Assess Your Kidneys & Stay Risk-Free

PART A – YOUR HEALTH

• Diabetes

  Have you been told you have diabetes / high blood sugar?

  Yes
  No

• Blood Pressure

  Have you been told you have high blood pressure / hypertension?

  Yes
  No

• Heart Disease

  Have you ever had heart attack, angioplasty, heart failure or stroke?

  Yes
  No

• Known Kidney Problem

  Has any doctor told you that you have kidney disease, “high creatinine”, protein/ leakage in urine, or only one working kidney / kidney cysts / stones?

  Yes
  No

PART B – FAMILY & LIFESTYLE

• Family History

  Has any parent, brother or sister been on dialysis or had a kidney transplant?

  Yes
  No

• Age

  Are you 60 years or older?

  Yes
  No

• Pain‑killer Use

  Do you take pain‑killer tablets like diclofenac, ibuprofen, naproxen, nimesulide, etc. (without doctor advice)?

  Yes
  No

• Tobacco

  Do you smoke or chew tobacco regularly?

  Yes
  No

• Weight / Waist

  Have you been told you are overweight / obese, or is your waist > 90 cm (men) or > 80 cm (women)?

  Yes
  No

PART C – CURRENT SYMPTOMS

(Think of how you have been most days in the last 3 months)

• Do you notice swelling of feet or around the eyes, especially in the morning or evening?

  Yes
  No

• Is your urine persistently (most days):

  very foamy, orvery dark / reddish / brown, or you are passing much less urine than usual (without drinking less)?

  Yes
  No