Nephrotic Syndrome(NS) Questionnaire

Your Name:
Q1:Are you a Nephrotic Syndrome patient?
Yes ,I have Nephrotic Syndrome No, my child or parents has Nephrotic Syndrome
Q2:Is the patient male or female?
Male Female
Q3:How old is the patient?
Q4:How long since Nephrotic Syndrome is found?
Q5:How is Nephrotic Syndrome found?
A relative had kidney disease so I had myself checked
By accident in physical examination
Symptoms and then it was confirmed
Q6:What is the creatinine level?
Q7:What is the GFR level? (If you do not know your GFR, you can test it now)
Q8. What is the daily urine output?
Q9:What symptoms the patient has?
Foamy urine/ bubbly urine Edema/Swelling Hypoalbuminemia Hyperlipidemia Reduced urine Fatigure Poor appetite High blood pressure
Others symptoms:
Q10:What complications the patient has?
Q11:What kind of treatments the patient has received?
Diuretic Glucocorticoid Cyclophosphamide Cyclosporin A Tacrolimus Mycophenloate Mofetil Tablets Dialysis Kidney Transplant Other treatment
Q12:What information would you like to be given?

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