Kidney Dumplication Questionnaire

Your Name *:
Country *:
Email *:
Phone(optional):
Q1:Are you a Kidney Dumplication patient?
Yes I have Kidney Dumplication No ,my friend, relative or patient has Kidney Dumplication
Q2:Is the patient male or female?
male female
Q3:How old is the patient?
Q4:How long since Kidney Dumplication is found?
Q5:How is Kidney Dumplication found?
A relative had Kidney Dumplication so I had myself checked 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?
Q9:What complications the patient has?
Kidney Stone Nephrotuberculosis Kidney Tumour Hydronephrosis
Others Complications
Q10:What kind of treatments the patient has received?
Q11:What information would you like to be given?
 

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