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Lupus Nephritis Questionnaire

This questionnaire aims at providing some guidance for people with lupus nephritis, their family and friends. After you submit the questionnaire, there will be free and detailed analysis for your specific illness condition, which can help you better understand your current condition. We also provide suggestions on your daily health care, prevention and treatment. Do not forget to leave your email address here or we can not send the illness analysis to you! We agree with personal privacy protection and promise not to reveal your info to anybody.

Patient Information

1. Are you the patient with lupus nephritis?

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

Male Female
3. How old is the person with Lupus Nephritis?

Under 18 18-30 30-45 45-60 Over 60
4. What is the GFR or kidney function? (Not clear, test it now)

More than 90 mL/min/1.73 ㎡ 60 - 89 mL/min/1.73 ㎡ 30 - 59 mL/min/1.73 ㎡ 15 - 29 mL/min/1.73 ㎡ Less than 15 mL/min/1.73 ㎡ Not clear.
5. Discomforts or symptoms of the patient:

Weight gain High blood pressure Dark urine Foamy urine Bad odor of mouth Increased urination at night Extreme fatigue Swelling in legs and around eyes
6. What treatment is the patient receiving now?

Corticosteroids Immunosuppressive drugs Blood pressure medications Dialysis Kidney transplant Other treatment
7. What is the urine output per day?

≥2500ml 1500-2500ml 1000-1500ml 400-1000ml ≤400ml
8. You can add more information that can be helpful for our analysis:

   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.