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Hypertensive Renal Disease Questionnaire

This questionnaire is aimed at providing some guidance for people with Hypertensive Renal Disease, 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! We agree with personal privacy protection and promise not to reveal your info to anybody.

Patient Information

1. Are you the patient with Hypertensive Renal Disease?

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 Hypertensive Renal Disease?

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

Less than 1 year 1-5 years 5-10 years Not clear
5. What is daily urine output now?

Above 2500ml 1500-2500ml 1000-1500ml 400-1000ml Below 400ml Not clear
6. 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
7. What is the GFR or kidney function?

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
8. Discomforts or symptoms of the patient:

Changes in mental status, such as restlessness, sleepiness, fatigue, confusion, decreased ability to concentrate Recurrent cough, cold, infections Chronic high blood pressure Weakness of the arm, legs, face or other areas Reduced urine output Frequent urination at night Chest pain Dizziness Headache Protein in the urine Blood in urine Back pain
Q9: What kind of treatments the patient has received?

Glucocorticoid Immunosuppressive agents Angiotensin converting anzyme inhibitior Angiotensin II receptor antagonists Lipid-lowing medicines Dialysis Kidney Transplant Other treatment
Other symptoms
9. What are the current treatments?

Antihypertensive drugs Dialysis Kidney transplant
Other treatments
10. 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.