# Nephritic Syndrome (Referral) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: KDIGO Clinical Practice Guideline for Glomerular Diseases 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) - Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph) ## Treatment metadata - Furosemide — 40 mg — oral.solid - Amlodipine — 5 mg — oral.solid ## Complete treatment card ```text NEPHRITIC SYNDROME (REFERRAL) Sources: KDIGO Clinical Practice Guideline for Glomerular Diseases 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph) Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Morning puffiness around the eyes and evening leg swelling are reported [leg swelling] - Cola-colored or red urine points to hematuria [blood in the urine] - Foamy urine occurs when protein content is high, though proteinuria stays under 3.5 g/day [proteinuria] - Reduced urine output points to renal insufficiency - A recent throat or skin infection, fever, or fatigue should be asked about [fatigue · fever] - Coughing up blood with breathlessness may point to Goodpasture syndrome or Wegener granulomatosis [breathlessness · coughing up blood] SIGNS - what you find (5) - Elevated blood pressure is a common vital sign finding [hypertension] - JVP distension, pitting edema, and lung crackles reflect fluid overload [crackles · leg swelling] - A new heart murmur raises suspicion for infective endocarditis [heart murmur] - Palpable purpura with swollen joints suggests a systemic vasculitic cause [purpura · rash] - Pallor and anemia may be found on exam [anaemia · pallor] TESTS (9) - Nephritic urine shows over 5 RBCs per HPF with dysmorphic cells and RBC casts - At least 1 in 20 red cells being an acanthocyte confirms a glomerular source of hematuria - Proteinuria is usually under 3.5 g/day but can reach the nephrotic range - Elevated creatinine with reduced GFR reflects impaired filtration - Kidney biopsy establishes the definitive underlying cause - Low C3/C4 complement points to immune-complex disease such as post-streptococcal GN or SLE - High ASO or anti-DNase B titers indicate a recent streptococcal infection - ANCA testing screens for systemic vasculitis such as granulomatosis with polyangiitis - Anti-GBM antibodies are checked to exclude Goodpasture syndrome IF NOT THIS - what else fits (2) - Nephrotic syndrome and familial nephritis are considered on the differential - Idiopathic hematuria and anaphylaxis are also listed as differentials Source StatPearls "Nephritic Syndrome" - disease-level clinical article Status traced to the source above 1. FUROSEMIDE [1st line] Adult Oral: Initial: 20-50 mg once then titrate as needed to achieve targeted effect. Peds 1-2 mg/kg/dose [child max 40 mg] (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.) 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 Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) Why Loop diuretic that controls the fluid overload driving edema and hypertension in nephritic syndrome while urgent nephrology referral is arranged. Caution Characterized by hematuria, oliguria, hypertension, and facial edema (often post- streptococcal). Monitor serum potassium, renal function, and fluid balance closely. Anuria Urgent nephrology referral is required. 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 2. AMLODIPINE [add-on - not a substitute] Adult Oral: Initial: 2.5 to 5 mg once daily; evaluate response after 2 to 4 weeks and titrate dose, as needed, up to a maximum of 10 mg once daily Peds Specialist pediatric nephrology management Source Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph) Why Calcium-channel blocker added to diuretic therapy for acute blood pressure control, not a replacement for urgent nephrology referral; preferred over ACE inhibitors at this acute stage because it does not compromise renal perfusion. Caution Monitor blood pressure closely. Preferred over ACE inhibitors in acute kidney injury stage due to stable hemodynamics. Egypt CORONAVINE 5 MG 10 TAB. PHAROPHARMA 6.00 EGP (0.60/unit) WINDIPINE 5 MG 30 TAB. SANOFI 21.00 EGP (0.70/unit) VASOPINE 5 MG 30 TABS. ARAB DRUG COM... 24.00 EGP (0.80/unit) AMILO 5 MG 30 TAB. ALFACURE PHAR... 54.00 EGP (1.80/unit) AMLODIPINE 5 MG 30 TAB. AMRIYA 60.00 EGP (2.00/unit) MYODURA 5 MG 30 TAB. GLOBAL NAPI P... 69.00 EGP (2.30/unit) NORVASC 5MG 10 TAB. PFIZER > VIAT... 54.00 EGP (5.40/unit) NORVASC 5MG 30 TAB. PFIZER > VIAT... 162.00 EGP (5.40/unit) 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)