A. What impairments do these listings cover?
- We use these listings to evaluate genitourinary impairments resulting from chronic renal disease.
- We use the criteria in 6.02 to evaluate renal dysfunction due to any chronic renal
disease, such as chronic glomerulonephritis, hypertensive renal vascular disease, diabetic nephropathy, chronic obstructive
uropathy, and hereditary nephropathies.
- We use the criteria in 6.06 to evaluate
nephrotic syndrome due to glomerular disease.
B. What do we mean by the following terms
in these listings?
- Anasarca is generalized massive edema (swelling).
- Creatinine is a normal product of muscle metabolism.
- Creatinine clearance test
is a test for renal function based on the rate at which creatinine is excreted by the kidney.
hypertension is elevated diastolic blood pressure.
- Fluid overload syndrome associated with
renal disease occurs when there is excessive sodium and water retention in the body that cannot be adequately removed by the
diseased kidneys. Symptoms and signs of vascular congestion may include fatigue, shortness of breath, hypertension, congestive
heart failure, accumulation of fluid in the abdomen (ascites) or chest (pleural effusions), and peripheral edema.
- Glomerular disease can be classified into two broad categories, nephrotic and nephritic. Nephrotic conditions
are associated with increased urinary protein excretion and nephritic conditions are associated with inflammation of the internal
structures of the kidneys.
- Hemodialysis, or dialysis, is the removal of toxic metabolic
byproducts from the blood by diffusion in an artificial kidney machine.
- Motor neuropathy is neuropathy
or polyneuropathy involving only the motor nerves.
- Nephrotic syndrome is a general name for a
group of diseases involving defective kidney glomeruli, characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia,
and varying degrees of edema.
- Neuropathy is a problem in peripheral nerve function (that is,
in any part of the nervous system except the brain and spinal cord) that causes pain, numbness, tingling, and muscle weakness
in various parts of the body.
- Osteitis fibrosa is fibrous degeneration with weakening and deformity
- Osteomalacia is a softening of the bones.
is a thinning of the bones with reduction in bone mass resulting from the depletion of calcium and bone protein.
- Pathologic fractures are fractures resulting from weakening of the bone structure by pathologic processes,
such as osteomalacia and osteoporosis.
- Peritoneal dialysis is a method of hemodialysis in which
the dialyzing solution is introduced into and removed from the peritoneal cavity either continuously or intermittently.
- Proteinuria is excess protein in the urine.
- Renal means pertaining
to the kidney.
- Renal osteodystrophy refers to a variety of bone disorders usually caused by chronic
- Sensory neuropathy is neuropathy or polyneuropathy that involves only the sensory
- Serum albumin is a major plasma protein that is responsible for much of the plasma colloidal
osmotic pressure and serves as a transport protein.
- Serum creatinine is the amount of creatinine
in the blood and is measured to evaluate kidney function.
evidence do we need?
- We need a longitudinal record of your medical history that includes
records of treatment, response to treatment, hospitalizations, and laboratory evidence of renal disease that indicates its
progressive nature. The laboratory or clinical evidence will indicate deterioration of renal function, such as elevation of
- We generally need a longitudinal clinical record covering a period of at least 3 months
of observations and treatment, unless we can make a fully favorable determination or decision without it. The record should
include laboratory findings, such as serum creatinine or serum albumin values, obtained on more than one examination over
the 3‑month period.
- When you are undergoing dialysis, we should have laboratory findings showing
your renal function before you started dialysis.
- The medical evidence establishing the clinical diagnosis
of nephrotic syndrome must include a description of the extent of edema, including pretibial, periorbital, or presacral edema.
The medical evidence should describe any ascites, pleural effusion, or pericardial effusion. Levels of serum albumin and proteinuria
must be included.
- If a renal biopsy has been performed, the evidence should include a copy of the report
of the microscopic examination of the specimen. However, if we do not have a copy of the microscopic examination in the evidence,
we can accept a statement from an acceptable medical source that a biopsy was performed, with a description of the results.
D. How do we consider the effects of treatment?
consider factors such as the:
- Type of therapy.
- Response to therapy.
- Side effects of therapy.
- Effects of any post-therapeutic residuals.
duration of treatment.
E. What other things do we consider when we
evaluate your chronic renal disease under specific listings?
- Chronic hemodialysis
or peritoneal dialysis (6.02A). A report from an acceptable medical source describing the chronic renal disease and the
need for ongoing dialysis is sufficient to satisfy the requirements in 6.02A.
- Kidney transplantation
(6.02B). If you have undergone kidney transplantation, we will consider you to be disabled for 12 months following the surgery
because, during the first year, there is a greater likelihood of rejection of the organ and recurrent infection. After the
first year posttransplantation, we will base our continuing disability evaluation on your residual impairment(s). We will
include absence of symptoms, signs, and laboratory findings indicative of kidney dysfunction in our consideration of whether
medical improvement (as defined in §§404.1579(b)(1) and (c)(1), 404.1594(b)(1) and (c)(1), 416.994(b)(1)(i) and
(b)(2)(i), or 416.994a, as appropriate) has occurred. We will consider the:
a. Occurrence of rejection episodes.
b. Side effects of immunosuppressants, including corticosteroids.
c. Frequency of any renal infections.
d. Presence of systemic complications such as other infections, neuropathy, or deterioration of other organ systems.
osteodystrophy (6.02C1). This condition is bone deterioration resulting from chronic renal disease. The resultant bone
disease includes the impairments described in 6.02C1.
- Persistent motor or sensory neuropathy
(6.02C2). The longitudinal clinical record must show that the neuropathy is a “severe” impairment as defined in
§§404.1520(c) and 416.920(c) that has lasted or can be expected to last for a continuous period of at least 12 months.
- Nephrotic syndrome (6.06). The longitudinal clinical record should include a description of
prescribed therapy, response to therapy, and any side effects of therapy. In order for your nephrotic syndrome to meet 6.06A
or B, the medical evidence must document that you have the appropriate laboratory findings required by these listings and
that your anasarca has persisted for at least 3 months despite prescribed therapy. However, we will not delay adjudication
if we can make a fully favorable determination or decision based on the evidence in your case record. We may also evaluate
complications of your nephrotic syndrome, such as orthostatic hypotension, recurrent infections, or venous thromboses, under
the appropriate listing for the resultant impairment.
F. What does the term "persistent"
mean in these listings?
Persistent means that the longitudinal clinical record shows that, with few exceptions,
the required finding(s) has been at, or is expected to be at, the level specified in the listing for a continuous period of
at least 12 months.
G. How do we evaluate impairments that do not meet one of the genitourinary
- These listings are only examples of common genitourinary impairments that
we consider severe enough to prevent you from doing any gainful activity. If your severe impairment(s) does not meet the criteria
of any of these listings, we must also consider whether you have an impairment(s) that satisfies the criteria of a listing
in another body system.
- If you have a severe medically determinable impairment(s)
that does not meet a listing, we will determine whether your impairment(s) medically equals a listing. (See §§404.1526
and 416.926.) If you have a severe impairment(s) that does not meet or medically equal the criteria of a listing, you may
or may not have the residual functional capacity to engage in substantial gainful activity. Therefore, we proceed to the fourth
and, if necessary, the fifth steps of the sequential evaluation process in §§404.1520 and 416.920. When we decide
whether you continue to be disabled, we use the rules in §§404.1579(b)(1) and (c)(1), 404.1594(b)(1) and (c)(1),
416.994(b)(1)(i) and (b)(2)(i), or 416.994a, as appropriate.
6.01 Category of Impairments, Genitourinary System
6.02 Impairment of renal function, due to any chronic renal disease that has lasted or can be expected to last for a continuous
period of at least 12 months. With:
A.Chronic hemodialysis or peritoneal dialysis
B. Kidney transplantation.
Consider under a disability for 12 months following surgery; thereafter, evaluate the residual impairment (see 6.00E2).
C. Persistent elevation of serum creatinine
to 4 mg per deciliter (dL) (100 ml) or greater or reduction of creatinine clearance to 20 ml per minute or less,
over at least 3 months, with one of the following:
1. Renal osteodystrophy
(see 6.00E3) manifested by severe bone pain and appropriate medically acceptable imaging demonstrating abnormalities such
as osteitis fibrosa, significant osteoporosis, osteomalacia, or pathologic fractures; or
Persistent motor or sensory neuropathy (see 6.00E4); or
3. Persistent fluid overload
a. Diastolic hypertension greater than or equal to diastolic blood pressure of 110 mm Hg; or
b. Persistent signs of vascular congestion despite prescribed therapy (see 6.00B5); or
4. Persistent anorexia with recent weight loss and current weight meeting the values in 5.08, table III or IV.
6.06 Nephrotic syndrome, with anasarca, persisting for at least 3 months despite prescribed therapy (see 6.00E5).
A. Serum albumin of 3.0 g per dL (100 ml) or less and proteinuria of 3.5 g or greater per 24 hours.
B.Proteinuria of 10.0 g or greater per 24