Dawaa Reference

chronic

Chronic kidney disease (primary care management)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (dapagliflozin monograph) · eMC SmPC, One-Alpha 0.25 microgram soft capsules (Cheplapharm), sections 4.1 and 4.2 · Enalapril maleate tablets US prescribing information, DOSAGE AND ADMINISTRATION - Hypertension and Dosage Adjustment in Hypertensive Patients with Renal Impairment (DailyMed SetID fa93d8e6-2ed2-4a3c-bf6d-33bd0a374efa); clinical position from KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease (kdigo.org/guidelines/blood-pressure-in-ckd)

Verified against5 documents
  • Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph)
  • Egyptian National Drug Formulary - Cardiovascular 2024 (dapagliflozin monograph)
  • eMC SmPC, One-Alpha 0.25 microgram soft capsules (Cheplapharm), sections 4.1 and 4.2
  • Enalapril maleate tablets US prescribing information, DOSAGE AND ADMINISTRATION - Hypertension and Dosage Adjustment in Hypertensive Patients with Renal Impairment (DailyMed SetID fa93d8e6-2ed2-4a3c-bf6d-33bd0a374efa); clinical position from KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease (kdigo.org/guidelines/blood-pressure-in-ckd)
  • Chronic Kidney Disease - disease-level clinical article (chronic-kidney-disease-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Early disease causes no symptoms at all; symptoms only show up once function has dropped to stage 4 or 5
  • Late-stage complaints include nausea, vomiting, poor appetite, tiredness and weakness, disturbed sleep, and low urine output [fatigue · nausea · poor appetite · vomiting]
  • Reduced mental sharpness, muscle cramps, swelling of the feet and ankles, and ongoing itching can also occur [itching · muscle cramps]
  • Chest pain from inflammation around the heart, and breathlessness from fluid backing up into the lungs, can occur in advanced disease [breathlessness · chest pain]
  • A history of long-standing high blood pressure, protein or blood in the urine, or prostate symptoms points toward a chronic rather than sudden process [blood in the urine · hypertension]

Signs — what you find (5)

  • Exam is often unrevealing, but skin pigmentation and scratch marks from itching can be found [itching]
  • A rubbing sound over the heart can be heard when inflammation surrounds it
  • A fine white powder can form on the skin from urea crystallizing out of sweat when blood urea nitrogen is very high
  • Overactive reflexes or muscle twitching, and high-blood-pressure changes seen in the back of the eye, can point to a long-standing process [hypertension]
  • Thickening of the heart's main pumping chamber on exam also suggests the disease has been present for a while

Tests (10)

  • A normal parathyroid hormone level favors a sudden kidney injury over long-standing disease, while low calcium and high phosphorus don't help tell the two apart
  • Kidney function should be rechecked within 2 weeks of a newly found low eGFR when it's unclear whether it's a sudden injury or long-standing disease
  • Creatinine clearance is used as a practical stand-in for the true reference test, inulin clearance, when estimating filtration rate
  • Protein in the urine is assessed with an early-morning albumin-to-creatinine ratio, graded from A1 to A3
  • When precise measurement isn't available, a dipstick of trace-to-1+ roughly corresponds to 30-299 mg/g of albumin, and 1+ or more to over 300 mg/g
  • Ultrasound showing small kidneys with a thin outer layer, brighter tissue, scarring, or several cysts points to a chronic process
  • Doppler ultrasound of the kidney is used when narrowing of the renal artery is suspected
  • Angiography of the renal arteries can show multiple small bulges and irregular narrowing in vasculitis or renal artery stenosis
  • Voiding cystourethrography is used mainly when long-standing reflux of urine up toward the kidney is a suspected cause
  • A kidney biopsy is the reference test for pinning down the underlying cause and grading how much scarring has occurred

If not this — what else fits (1)

  • Consider a sudden kidney injury, Alport syndrome, anti-glomerular basement membrane disease, diabetic kidney disease, multiple myeloma, kidney stones, rapidly progressive glomerulonephritis, or renal artery narrowing

SourceStatPearls "Chronic Kidney Disease" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Renoprotection - SGLT2 inhibitor | Main treatment

RENOPROTECTION - SGLT2 INHIBITOR

1

DAPAGLIFLOZIN

Renoprotection - SGLT2 inhibitor

1st line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily - Long-term

Paediatric dose

No paediatric dosing is given in the monograph. Paediatric chronic kidney disease is managed in a specialist centre.

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (dapagliflozin monograph)

Why

26 live products. Chronic kidney disease is one of the three indications the formulary lists for dapagliflozin, alongside type 2 diabetes and heart failure with reduced ejection fraction, and 10 mg once daily is the fixed non-diabetes dose it gives. Slowing progression, rather than glucose control, is what it is for here.

Cautions
  • The formulary gives 10 mg once daily as the fixed dose for chronic heart failure and lists chronic kidney disease as an indication without stating a separate dose - it does not describe a different CKD dose.
  • Do not start if eGFR is below 25 mL/min/1.73 m2; a patient already established on it may continue. Contraindicated in patients on dialysis.
  • The glucose-lowering effect largely disappears below eGFR 45 - the kidney and heart benefit does not, so do not stop it for a rising HbA1c.
  • Euglycaemic diabetic ketoacidosis: warn about rapid weight loss, nausea, vomiting, abdominal pain, deep breathing, sleepiness or a metallic taste, and test for ketones even when the glucose looks normal.
  • Withhold during acute illness, before surgery, and during prolonged fasting including Ramadan if the patient becomes unwell.
  • Genital mycotic infection and, rarely, Fournier's gangrene - counsel on perineal hygiene and on seeking help urgently for perineal pain.
  • Expect an initial dip in eGFR of up to about 5 mL/min - this is haemodynamic and is not a reason to stop.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAPABLIX 10 MG 30 F.C. TABS.AL ESRAA PHARMACEUTICAL OPTIMA186.00 EGP (6.20/unit)
DEXIGLOFOZIN 10 MG 30 F.C. TABS.ZETA PHARMA195.00 EGP (6.50/unit)
GLIFLOZINO 10 MG 30 F.C.TABSINSPIRE PHARMACEUTICAL COMPANY214.50 EGP (7.15/unit)
DAPAGLIFLOZIN-EVA 10 MG 30 F.C. TABS.EVA PHARMA271.50 EGP (9.05/unit)
ZEGAPETS 10 MG 28 F.C. TABS.OCTOBER PHARMA280.00 EGP (10.00/unit)
DIGLIFLOZ 10 MG 30 F.C. TABS.MARCYRL318.00 EGP (10.60/unit)
DAPAVELDACTIN 10 MG 28 F.C. TABS.LIPTIS368.00 EGP (13.14/unit)
FORXIGA 10 MG 28 TABS.ASTRA ZENECA602.00 EGP (21.50/unit)

MAIN TREATMENT

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Chronic Kidney Disease - disease-level clinical article (chronic-kidney-disease-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Avoid nephrotoxic agents including NSAIDs and aminoglycoside antibiotics in CKD patients.
  • RED FLAG - Note the warning regarding teratogenicity of ACE inhibitors in pregnant women or women planning pregnancy.
3

FUROSEMIDE

add-on - not a substitute

Strength40 mg

Formoral.solid

Adult dose and duration

Oral: Initial: 20-50 mg once then titrate as needed to achieve targeted effect. - long-term

Paediatric dose

Acute: Initial: 2 mg/kg as a single dose; if ineffective, may increase in 6 to 8 hours in increments of 1 to 2 mg/kg/dose; maximum dose: 6 mg/kg/dose.

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph)

Why

Preferred loop diuretic when eGFR < 30 mL/min as thiazides lose efficacy

Cautions
  • Monitor volume status and serum electrolytes.
  • High doses in severe renal failure require monitoring for ototoxicity.
  • May worsen hyperuricaemia.
Egyptian brands
Egyptian brandManufacturerIndicative price
ODEMENT 40MG 10 TAB.EL NASR1.30 EGP (0.13/unit)
FRUZEX 40MG 12 TAB.MISR3.25 EGP (0.27/unit)
FUROSEMIDE 40MG 20 TAB.SEDICO7.50 EGP (0.38/unit)
FURORETIC 40 MG 30 TABS.DEBEIKY > VETOPHARM14.25 EGP (0.47/unit)
LAFUREX 40MG 20 TAB.AMOUN9.50 EGP (0.47/unit)
SALEX 40 MG 20 TABS.ARAB DRUG COMPANY (ADCO)10.00 EGP (0.50/unit)
FUROSEMIDE-ALEX 40MG 20 TAB.ALEXANDRIA19.00 EGP (0.95/unit)
LASIX 40 MG 24 TABS.SANOFI30.00 EGP (1.25/unit)
GENESEMIDE 20MG/5ML SYRUP 120 ML? strength differs? different route - not oral solidMEDIZEN PHARMACEUTICAL INDUSTRIES > VODACHEM56.00 EGP
4

ALFACALCIDOL

add-on - not a substitute

Strength0.001 mg

Formoral.solid

Adult dose and duration

1 microgram once daily initially (0.5 microgram once daily in the elderly), adjusted in 0.25-0.5 microgram steps by biochemical response; maintenance is usually 0.25-1 microgram daily, and most adults respond to 1-3 micrograms daily - Long-term, titrated to plasma calcium and parathyroid hormone

Paediatric dose

Children from 6 year of age and under 20 kg bodyweight: 0.05 microgram/kg/day

Dose source

eMC SmPC, One-Alpha 0.25 microgram soft capsules (Cheplapharm), sections 4.1 and 4.2

Why

29 live products. The SmPC indication is precisely the disturbance of calcium metabolism caused by impaired 1-alpha hydroxylation in reduced renal function - renal osteodystrophy and hyperparathyroidism with bone disease. That is the mineral and bone axis of chronic kidney disease.

Cautions
  • This is NOT the drug for simple nutritional vitamin D deficiency. Colecalciferol is, and it is already listed under Vitamin D Deficiency. Alfacalcidol bypasses renal 1-alpha hydroxylation and is for the bone disease of renal failure and for hypoparathyroidism.
  • Measure plasma calcium weekly at first, then every 2-4 weeks once stable, and after every dose change.
  • Stop for hypercalcaemia - muscle and bone pain, weakness, confusion, dehydration, anorexia, fatigue, nausea and vomiting. Prolonged hypercalcaemia itself worsens renal function.
  • Watch the total calcium load if the patient is also on a calcium-containing phosphate binder.
  • Hypersensitivity to the active substance, arachis oil (peanut oil), soya or to any of the excipients listed in section 6.1.
Egyptian brands
Egyptian brandManufacturerIndicative price
SAFEDALFA 1 MCG 30 CAPS.SAFE PHARMA105.00 EGP (3.50/unit)
BONE CARE 1 MCG 30 CAPS.ARAB CAPS > MULTICARE132.00 EGP (4.40/unit)
BON-ONE 1 MCG 30 TABS.MINA PHARM > TEIJIN LIMITED-JAPAN153.00 EGP (5.10/unit)
CALCIDOL 1 MCG 30 CAPS.KAHIRA > MULTIPHARMA153.00 EGP (5.10/unit)
ONE ALPHA 1 MCG 30 CAPS.MINA PHARM > LEO PHARMACEUTICAL PRODUCTS200.00 EGP (6.67/unit)
ALFACIDOCAL 1 MCG 30 S.G. CAPS.EVA PHARMA54.00 EGP
TAMINORIG 2MCG/ML ORAL DROPS. 10 ML? strength differs? different route - not oral solidMARCYRL PHARMACEUTICAL INDUSTRIES (MPI)46.00 EGP
ALFACARENO 2MCG/ML ORAL DROPS. 10 ML? strength differs? different route - not oral solidKAHIRA > GLOBE INTERNATIONAL PHARMACEUTICALS152.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.