Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Abscess, Renal and Perinephric


Related Terms

  • Kidney Abscess
  • Nephritic Abscess
  • Perirenal Abscess
  • Renal Carbuncle

Differential Diagnosis

Specialists

  • General Surgeon
  • Nephrologist
  • Urologist

Comorbid Conditions

Factors Influencing Duration

Length of disability may be prolonged by the complications listed above. Older individuals may have a longer period of disability following surgery, as they recover more slowly. Disability relates to job requirements.

Medical Codes

ICD-9-CM:
590.2 - Renal and Perinephric Abscess; Abscess: Kidney, Nephritic, Perirenal; Carbuncle of Kidney

Overview

A renal or perinephric abscess is a localized collection of pus in or around the kidney (perirenal space). Renal and perinephric abscesses are serious infections that are caused by one or several different kinds of bacteria, or rarely, fungi (especially in diabetics).

Most renal and perinephric abscesses develop from urinary obstruction or are spread from the blood. They are an uncommon complication of a lower urinary tract infection. The main risk factors for renal or perinephric abscess are renal or ureteral mineral deposits (calculi) and diabetes mellitus. Other predisposing conditions include polycystic kidney disease (especially if the individual is on dialysis), spinal cord injury, a deficient (compromised) immune system, an abnormal growth (neoplasm) in the kidney, genitourinary tuberculosis, renal transplantation, and surgical trauma to the kidney (e.g., renal biopsy, urinary instrumentation, urologic surgery).

Renal or perinephric abscesses usually occur singly and in only one kidney (unilateral).

Incidence and Prevalence: This condition is uncommon. The incidence of renal or perinephric abscess ranges from 1 to 10 cases per every 10,000 individuals (Willard).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The condition affects men and women in equal proportion (Willard).

Source: Medical Disability Advisor



Diagnosis

History: The onset of symptoms may be very gradual, occurring over 2 or more weeks. Individuals may report fever, flank or abdominal pain, chills, pain during urination (dysuria), blood in the urine, weight loss, nausea, vomiting, recent infection of the skin or urinary tract, and loss of appetite (anorexia). There may be a history of recurrent urinary tract infections.

Physical exam: The exam may reveal pain during manual examination (palpation) of the abdomen or flank, or abdominal lump (mass). Curvature (scoliosis) of the spine may be noted. Examination of the muscles and joints (musculoskeletal system) may reveal pain on bending toward the side opposite (contralateral) to the flank pain. Also, pain may be produced by active flexion of the thigh against resistance on the same (ipsilateral) side as the flank pain, or extension of the ipsilateral thigh while walking.

Tests: Lab tests include a complete blood count (CBC) with differential, electrolytes, creatinine, and urinalysis, as well as urine and blood cultures. Urinalysis may show pus in the urine (pyuria), blood in the urine (hematuria), and/or protein in the urine (proteinuria). Gram stain and culture is done on samples of abscess fluid in order to identify the infectious bacterium. Other tests may include imaging of the kidney using x-rays of the abdomen or chest, high-frequency sound waves (renal ultrasound), computer-aided x-ray analysis (computerized tomography, or CT scan), or magnetic resonance imaging (MRI). Accurate diagnosis in the early stages of infection is critical to the individual's survival.

Source: Medical Disability Advisor



Treatment

Treatment calls for immediate intravenous administration of broad-spectrum antibiotics and drainage of the abscess. The drainage technique depends on the size and location of the abscess. Smaller, isolated lesions may be drained with a needle inserted through the skin (percutaneous aspiration) under ultrasound guidance. For simple, one-cavity (unilocular) abscesses within the kidney, drainage is done through a small tube (catheter drainage). If the abscess is large, located in certain areas of the kidney (renal cortex), or the patient is older and septic, open surgical drainage may be necessary. Sometimes it is not possible to save the kidney and removal of part or all of the kidney (simple, partial, or complete nephrectomy) may be necessary.

Gram stain and culture are done on samples of abscess fluid in order to identify the infectious agent(s). Specific antimicrobial therapy is administered intravenously until the individual has been without fever (afebrile) for 24 hours. At that time, oral antibiotics are begun. Severely ill individuals may also require feeding through an intravenous line (parenteral nutrition).

Source: Medical Disability Advisor



Prognosis

Accurate diagnosis in the early stages of infection is critical to the individual's survival. However, the typically non-specific symptoms present a diagnostic challenge to even the most astute clinician. Full recovery occurs in the vast majority of cases after abscess drainage and appropriate antibiotic treatment. If left untreated, renal and perinephric abscesses have a mortality rate of approximately 56%; even with surgery for abscess drainage, mortality ranges from 8% to 35% (Shukla).

Source: Medical Disability Advisor



Rehabilitation

An exercise rehabilitation program under the direction of a physician may benefit individuals who are receiving dialysis treatment.

Source: Medical Disability Advisor



Complications

Complications of renal or perinephric abscess may include development of a sub-diaphragmatic (subphrenic) abscess; empyema; fistula formation to the stomach, small bowel, or lung; puncture (perforation) into the abdominal (peritoneal) cavity or the colon; psoas abscess; or systemic infection (sepsis). Individuals with severe infection may develop renal failure and require removal of part or all of the kidney (nephrectomy). Late-stage diagnosis may result in death (mortality).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Extended sick leave may be required before the individual can return to work. Strenuous physical activity may need to be modified. If kidney dialysis is required, the individual may require an extended leave of absence or a switch to part-time or flex-time to accommodate the treatment schedule. Individuals receiving dialysis treatments should be assigned more sedentary duties.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • What is the size of individual's abscess? Where is it located?
  • Has individual had a recent urinary tract infection?
  • Does individual have any risk factors such as polycystic renal disease, hemodialysis treatment, spinal cord injury, compromised immune system, diabetes, urinary tract obstruction or calculi, kidney neoplasm or tuberculosis, history of renal transplant, surgical trauma to the kidney, steroid administration, or chronic or recurrent urinary tract infection?
  • Has individual had fever, flank pain, chills or night sweats, pain with urination, nausea, vomiting, weight loss or loss of appetite?
  • On examination, was an abdominal or flank mass palpable?
  • Were urine and blood cultures done?
  • Did individual have a CBC, electrolytes, and kidney function tests?
  • Was a urinalysis done?
  • Did individual have renal ultrasound, CT scan, or MRI?
  • Were similar conditions ruled out?

Regarding treatment:

  • Was individual started on broad-spectrum IV antibiotics? What technique was used to drain the abscess?
  • Was specific antimicrobial therapy continued until individual was fever-free for 24 hours? Were oral antibiotics started at that time?
  • Was it necessary to do a partial or complete nephrectomy?
  • Was it necessary for individual to undergo dialysis?

Regarding prognosis:

  • Is individual's employer able to accommodate flex-time or part-time work?
  • Does individual have chronic or acute renal failure, diabetes mellitus, chronic obstructive pulmonary disease, or coronary artery disease?
  • Did individual have any complications?

Source: Medical Disability Advisor



References

Cited

Shukla, Prem C., and Edward David Kim. "Perinephric Abscess." eMedicine. Eds. Daniel B. Rukstalis, et al. 7 Nov. 2004. Medscape. 13 Jan. 2005 <http://emedicine.com/med/topic2844.htm>.

Willard, Brian T., Lynn J. Teague, and Keith Steinbecker. "Renal Corticomedullary Abscess." eMedicine. Eds. Jong M. Choe, et al. 27 Jul. 2004. Medscape. 13 Jan. 2005 <http://emedicine.com/med/topic2848.htm>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.