multicarehomeopathy - kidney-failure-case-history-form

Swelling (Oedema):*

If Yes (Click in the appropriate box)

Edema WITH Thirst
Edema WITHOUT Thirst
Oedema on Face
Oedema above eyes
Oedema below eyes
Oedema around eyes
Oedema Feet and legs
Breathing Difficulties (Oedema on chest portion)
Oedema Feet and legs
Hydrocephalous (Water inside the brain)

Urine:*

Scanty (small quantity)
Normal
No desire for urine

Urine color:

Reddish
Deep yellow
Frothy

Urine odor:

Normal
More Offensive

Urine Consistency :

Thin
Sediment at the bottom of urine collected
Normal

Urination Frequency:

More frequency (Especially in night)
Normal Frequency

Urging to urinate:

Sudden and intolerable
Involuntary Urination
Normal

Pain in urination :

If yes

Pain before urination
Pain during Urination
Pain after Urination
Burning pain
Pain on thigh and loin during urination

Microscopically features:

Albumin
Glucose
RBC
Casts

PHYSICAL GENERAL

Physical weakness/debility
Pulse missing sometimes
Burning of back portion
Burning of hands and legs

Nauseatic feeling/or vomiting

If yes

More in morning
More in forenoon
More in afternoon
More in evening
More in night
More on smell of cooking foods
More while eating
More after drinking water
Nausea with headache

Itching of skin

If yes

More in morning
More in forenoon
More in afternoon
More in evening
More in night
More when sweating
More after bathing
More when putting out cloth
Itching with burning sensation after that
Itching with allergic rashes
More on hot atmosphere
More on cold atmosphere
Itching with small eruptions
Itching without any eruption

Numbness of Feet

If Yes

More on sole
More on heel
Left leg
Right leg
More during sitting condition
More in evening time
More in night time
Not specific

Numbness of Hand

More on forearm
More upper arm
Left arm
Right arm
More in evening time
More in night time
Not specific

Kidney Failure Case History Form
*Fields indicated with an asterisk () are required to send this form.**
Name:*
Age:*
Sex:*	Male Female
Phone:
Email:*
Under Dialysis?*
If Yes How many times dialysis in a month:
Do you have any other diseases associated with kidney failure:*	Diabetes Mellitus Hypertension SLE (Systemic Lupus Erythematosus) Poly Cystic Kidneys Renal Carcinoma Nothing
Family History of Any Diseases:*	Tuberculosis Cancer Skin Disease like eczema or ring worm Diabetes Asthma Not any Specific If your family history have any such diseases then click at the left side of the disease name. If there is no Diseases then clik on 'Not any Specific' .
Past History of Any Disease:*	Tuberculosis Cancer Skin Disease like eczema or ring worm Allergic Cold & Sneezing Not any Specific Your past history of having any such diseases then click at the left side of the disease name. If there is no Diseases then clik on 'Not any Specific'

Glomerular Filtration Rate (GFR):*
Serum Creatinine:*
Blood Urea Nitrogen (BUN):*
Haemoglobin percentage (Hb%) :*
Serum Potassium (K):
Serum Calcium (Ca):

Pins and needles sensation of extremities
Disturbed sleep
Fidgety (restlessness) of legs
If Yes	More during evening More during night More on lower portion of leg More on thigh region Lying on bed
Leg pain
Pinching pain on leg.
Joint pain
If Yes	Large joints Small joints More on morning after waking up when trying to walk More on rest More when walking More during night time Relieve on hot application Relieve on cold application
Shortness of breath.
Bleeding from any part.
Erectile dysfunction (decreased sexual interest)
Soreness of the back.
If Yes	More on sitting lying position
Fatty degeneration of kidney.
Kidneys sensitive to pressure
Face - sunken, catechetic look , sunken cheeks.
Burning of whole body
Desire salt
Appetite	Loss Normal More
Thirst	More but after taking a little quantity desire lost Less Normal Nausea after drinking With dry lips
MENTAL GENERAL	Anxiety state of mind Mentally restless Fear that disease is incurable Forgetfulness Fear Death Anxious, Nervous nature
I have read & understood the Terms, Condition & Disclaimer on this site* I Accept
Group for Consultation Plan*
Consulation Duration*

Kidney Failure Case History

WRITE DOWN THE VALUE (FROM MOST LATEST REPORTS)

SIGN AND SYMPTOMS

OTHER SYMPTOMS

SEARCH IN BLOGS

Related Article

RECENT POSTS

Connect With Us