# Nephrotic Syndrome (Referral & Supportive Care) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Furosemide — 40 mg — oral.solid ## Complete treatment card ```text NEPHROTIC SYNDROME (REFERRAL & SUPPORTIVE CARE) 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 Review status: REVIEWED against 2 sources listed above (2026-08) 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 Source StatPearls "Nephrotic Syndrome" - disease-level clinical article Status traced to the source above 1. FUROSEMIDE [1st line] Adult The usual initial dose of furosemide is 20 mg to 40 mg given as a single-dose, injected intramuscularly or intravenously. Peds 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).) 3kg -> 3-6 mg/dose 4kg -> 4-8 mg/dose 5kg -> 5-10 mg/dose 6kg -> 6-12 mg/dose 7kg -> 7-14 mg/dose 8kg -> 8-16 mg/dose 9kg -> 9-18 mg/dose 10kg -> 10-20 mg/dose 11kg -> 11-22 mg/dose 12kg -> 12-24 mg/dose 13kg -> 13-26 mg/dose 14kg -> 14-28 mg/dose 15kg -> 15-30 mg/dose 16kg -> 16-32 mg/dose 17kg -> 17-34 mg/dose 18kg -> 18-36 mg/dose 19kg -> 19-38 mg/dose 20kg -> 20-40 mg/dose 21kg -> 21-40 mg/dose (upper capped) 22kg -> 22-40 mg/dose (upper capped) 23kg -> 23-40 mg/dose (upper capped) 24kg -> 24-40 mg/dose (upper capped) 25kg -> 25-40 mg/dose (upper capped) 26kg -> 26-40 mg/dose (upper capped) 27kg -> 27-40 mg/dose (upper capped) 28kg -> 28-40 mg/dose (upper capped) 29kg -> 29-40 mg/dose (upper capped) 30kg -> 30-40 mg/dose (upper capped) 31kg -> 31-40 mg/dose (upper capped) 32kg -> 32-40 mg/dose (upper capped) 33kg -> 33-40 mg/dose (upper capped) 34kg -> 34-40 mg/dose (upper capped) 35kg -> 35-40 mg/dose (upper capped) 36kg -> 36-40 mg/dose (upper capped) 37kg -> 37-40 mg/dose (upper capped) 38kg -> 38-40 mg/dose (upper capped) 39kg -> 39-40 mg/dose (upper capped) 40kg -> 40 mg/dose (capped) 41kg -> 40 mg/dose (capped) 42kg -> 40 mg/dose (capped) 43kg -> 40 mg/dose (capped) 44kg -> 40 mg/dose (capped) 45kg -> 40 mg/dose (capped) 46kg -> 40 mg/dose (capped) 47kg -> 40 mg/dose (capped) 48kg -> 40 mg/dose (capped) 49kg -> 40 mg/dose (capped) 50kg -> 40 mg/dose (capped) 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. Caution 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. Egypt ODEMENT 40MG 10 TAB. EL NASR 1.30 EGP (0.13/unit) FRUZEX 40MG 12 TAB. MISR 3.25 EGP (0.27/unit) FUROSEMIDE 40MG 20 TAB. SEDICO 7.50 EGP (0.38/unit) FURORETIC 40 MG 30 TABS. DEBEIKY > VET... 14.25 EGP (0.47/unit) LAFUREX 40MG 20 TAB. AMOUN 9.50 EGP (0.47/unit) SALEX 40 MG 20 TABS. ARAB DRUG COM... 10.00 EGP (0.50/unit) FUROSEMIDE-ALEX 40MG 20 TAB. ALEXANDRIA 19.00 EGP (0.95/unit) LASIX 40 MG 24 TABS. SANOFI 30.00 EGP (1.25/unit) GENESEMIDE 20MG/5ML SYRUP 120 ML MEDIZEN PHARM... 56.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)