Genitourinary Disorders

• Author: David A. Morton III
• Pages: 699-740

6-1

Chapter 6

Genitourinary Disorders

Contents

Part I – Adults

§6.00 Genitourinary Disorders

§6.01 Category of Impairments, Genitourinary Disorders

§6.02 (Reserved)

§6.03 Chronic kidney disease, with chronic hemodialysis or peritoneal dialysis

§6.04 Chronic kidney disease, with kidney transplant

§6.05 Chronic kidney disease, with impairment of kidney function

§6.06 Nephrotic syndrome

§6.07 (Reserved)

§6.08 (Reserved)

§6.09 Complications of chronic kidney disease

Part II – Children

§106.00 Genitourinary Disorders

§106.01 Category of Impairments, Genitourinary Disorders

§106.02 (Reserved)

§106.03 Chronic kidney disease, with chronic hemodialysis or peritoneal dialysis

§106.04 Chronic kidney disease, with kidney transplant

§106.05 Chronic kidney disease, with impairment of kidney function

§106.06 Nephrotic syndrome

§106.07 Congenital genitourinary disorders

§106.08 Growth failure due to any chronic renal disease

§106.09 Complications of chronic kidney disease

Relevant Medical Data Forms: 6.02 (long and short forms)

§6.00 MEDICAL ISSUES IN SOCIAL SECURITY DISABILITY 6-2

Part I - Adults

§6.00 Genitourinary Disorders

A. Which disorders do we evaluate under these

listings?

We evaluate genitourinary disorders resulting in

chronic kidney disease (CKD). Examples of such

disorders include chronic glomerulonephritis, hyper-

tensive nephropathy, diabetic nephropathy, chronic

obstructive uropathy, and hereditary nephropathies.

We also evaluate nephrotic syndrome due to glo-

merular dysfunction under these listings.

B. What evidence do we need?

1. We need evidence that documents the signs,

symptoms, and laboratory findings of your CKD.

This evidence should include reports of clinical

examinations, treatment records, and documentation

of your response to treatment. Laboratory findings,

such as serum creatinine or serum albumin levels,

may document your kidney function. We generally

need evidence covering a period of at least 90 days

unless we can make a fully favorable determination

or decision without it.

2. Estimated glomerular filtration rate (eGFR). The

eGFR is an estimate of the filtering capacity of the

kidneys that takes into account serum creatinine

concentration and other variables, such as your age,

gender, and body size. If your medical evidence

includes eGFR findings, we will consider them

when we evaluate your CKD under 6.05.

3. Kidney or bone biopsy. If you have had a kidney

or bone biopsy, we need a copy of the pathology

report. When we cannot get a copy of the pathology

report, we will accept a statement from an accept-

able medical source verifying that a biopsy was per-

formed and describing the results.

C. What other factors do we consider when we

evaluate your genitourinary disorder?

1. Chronic hemodialysis or peritoneal dialysis.

a. Dialysis is a treatment for CKD that uses artifi-

cial means to remove toxic metabolic byproducts

from the blood. Hemodialysis uses an artificial

kidney machine to clean waste products from the

blood; peritoneal dialysis uses a dialyzing solu-

tion that is introduced into and removed from

the abdomen (peritoneal cavity) either continu-

ously or intermittently. Under 6.03, your ongoing

dialysis must have lasted or be expected to last

for a continuous period of at least 12 months. To

satisfy the requirements in 6.03, we will accept

a report from an acceptable medical source that

describes your CKD and your current dialysis,

and indicates that your dialysis will be ongoing.

b. If you are undergoing chronic hemodialysis or

peritoneal dialysis, your CKD may meet our defi-

nition of disability before you started dialysis.

We will determine the onset of your disability

based on the facts in your case record.

2. Kidney transplant.

a. If you receive a kidney transplant, we will

consider you to be disabled under 6.04 for 1 year

from the date of transplant. After that, we will

evaluate your residual impairment(s) by consid-

ering your post-transplant function, any rejection

episodes you have had, complications in other

body systems, and any adverse effects related to

ongoing treatment.

b. If you received a kidney transplant, your CKD

may meet our definition of disability before you

received the transplant. We will determine the

onset of your disability based on the facts in your

case record.

3. Renal osteodystrophy. This condition is the bone

degeneration resulting from chronic kidney disease-

mineral and bone disorder (CKD-MBD). CKD-MBD

occurs when the kidneys are unable to maintain the

necessary levels of minerals, hormones, and vita-

mins required for bone structure and function. Under

6.05B1, “severe bone pain” means frequent or intrac-

table (resistant to treatment) bone pain that interferes

with physical activity or mental functioning.

4. Peripheral neuropathy. This disorder results when

the kidneys do not adequately filter toxic substances

from the blood. These toxins can adversely affect

nerve tissue. The resulting neuropathy may affect

peripheral motor or sensory nerves, or both, causing

pain, numbness, tingling, and muscle weakness in

various parts of the body. Under 6.05B2, the periph-

eral neuropathy must be a severe impairment. (See

§§404.1520(c), 404.1521, 416.920(c), and 416.921 of

this chapter.) It must also have lasted or be expected

to last for a continuous period of at least 12 months.

5. Fluid overload syndrome. This condition occurs

when excess sodium and water retention in the body

due to CKD results in vascular congestion. Under

6.05B3, we need a description of a physical exami-

nation that documents signs and symptoms of vas-

cular congestion, such as congestive heart failure,

pleural effusion (excess fluid in the chest), ascites

SSA Pub No. 64-039 Listing of Impairments (footnotes written by author)

6-3 GENITOURINARY IMPAIRMENTS §6.01

(excess fluid in the abdomen), hypertension, fatigue,

shortness of breath, or peripheral edema.

6. Anasarca (generalized massive edema or swelling).

Under 6.05B3 and 6.06B, we need a description of the

extent of edema, including pretibial (in front of the

tibia), periorbital (around the eyes), or presacral (in

front of the sacrum) edema. We also need a description

of any ascites, pleural effusion, or pericardial effusion.

7. Anorexia (diminished appetite) with weight loss.

Anorexia is a frequent sign of CKD and can result

in weight loss. We will use body mass index (BMI)

to determine the severity of your weight loss under

6.05B4. (BMI is the ratio of your measured weight

to the square of your measured height.) The formula

for calculating BMI is in section 5.00G.

8. Complications of CKD. The hospitalizations in

6.09 may be for different complications of CKD.

Examples of complications from CKD that may

result in hospitalization include stroke, congestive

heart failure, hypertensive crisis, or acute kidney

failure requiring a short course of hemodialysis. If

the CKD complication occurs during a hospitaliza-

tion that was initially for a co-occurring condition,

we will evaluate it under our rules for determining

medical equivalence. (See §§404.1526 and 416.926

of this chapter.) We will evaluate co-occurring

conditions, including those that result in hospitaliza-

tions, under the listings for the affected body system

or under our rules for medical equivalence.

D. How do we evaluate disorders that do not

meet one of the genitourinary listings?

1. The listed disorders are only examples of com-

mon genitourinary disorders that we consider severe

enough to prevent you from doing any gainful activ-

ity. If your impairment(s) does not meet the crite-

ria 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.

2. 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 of this

chapter.) Genitourinary disorders may be associated

with disorders in other body systems, and we con-

sider the combined effects of multiple impairments

when we determine whether they medically equal a

listing. If your impairment(s) does not meet or medi-

cally equal the criteria of a listing, you may or may

not have the residual functional capacity to engage

in substantial gainful activity. We proceed to the

fourth and, if necessary, the fifth steps of the sequen-

tial evaluation process in §§404.1520 and 416.920

of this chapter. We use the rules in §§404.1594 and

416.994 of this chapter, as appropriate, when we

decide whether you continue to be disabled.

§6.01 Category of Impairments,

Genitourinary Disorders

Figure 6.01.1.a – 1: Urinary System1

1 Source: National Cancer Institute (NCI)