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Kidney Health Check
Full Name
Do you have diabetes?
Yes
No
Do you have, or are you being treated for, high blood pressure?
Yes, I have high blood pressure but I'm not being treated
Yes, I am being treated for high blood pressure
No
Have you had any of the following circulation problems?
Angina
Heart attack
Stroke or mini stroke
Poor circulation in your legs
Amputation due to poor circulation
Aortic aneurysm
Heart failure
None of these
Have you had any of the following?
Multiple kidney stones
Multiple urine infections, for example three or more in a six month period
Kidney surgery
Enlarged prostate gland
Cancer of the prostate gland
Bladder cancer
None of these
Email
Have you been diagnosed with any of the following?
Systemic lupus erythematosus (SLE)
Multiple myeloma
Rheumatoid arthritis
Liver disease
Sickle cell disease
HIV infection
None of these
Do you have a family history of kidney disease?
Parent or child who has a kidney disease that may be inherited
Parent or child who requires regular kidney dialysis
Parent or child who has had a kidney transplant
No
Have you ever had a urine test that was positive for blood or protein?
Yes
No
Are you taking any of the following drugs?
Ciclosporin
Tacrolimus
Lithium
Mesalazine
Any non-steroidal anti-inflammatory drugs
Non of these
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