难治性肾病综合征典型病例的临床决策

难治性肾病综合征在肾内科临床实践中并不少见，其主要治疗是联合应用激素和细胞毒药物（如环磷酰胺、环孢素等）。少数患者，经以上联合治疗后仍不能达到临床缓解。而对于这些患者，长期使用激素及细胞毒药物不仅不能取得满意的效果，而且可能出现严重感染等并发症，甚至危及患者的生命，故在临床中应权衡利弊进行治疗决策。

Clinical Decision Making in Refractory Nephrotic Syndrome

Refractory nephrotic syndrome is the common and special type in nephrotic syndrome. Use of corticosteroids combined with cytotoxic immunosuppressive （such as cyclophosphamide,cyclosporine,et al.） are the mainly therapy for refractory nephrotic syndrome. Despite treated with immunosuppressive agents,some patients could not receive clinical remission. Long-term treatment for these patients with more aggressive immunosuppressive agents could not receive satisfactory clinical results, but the risk of developing significant infections was significantly higher in these patients. They may occur serious complication such as life-threatening infection. So the clinical decision should be made after weighing the merits and demerits.