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Nephrotic Syndrome Questionnaire

This questionnaire is aimed at providing some guidance for people with Nephrotic Syndrome, 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 Nephrotic Syndrome?

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 Nephrotic Syndrome?

Under 18 18-30 30-45 45-60 Over 60
4. How long has the patient been living with Nephrotic Syndrome?

Less than 1 year 1-5 years 5-10 years Not clear
5. 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 Not clear
6. 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
7. What is the urine output per day?

Above 2500ml 1500-2500ml 1000-1500ml 400-1000ml Below 400ml Not clear
8. Discomforts or symptoms of the patient:

Foamy/bubbly urine Edema/Swelling Low levels of blood protein High level of cholesterol in the blood Weight gain Tiredness Dry skin
Other symptoms:
9. Are there any complications?

Infections Acute Renal Injury Coronary heart disease Blood clots (thrombus) Disorder of electrolytes and metabolism Chronic Kidney Failure
10. What are the current treatments?

Hormones Immunosuppressive agents High blood pressure medications Diuretics Cholesterol-reducing medications Blood thinners Dialysis Kidney Transplant
Other treatments:
11. 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.