Immunoglobulin A Nephropathy Survey
Please complete this survey to help us better understand the experiences of individuals with IgA Nephropathy. Your responses are confidential and will contribute to research and patient care improvements.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Other
When were you diagnosed with IgA Nephropathy?
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How was your IgA Nephropathy diagnosed?
*
Kidney biopsy
Blood/urine tests
Other (please specify)
Please indicate how frequently you have experienced the following symptoms in the past 3 months:
*
Rows
Never
Rarely
Sometimes
Often
Always
Blood in urine
1
2
3
4
5
Swelling (edema)
6
7
8
9
10
High blood pressure
11
12
13
14
15
Fatigue
16
17
18
19
20
Protein in urine
21
22
23
24
25
Are you currently receiving any of the following treatments for IgA Nephropathy? (Select all that apply)
*
Blood pressure medications (ACE inhibitors/ARBs)
Immunosuppressive therapy
Corticosteroids
Dietary changes
No current treatment
Other
How would you rate your overall quality of life in the past month?
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
How satisfied are you with the information and support you have received about IgA Nephropathy?
*
1
2
3
4
5
Is there anything else you would like to share about your experience with IgA Nephropathy?
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