Hypertensive Nephropathy Health Assessment Questionnaire

Your Name *:
Country *:
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Q1:Are you a patient with Hypertensive Nephropathy?
Yes I have Hypertensive Nephropathy No my friend relative or patient has Hypertensive Nephropathy
Q2:How old is the patient?
Q3: How long has the patient suffered from Hypertension?
Less than 1 year 1-5 years 5-10 years 10-20 years Do not know
Q4:What is daily urine output now?
Above 2500ml 1500-2500ml 1000-1500ml 400-1000ml Below 400ml Do not know
Q5:What is your current blood pressure?
Q6:What is the GFR level?
10-15 mL/min/1.73 m2 8-10 mL/min/1.73 m2 5-10 mL/min/1.73 m2 <5 mL/min/1.73m2 Not sure
Q7: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
Q8:Choose if you have any of the following problems
Uncontrolled blood pressure Frequent urination at night Protein in urine Swelling/edema Hard breath Fatigue/tiredness Dizziness Poor appetite Nausea/vomit
Others problems
Q9:What medicines are you taking now?
Q10: 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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