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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.

Glomerulonephritis, Acute


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
580.0 - Glomerulonephritis, Acute, With Lesion of Proliferative Glomerulonephritis; Acute (Diffuse) Proliferative Glomerulonephritis; Acute Poststreptococcal Glomerulonephritis
580.4 - Glomerulonephritis, Acute, with Lesion of Rapidly Progressive Glomerulonephritis; Acute Nephritis with Lesion of Necrotizing Glomerulitis
580.81 - Acute Glomerulonephritis in Diseases Classified Elsewhere
580.89 - Glomerulonephritis, Acute, Other; Exudative Nephritis; Interstitial (Diffuse) (Focal) Nephritis
580.9 - Acute Glomerulonephritis with Unspecified Pathological Lesion in Kidney; Glomerulonephritis: Specified as Acute; Hemorrhagic Specified as Acute; Nephritis Specified as Acute; Nephropathy Specified as Acute

Related Terms

  • Acute Poststreptococcal Glomerulonephritis
  • Glomerular Disease
  • Infectious Glomerulonephritis
  • Postinfectious Glomerulonephritis

Overview

Acute glomerulonephritis results when the capillaries in the kidney (glomeruli) that control filtering and excretion become inflamed and unable to function properly. With the selective filtering mechanism damaged, blood and protein are lost in the urine, and excess body fluids accumulate (it is the protein in the bloodstream that maintains our fluid balance). Most often, the inflammation that triggers the disease stems from an immune response to a specific bacterium called Streptococcus. Typically, the body launches this immune response when the bacteria attacks the lungs or, less commonly, the skin.

Other bacteria, viruses, fungi, and parasites may also trigger such a response, but it is less usual. Acute glomerulonephritis may also stem from systemic causes that affect the body as a whole and for a variety of reasons also result in compromised glomerular function. Some of these conditions are hypersensitivity vasculitis, Wegener granulomatosis, systemic lupus erythematosus, polyarteritis nodosa, cryoglobinemia, and Goodpasture syndrome. Because it is the dominant, specific cause of acute glomerulonephritis, this topic will focus on the streptococcal origins of glomerulonephritis.

There are two forms of acute glomerulonephritis: postinfectious glomerulonephritis and infectious glomerulonephritis. Postinfectious glomerulonephritis typically occurs about 21 days after a respiratory or skin infection with Streptococcus. Infectious glomerulonephritis occurs during or within a few days of streptococcal infection. The disease may result in high blood pressure (hypertension), fluid accumulation (edema), and kidney failure. Of the two types, postinfectious glomerulonephritis (also called acute poststreptococcal glomerulonephritis) is the most common.

The most common risk factor for development of postinfectious glomerulonephritis is an untreated streptococcal infection of the respiratory tract and, less commonly, of the skin (impetigo).

Incidence and Prevalence: There has been a significant decline in the incidence of acute glomerulonephritis in developed countries such as the US, and cases are reported only sporadically. The declining incidence rates are probably related to improved nutritional status in these countries and more liberal use of antibiotics. Developing countries, such as those in Africa and the Caribbean, appear to have a higher potential for development of streptococcal infections, and the incidence of acute glomerulonephritis is proportionally higher in these areas.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Males are twice as likely to have the condition as females, and although glomerulonephritis can appear at any age, 90% of cases occur in those under 40 years. The disease most often develops in boys between 2 and 14 years (Kazzi).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report a recent bacterial (streptococcal) or viral illness. In some cases, symptoms are mild, and individuals may report only vague weakness, loss of appetite (anorexia), and lethargy. In more severe cases, they may complain of cola- or tea-colored urine, fever, chills, weakness, headache, blurred vision (reduced visual acuity), abdominal or flank pain, reduced or no urine output (oliguria or anuria, respectively) for several days, nausea, and vomiting.

Physical exam: Examination usually reveals generalized swelling (edema) particularly around the face and eyes (periorbital), fluid in the abdomen (ascites), fluid in the lungs (pulmonary edema) and chest cavity (pleural effusion), elevated blood pressure (hypertension), bloody urine, and skin rashes.

Tests: Visual examination of the urine usually provides enough information necessary for a definitive diagnosis of acute glomerulonephritis. The urine, which may be scanty in amount, will typically be dark, smoky, or cola-colored or red or brown in hue. There is usually persistent and excessive foam in the specimen, indicating a high level of protein in the urine. A laboratory test of the urine (urinalysis) may show protein and blood, high acid levels (low pH), and mid- to high-normal range values for specific gravity. Other laboratory tests may include an analysis of how well the kidneys are working (renal function test) and specific blood tests for serum urea nitrogen, creatinine, hyaluronidase, deoxyribonuclease B, and serum complement. The percentage of red blood cells (hematocrit) and the amount of hemoglobin in the blood can be measured using a complete blood count (CBC). A streptozyme test and cultures of the throat and skin may show evidence of the streptococcus bacterium.

Source: Medical Disability Advisor



Treatment

Treatment for acute glomerulonephritis depends on the underlying cause of the disease. In most cases, it is designed to relieve symptoms and reduce the potential for complications. Antibiotic therapy is used to treat the infection that resulted in acute glomerulonephritis (e.g., a penicillin derivative is given for streptococcal bacteria). Fluid retention (edema) and high blood pressure (hypertension) are treated with drugs that promote fluid loss (diuretics) and lower blood pressure (angiotensin converting enzyme [ACE] inhibitors). Other drug treatments may include anti-inflammatory drugs (corticosteroids), drugs that decrease the response of the immune system (immunosuppressive), and drugs that prevent clotting (anticoagulants or antiplatelet agents). Usually, dietary salt (sodium) and water will be restricted.

Source: Medical Disability Advisor



Prognosis

The predicted outcome is extremely variable, and the results of clinical studies regarding treatment effects are contradictory. Heart, lung, or neurological complications will worsen the outcome. Individuals who lose kidney function will have to be treated on an ongoing basis with dialysis, and if there is no meaningful recovery of kidney function, they may be a candidate for a kidney transplant. Generally, adults have a poorer prognosis for acute glomerulonephritis than do young individuals. Drug treatments are usually effective, and very few individuals die as a result of fluid in the lungs (pulmonary edema), brain inflammation (hypertensive encephalopathy), or uncontrolled infection.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Internal Medicine Physician
  • Nephrologist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications of acute glomerulonephritis include elevated blood pressure (hypertension), urinary tract or kidney infection (pyelonephritis), inflammation of the brain tissue (hypertensive encephalopathy), and decreased pumping ability of the heart (congestive heart failure). In rare cases (0.5% to 2%), the disease may progress to chronic renal failure (Kazzi).

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that may influence disability include the severity of the disease symptoms, the progression of the disease, and the individual's response to treatment for the underlying cause. Advanced age may also further lengthen disability, because older individuals are slower to recover and are more susceptible to recurrent infection. Because acute glomerulonephritis requires extensive bed rest and inactivity for proper recovery, the individual's mental health is of primary importance.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Rest is an important part of recovery from acute glomerulonephritis. Bed rest followed by a period of very limited activity may continue for several weeks to months. Individuals who are able to return to work will be very limited in their capacity to perform physical labor and may have to be reassigned to a desk job for a period of time. If kidney dialysis is required, the individual may require an extended leave of absence or a switch to a part-time or flex-time schedule to accommodate treatment. Individuals who are 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:

  • Has diagnosis of acute glomerulonephritis been confirmed?
  • Has individual experienced any complications related to glomerulonephritis?
  • Does individual have an underlying condition that may affect recovery? Is this condition receiving appropriate treatment?

Regarding treatment:

  • Is individual taking medication as prescribed?
  • Is individual compliant with dietary modifications?
  • Is individual receiving adequate rest for optimal recovery?

Regarding prognosis:

  • Do symptoms persist despite treatment?
  • Did individual experience residual kidney impairment?
  • Was hypertension effectively resolved?
  • Is additional drug therapy warranted?
  • Did individual experience permanent kidney damage?
  • Is dialysis required?
  • Is individual a candidate for a kidney transplant?
  • Is individual on local/national transplant lists?

Source: Medical Disability Advisor



References

Cited

Kazzi, Amin Antoine, and Arash David Tehranzadeh. "Glomerulonephritis, Acute." eMedicine. Eds. Edward A. Michelson, et al. 12 Aug. 2004. Medscape. 12 Oct. 2004 <http://emedicine.com/emerg/topic219.htm>.

Source: Medical Disability Advisor