Amyloid Nephropathy Health Assessment Questionnaire

Your Name *:
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Q1:Are you an Amyloid Nephropathy patient?
Yes ,I have Amyloid Nephropathy No, my friend, relative or patient has Amyloid Nephropathy
Q2:Is the patient male or female?
Male Female
Q3:How old is the patient?
Q4:How long since Amyloid Nephropathy is found?
Less than 1 year 1-5 years 5-10 years Do not know
Q5:How is Amyloid Nephropathy found?
By accident in physical examination Symptoms and then it was confirmed Others
Q6: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 Do not know
Q7:What is the GFR level?
90 - 120 mL/min/1.73 m2 60 - 90 mL/min/1.73 m2 15 - 60 mL/min/1.73 m2 Below 15 mL/min/1.73 m2 Do not know
Q8:What symptoms the patient has?
Proteinuria/Foamy urine Edema/Swelling Frequent urination Hypoproteinemia Hyperlipemia Catch cold easily Fatigue Poor immunity Poor appetite Fatigue/Tiredness Dizziness Nausea/Vomit
Others symptoms
Q9. What is the daily urine output?
Above 2500ml 1500-2500ml 1000-1500ml 400-1000ml Below 400ml Do not know
Q10: What medicines is the patient taking now?
Q11: Has the patient start dialysis?
Yes No
Q11: If the above answer is yes, how long have you been on dialysis?
< 3 months 3-6 months 6 months to one year 1-3 years 3-5 years 5-10 years Over 10 years
Q12: Are you waiting for a kidney donor?
Yes No
Q13:For any of your concerned information, you may leave us a message
Latest news for treatment of Hypertensive Nephropathy
Analysis for individualized illness condition
Management of symptoms of Hypertensive Nephropathy
Proper dietary plan to improve health status
Improve quality of life on dialysis
Q14: Any other things you want to say?

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