Genitourinary Disorders

• Author: David A. Morton III
• Pages: 661-700

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

§6.07-08 (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)

GENITOURINARY

DISORDERS

§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 disor-

ders include chronic glomerulonephritis, hypertensive

nephropathy, diabetic nephropathy, chronic obstructive

uropathy, and hereditary nephropathies. We also evaluate

nephrotic syndrome due to glomerular dysfunction under

these listings.

B. What evidence do we need?

1. We need evidence that documents the signs, symptoms,

  

should include reports of clinical examinations, treat-

ment records, and documentation of your response to



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.     The

      

kidneys that takes into account serum creatinine con-

centration and other variables, such as your age, gender,

and body size. If your medical evidence includes eGFR



CKD under 6.05.

3.   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 acceptable medi-

cal source verifying that a biopsy was performed and

describing the results.

C. What other factors do we consider when we eval-

uate your genitourinary disorder?

1. 



means to remove toxic metabolic byproducts from the



to clean waste products from the blood; peritoneal

dialysis uses a dialyzing solution that is introduced

into and removed from the abdomen (peritoneal

cavity) either continuously 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 peri-



disability before you started dialysis. We will deter-

mine the onset of your disability based on the facts

in your case record.

2. 

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 considering your post-trans-

plant function, any rejection episodes you have had,

complications in other body systems, and any adverse



b. If you received a kidney transplant, your CKD may



the transplant. We will determine the onset of your

disability based on the facts in your case record.

3.   This condition is the bone

degeneration resulting from chronic kidney disease-min-

eral and bone disorder (CKD-MBD). CKD-MBD occurs

when the kidneys are unable to maintain the necessary

levels of minerals, hormones, and vitamins required for

bone structure and function. Under 6.05B1, “severe bone

pain” means frequent or intractable (resistant to treat-

ment) bone pain that interferes with physical activity or

mental functioning.

4.  This disorder results when







motor or sensory nerves, or both, causing pain, numb-

ness, tingling, and muscle weakness in various parts of

the body. Under 6.05B2, the peripheral 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.  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 examination that docu-

ments signs and symptoms of vascular congestion, such

GENITOURINARY

DISORDERS

6-3 GENITOURINARY DISORDERS §6.01



-

tension, fatigue, shortness of breath, or peripheral edema.

6.  (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,



7.     

Anorexia is a frequent sign of CKD and can result in

weight loss. We will use body mass index (BMI) to deter-

mine 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.  The hospitalizations in 6.09



complications from CKD that may result in hospitaliza-

tion include stroke, congestive heart failure, hypertensive

crisis, or acute kidney failure requiring a short course of

hemodialysis. If the CKD complication occurs during a

hospitalization that was initially for a co-occurring con-

dition, 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 hospitalizations, under the

 

for medical equivalence.

1 Source: National Cancer Institute (NCI)

D. How do we evaluate disorders that do not meet one

of the genitourinary listings?

1. The listed disorders are only examples of common

genitourinary disorders that we consider severe enough

to prevent you from doing any gainful activity. If your

impairment(s) does not meet the criteria of any of these

listings, we must also consider whether you have an

   

another body system.

2. If you have a severe medically determinable impair-

ment(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.) Genitouri-

nary disorders may be associated with disorders in other

 

multiple impairments when we determine whether they

medically equal a listing. If your impairment(s) 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. We proceed to the



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

GENITOURINARY

DISORDERS