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Renal Amyloidosis Questionnaire

This health assessment questionnaire regarding Renal Amyloidosis aims to provide some guidance for patients and their families, friends and nursing personnel. After several questions, you can get a personalized guidance for your kidney problems. Do not forget to leave your email address here or we can not send the illness analyses to you! We agree with personal privacy protection and promise not to reveal your info to anybody.

Patient Information

Q1: Are you a Renal Amyloidosis patient?

Yes, I have.  No, my friend, relative or patient has.
Q2: Is the patient male or female?

Male Female
Q3: How old is the patient?

Under 18 18-30 30-45 45-60 Above 60
Q4: How long since Renal Amyloidosis is found?

< 1 year 1-5 years 5-10 years No idea
Q5: What is the creatinine level?

0.5-1.2mg/dl 1.2-2.0mg/dl 2.0-4.0mg/dl 4.0-5.0mg/dl Above 5.0mg/dl No idea
Q6: What is the GFR level? (Not clear, test it now)

90 - 120 mL/min/1.73 ㎡ 60 - 90 mL/min/1.73 ㎡ 30 - 60 mL/min/1.73 ㎡ 15 - 30 mL/min/1.73 ㎡ < 15 mL/min/1.73 ㎡ No idea
Q7: What is the daily urine output?

Above 2500ml 1500-2500ml 1000-1500ml 400-1000ml Under 400ml No idea
Q8: What symptoms the patient has?

Foamy urine Blood in the urine Pain in the abdomen loin and back pain Edema/Swelling Enlargement of tongue (amyloid macroglossia) Hypoalbuminemia Hyperlipidemia High blood pressure Feeling of sick Bad appetite
Q9: What kind of treatments the patient has received?

Glucocorticoid Immunosuppressive agents Angiotensin converting anzyme inhibitior Angiotensin II receptor antagonists Lipid-lowing medicines Dialysis Kidney Transplant Other treatment
Q10: What information would you like to be given?

   Your Name: *

    Country: *

    Email: *

    Phone: (optional)

About Us

Unlike any other charity, we can offer a comprehensive menu of outpatient, Hospital-based and Web offerings that enable use to provide the ongoing support for children and families--from diagnosis through the entire medical treatment course. We can help them relieve their pain and manage their illness better.