Nephro care NEPAL
In Loving Memory · A Son's Promise

Built for my Aama.
So others may live.

This tool is dedicated to my beloved mother — because love, when it has nowhere left to go, becomes purpose.

My mother passed away in October 2025 after a long and painful struggle with kidney disease. She was strong, patient, and full of life until the disease took everything from her — first her energy, then her independence, then her time with us.

Kidney disease killed my mother. And I am a physician who works in clinical AI — someone who is committed to helping people live disease-free by combining clinical knowledge and technology to build tools that are accessible to everyone.

Thousands of young Nepali men and women leave their country every year in search of a better life — and the Gulf countries remain their largest destination. Construction workers, laborers, domestic workers: the backbone of Nepal's remittance economy, sending home billions that sustain families and build a nation. Yet while they contribute so much to the prosperity of an entire country, their own health and safety is too often neglected, overlooked, and underfunded. They return years later with damaged kidneys nobody warned them about — worn down by long shifts under a 48°C (118°F) sun, chronic dehydration, no shade, no clean water, and painkillers taken just to keep working through exhaustion. This is preventable.

This tool is my answer. It is built for every Nepali worker standing at the departure gate not knowing what they are walking into. It is built for the doctors at pre-migration clinics who deserve better screening tools. And it is built in honor of my beloved mother — who would have been proud to see this tool working and saving lives.

— Bishal Bhandari, MD MBA · Clinical AI Physician · Son
Start the Free Risk Assessment ↓
The Crisis

Nepali Migrant Workers & Kidney Disease:
A Silent Epidemic

Over 500,000 Nepali men and women depart for Gulf countries every year in search of a better life. Most are young and healthy when they leave — taking on heavy outdoor labour in extreme heat, contributing to an economy far from home, while their own health and safety goes unprotected. Many come back with kidneys that will never fully recover. This is not inevitable. It is preventable.

500K+
Nepali workers depart for GCC & Malaysia annually
Nepal Ministry of Labour, 2024
18%
Construction workers in Saudi Arabia developed kidney injury within one summer season
Longitudinal study, Al-Ahsa Province 2020
70.5%
Of Nepali returnees with CKD were in manual or semi-manual labour in GCC
Hospital-based study, Nepal 2021
77.3%
Of CKD cases in returnee Nepali migrants had unknown cause — likely CKDnT
Returnee CKD study, Nepal
70%
Worked more than 60 hours per week — a direct driver of heat-related kidney injury
Nepali returnee cohort study
24%
Increased CKD risk from regular NSAID (painkiller) use — commonly taken by workers to keep working through pain
Meta-analysis, 2025

How CKDnT Develops in Migrant Workers

🧑‍🔧
Healthy young worker departs
No kidney disease. Pre-existing risks often undiagnosed.
☀️
Daily heat exposure 40–50°C
Long shifts of heavy labour daily, limited shade or rest breaks.
💧
Chronic dehydration
<1L water intake per shift documented. Uric acid crystals damage tubules.
💊
NSAIDs to keep working
Ibuprofen/diclofenac used daily — reduces renal blood flow, accelerates injury.
🫘
Permanent kidney damage
CKDnT — no cure, progressive, dialysis or transplant the only options.

The NephroCare Risk Calculator

A clinician-designed, evidence-based risk assessment tool for doctors conducting pre-departure health screenings. Takes 5–8 minutes. Stratifies workers into four risk categories. Generates an AI-interpreted personalised risk narrative and clinical recommendations.

Evidence-based AI Risk Interpretation Nepali & English 3 Domains Assessed Free · No login Phase 2 Daily Monitoring
Launch Risk Calculator →
40+
RISK FACTORS ASSESSED
3
CLINICAL DOMAINS
4
RISK CATEGORIES
🧬
Risk Scoring Methodology
This tool uses a composite multi-domain risk scoring model built from three validated clinical frameworks:
CLINICAL DOMAIN
SCORED + QKidney
Screening for Occult Renal Disease (SCORED) validated in 5,000+ patients. QKidney validated in UK primary care with 2M+ records. Adapted with Asian BMI thresholds (≥23/≥27.5 kg/m²).
OCCUPATIONAL DOMAIN
CKDnT Framework
Built from CKD of non-traditional origin (CKDnT) occupational literature. Incorporates WBGT heat stress data, El Salvador / Sri Lanka / Nepal returnee cohort studies, and the DEGREE study tool (6-domain survey).
HYDRATION DOMAIN
WUT + Urine Colour Scale
Weight-Urine-Thirst (WUT) validated hydration framework. 8-level urine colour chart validated for occupational heat-stress settings. Daily monitoring adapted from NIOSH heat illness prevention guidelines.
⚠ Important: Risk thresholds (Low 0–6 / Moderate 7–13 / High 14–20 / Very High 21+) were derived by expert clinical judgment calibrating the SCORED + CKDnT + WUT domains against published outcome data for migrant worker populations. This is a screening tool, not a diagnostic instrument. Individual risk scoring has not been prospectively validated in a Nepali migrant worker cohort — validation is planned as a next phase of this project.
Pre-Departure Kidney Risk Screening Tool

NephroCare Risk Calculator

Complete all three sections. The AI will interpret the results and generate personalised recommendations.

🌐 CHOOSE LANGUAGE / भाषा छान्नुहोस्
1. Clinical History
2. Occupational Risk
3. Lifestyle & Hydration
4. Daily Health Log
🩺
Section 1 — Clinical History & Traditional Risk Factors
Based on SCORED, QKidney, and CRONICAS validated CKD risk tools
Age up to 3 pts
Sex 0–1 pts
Male sex is an independent CKD risk factor in occupational settings
BMI / Body Weight up to 2 pts
Asian BMI thresholds applied. Obesity is a confirmed risk factor in Saudi Arabia construction study.
Known Medical Conditions — select all that apply
Diabetes (Type 1 or 2)
+3
High blood pressure (Hypertension)
+2
Known kidney disease (CKD)
+4
Gout or high uric acid
+1
Kidney stones (history)
+1
None of the above
0
Family History — select all that apply
Family member with kidney disease
+2
Family member with diabetes
+1
No significant family history
0
Medication Use up to 2 pts
Regular painkiller use (ibuprofen, diclofenac) — ≥3×/week
+2
Occasional painkiller use
+1
No regular painkiller use
0
⚠ NSAIDs raise CKD risk by 24–50%. Commonly used by workers to push through pain.
Smoking 0–1 pts
Running score: 0 pts
🏗️
Section 2 — Occupational Exposure Risk
The dominant risk domain for migrant workers
Type of Work Abroad up to 3 pts
Destination Country up to 3 pts
Saudi Arabia records the highest wet-bulb globe temperatures (WBGT) — up to 41.7°C (107°F) at construction sites. Qatar and Kuwait also rank extremely high. UAE and Oman have slightly lower average WBGT but remain dangerous for outdoor labour. All GCC destinations carry significant heat stress risk.
Expected Working Hours Per Day up to 2 pts
70% of Nepali returnees with CKD worked >60 hours/week. Long hours in heat = cumulative kidney stress.
Work Environment Conditions — select all that apply
No guaranteed shade or rest breaks during outdoor work
+1
Uncertain access to clean drinking water at worksite
+1
Potential exposure to chemicals, dust, or heavy metals at work
+2
Limited access to toilet facilities (may reduce water intake deliberately)
+1
Prior Migration History up to 2 pts
Cumulative heat exposure across multiple contracts significantly increases CKDnT risk.
Expected Sleep Per Night 0–1 pts
Sleep deprivation identified as a significant risk factor in the Saudi Arabia construction worker study.
Running score: 0 pts
💧
Section 3 — Lifestyle, Diet & Baseline Hydration
Hydration habits and lifestyle factors that modify kidney injury risk
Current Daily Water Intake up to 2 pts
Urine Colour — most recent void up to 3 pts
Choose the colour that best matches your urine today. This is a validated hydration assessment method.
Pale/Clear
Light yellow
Yellow
Dark yellow
Amber
Dark amber
Brown/orange
Urination Frequency — typical day up to 2 pts
Dietary & Lifestyle Habits — select all that apply
High intake of sugary drinks (sodas, energy drinks, juices)
+1
Alcohol use ≥ 3 times per week
+1
High salt diet (processed, pickled foods)
+1
Current Symptoms — do you experience any of these?
Swelling in legs or ankles
+2
Unusual fatigue or weakness
+1
Foamy or frothy urine
+2
Flank or back pain
+1
No symptoms
0
Running score: 0 pts
📅
Section 4 — Daily Health Log & Monitoring
Create a dated log entry. Download as PDF to share with your doctor.
📋 For workers already deployed abroad — create a dated health log, run a daily risk check, and download a PDF to email to your doctor.

If you are at the clinic before departure, you can skip this section — your pre-departure score from Sections 1–3 is sufficient.
🚧
Coming in 3–4 weeks — Mobile Daily Monitoring
We are building a WhatsApp chatbot and lightweight PWA for daily logging from your phone. Includes photo-selectable urine colour chart, bilingual push reminders in Nepali and English, and automatic risk trend tracking.
Worker Name & Log Date
Full Name
Log Date
Work Location & Country Today
Water consumed today up to 3 pts
Urination frequency today up to 3 pts
Urine colour — most recent void
Pale ✓
Light
Yellow ⚠
Dark ⚠
Amber 🔴
Brown 🔴
Symptoms today — select all that apply
Muscle cramps during shift
+1
Dizziness or feeling faint
+2
Severe headache
+1
Took ibuprofen / diclofenac today
+2
No shade or rest breaks during work
+2
Slept less than 5 hours last night
+1
No symptoms — feeling well
0
Ankle or leg swelling today
+2
Additional Notes for Doctor
Log Preview
Fill in the form above to generate your log entry...
⚠️
AI-GENERATED RISK ASSESSMENT — NOT A CLINICAL CONSULTATION
This result is generated by an AI risk model based on your answers. It is intended as a screening and awareness tool only. It does not constitute a medical diagnosis or replace a consultation with a licensed physician. If you are at moderate, high, or very high risk, please consult a qualified doctor or nephrologist before departure.

Score Breakdown by Domain

🩺 Clinical / Medical History
0
🏗️ Occupational Exposure
0
💧 Lifestyle & Hydration
0
📅 Daily Monitoring (Phase 2)
0

AI Risk Interpretation Claude API

Generating personalised risk interpretation...