor) and other adverse reactions, to be taken seriously. (5) Lei Gongteng total glucoside 10-20mg once, 3 times a day orally, has the effect of lowering urinary protein, can be used with hormone application. Domestic research shows that the drug has the effect of inhibiting immunity, inhibiting the proliferation of glomerular thylakoid cells, and improving the permeability of glomerular filtration membrane. The main side effects are gonadal suppression, liver function damage and peripheral blood leukopenia, etc., which can be recovered after stopping the drug in time. This drug has greater toxic side effects, and can even cause acute renal failure, when used with careful supervision. (6) Other: there are also about the application of nitrogen mustard phenylbutyrate, azathioprine, leflunomide and other cytotoxic drugs. The application of glucocorticoids and immunosuppressants should strictly grasp the indications and contraindications, reduce adverse reactions and use the smallest possible dose to achieve the greatest possible efficacy. The application of glucocorticoids, dosage and duration, and the selection of immunosuppressive agents should be based on the etiology of NS, the type of renal biopsy pathology, clinical features (such as renal function, urinary proteins, etc.), age and other major factors.