Dawaa Reference

chronic

Nephrotic Syndrome (Referral & Supportive Care)

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

Evidence status

Checked against the sources named below

Sources3 sources

Enalapril Maleate 10mg tablets SmPC section 4.2 Posology and method of administration (eMC product 561) · Furosemide 40mg Tablets SmPC (https://www.medicines.org.uk/emc/product/2465/smpc) · KDIGO Clinical Practice Guideline for Glomerular Diseases 2021

Verified against2 documents
  • Enalapril Maleate 10mg tablets SmPC section 4.2 Posology and method of administration (eMC product 561)
  • Furosemide 40mg Tablets SmPC (https://www.medicines.org.uk/emc/product/2465/smpc)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Facial swelling is usually the first sign in children, then spreads to whole-body edema [facial swelling · oedema]
  • Frothy urine can be a presenting symptom
  • Tiredness and poor appetite are common features [fatigue · poor appetite]
  • A DVT or pulmonary embolus can be the first sign of the disease
  • Recently starting an NSAID suggests the drug as the cause
  • Over 10 years of diabetes with symptomatic neuropathy points to diabetic nephropathy

Signs — what you find (3)

  • Edema begins around the eyes and legs, later becoming generalized with ascites or pleural fluid [ascites · oedema]
  • Hematuria and hypertension occur less often here than in nephritic syndrome [blood in the urine · hypertension]
  • Diabetic retinopathy on exam is closely linked to diabetic nephropathy

Tests (9)

  • A 3+ or 4+ dipstick reading corresponds to nephrotic-range proteinuria
  • A 3+ dipstick corresponds to roughly 300 mg/dL of urine protein, equivalent to shedding at least 3 grams over a day
  • A 24-hour urine collection showing 3 g of protein confirms the diagnosis
  • Urinalysis can show hyaline, granular, fatty, or waxy casts along with lipiduria
  • Serum albumin is classically below the normal 3.5 to 4.5 g/dL range
  • Total cholesterol and triglycerides are typically elevated
  • Biopsy is indicated for congenital disease, onset after age 8, steroid resistance, or frequent relapse
  • About 70% of idiopathic membranous nephropathy cases carry anti-PLA2R autoantibodies
  • Increased renal echogenicity on ultrasound suggests intrarenal fibrosis

If not this — what else fits (4)

  • Liver disease such as cirrhosis or Budd-Chiari syndrome can mimic the edema
  • Exudative enteropathy or malnutrition can cause similar protein loss and edema
  • Hereditary angioneurotic edema and anaphylaxis are also considered
  • Renal causes include diabetic nephropathy, FSGS, IgA nephropathy, and minimal change disease

SourceStatPearls "Nephrotic Syndrome" - disease-level clinical article

Presentation findings are traced to the source above.

1

FUROSEMIDE

1st line

Strength40 mg

Formoral.solid

Adult dose and duration

The usual initial dose of furosemide is 20 mg to 40 mg given as a single-dose, injected intramuscularly or intravenously.

Paediatric dose

1-2 mg/kg/dose [child max 40 mg]

(The usual initial dose of Furosemide Injection (intravenously or intramuscularly) in pediatric patients is 1 mg/kg body weight administered slowly (over 1 minute to 2 minutes).)

Dose by weight
3kg3-6 mg/dose
4kg4-8 mg/dose
5kg5-10 mg/dose
6kg6-12 mg/dose
7kg7-14 mg/dose
8kg8-16 mg/dose
9kg9-18 mg/dose
10kg10-20 mg/dose
11kg11-22 mg/dose
12kg12-24 mg/dose
13kg13-26 mg/dose
14kg14-28 mg/dose
15kg15-30 mg/dose
16kg16-32 mg/dose
17kg17-34 mg/dose
18kg18-36 mg/dose
19kg19-38 mg/dose
20kg20-40 mg/dose
21kg21-40 mg/dose (upper capped)
22kg22-40 mg/dose (upper capped)
23kg23-40 mg/dose (upper capped)
24kg24-40 mg/dose (upper capped)
25kg25-40 mg/dose (upper capped)
26kg26-40 mg/dose (upper capped)
27kg27-40 mg/dose (upper capped)
28kg28-40 mg/dose (upper capped)
29kg29-40 mg/dose (upper capped)
30kg30-40 mg/dose (upper capped)
31kg31-40 mg/dose (upper capped)
32kg32-40 mg/dose (upper capped)
33kg33-40 mg/dose (upper capped)
34kg34-40 mg/dose (upper capped)
35kg35-40 mg/dose (upper capped)
36kg36-40 mg/dose (upper capped)
37kg37-40 mg/dose (upper capped)
38kg38-40 mg/dose (upper capped)
39kg39-40 mg/dose (upper capped)
40kg40 mg/dose (capped)
41kg40 mg/dose (capped)
42kg40 mg/dose (capped)
43kg40 mg/dose (capped)
44kg40 mg/dose (capped)
45kg40 mg/dose (capped)
46kg40 mg/dose (capped)
47kg40 mg/dose (capped)
48kg40 mg/dose (capped)
49kg40 mg/dose (capped)
50kg40 mg/dose (capped)
Dose source

Furosemide 40mg Tablets SmPC (https://www.medicines.org.uk/emc/product/2465/smpc)

Why

Loop diuretic controlling the edema caused by heavy proteinuria and hypoalbuminemia while nephrology referral for biopsy and immunosuppressive therapy is arranged.

Cautions
  • Requires urgent nephrology referral for diagnostic renal biopsy and immunosuppressive therapy.
  • Monitor for intravascular volume depletion, hypokalemia, and hypercoagulability (DVT risk).
  • Dietary sodium restriction (<2 g/day) is essential.
  • Furosemide Injection is contraindicated in patients with anuria.
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

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