Refractory nephrotic syndrome (RNS) is an immune-related kidney disease with poor clinical outcomes. Standard treatments\ninclude corticosteroids as the initial therapy and other immunosuppressants as second-line options. A substantial proportion\nof patients with RNS are resistant to or dependent on immunosuppressive drugs and often experience unremitting edema and\nproteinuria, cycles of remission and relapse, and/or serious adverse events due to long-term immunosuppression. Traditional\nChinese medicine has a long history of treating complicated kidney diseases and holds great potential for providing effective\ntreatments for RNS. This review describes the Chinese medical theories relating to the pathogenesis of RNS and discusses the\nstrategies and treatment options using Chinese herbal medicine. Available preclinical and clinical evidence strongly supports the\nintegration of traditional Chinese medicine and Western medicine for improving the outcome of RNS. Herbal medicine such as\nAstragalus membranaceus, Stephania tetrandra S. Moore, and Tripterygium wilfordii Hook F can serve as the alternative therapy\nwhen patients fail to respond to immunosuppression or as the complementary therapy to improve therapeutic efficacy and reduce\nside effects of immunosuppressive agents.Wuzhi capsules (Schisandra sphenanthera extract) with tacrolimus and tetrandrine with\ncorticosteroids are two herb-drug combinations that have shown great promise and warrant further studies
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