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Nephritis Questionnaire

This questionnaire is aimed at providing some guidance for people with 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!

Patient Information

1. Are you the patient with 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 Nephritis?

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

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's the GFR level? (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 urine/bubbly urine Edema/Swelling High blood pressure Dark urine
Other symptoms:
9. Are there any complications?

10. What are the current treatments?

Steroids Immunosuppressive agents Antibiotics Anti-hypertensive medicines 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.