Self Risk Assessment of Renal Disease
Yes
No
History of kidney disease in your family.
Are you suffering from
(i) Diabetes
(ii) Hypertension
(iii) Kidney diseases such as Nephritis, recurrent Urinary tract infection, kidney stones
Do you have the following symptoms
(i) Blood in urine / tea color urine
(ii) Frothy urine
(iii) Turbid urine
(iv) Pain and frequency when passing urine
(v) Difficulty / slow in passing urine
(vi) Passing gravel or stone with urine
(vii) Passing urine at night (very frequent)
(viii) Loin / back pain
(ix) Swollen ankles or puffy face
Please answer all questions - Yes or No
