Medical History
Do you have type 1 or type 2 diabetes?
- Yes
- No
Do you have high blood pressure?
- Yes
- No
Does a close family member have kidney disease?
- Yes
- No
Were you a preemie?
- Yes
- No
Are you over age 50?
- Yes
- No
Do you smoke?
- Yes
- No
Are you African American, Hispanic, Native American Asian?
- Yes
- No
Symptoms
Is your urine: a dark color, foamy, a larger or smaller amount than usual, or do you get up at night to urinate?
- Yes
- No
Do you feel very tired or have muscle weakness?
- Yes
- No
Do you feel cold all the time?
- Yes
- No
Do you have pale skin, gums, or nails?
- Yes
- No
Do you have metallic taste in your mouth?
- Yes
- No
Have you stopped wanting to eat meat, chicken, or fish?
- Yes
- No
Do you feel sick to your stomach or throw up a lot?
- Yes
- No
Do you have any swelling in your hands, stomach, feet, or face?
- Yes
- No
Does your skin itch all over?
- Yes
- No
Do you feel short of breath even when you’re not active?
- Yes
- No
Do you have frequent strep throat?
- Yes
- No
Do you suffer from muscle cramps often?
- Yes
- No
