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.

Glomerulosclerosis


Related Terms

  • Focal and Segmental Hyalinosis
  • Focal Glomerulosclerosis
  • Focal Sclerosis with Hyalinosis
  • Focal Segmental Glomerulosclerosis
  • FSGS
  • Glomerular Sclerosis
  • Segmental Glomerulosclerosis
  • Segmental Hyalinosis

Differential Diagnosis

  • Abdominal aortic aneurysm
  • Acute nephritic syndrome
  • Diabetes
  • Glomerulonephritis
  • Human immunodeficiency virus (HIV)
  • Hypertensive nephropathy
  • Intravenous drug abuse
  • Lymphoma
  • Medication-induced interstitial nephritis
  • Postobstructive nephropathy
  • Renal artery stenosis
  • Sarcoidosis
  • Severe obesity

Specialists

  • Internal Medicine Physician
  • Nephrologist
  • Urologist

Comorbid Conditions

Factors Influencing Duration

The degree of symptoms and extent of kidney damage at the time of diagnosis will affect the disability duration. Progression of the condition and development of nephrotic syndrome will increase the length of disability.

Medical Codes

ICD-9-CM:
582.1 - Glomerulosclerosis, Chronic, with Lesion of Membranes

Overview

Glomerulosclerosis, a chronic renal disease, occurs when scattered (segmental) scar tissue forms in some (focal) of the kidney's ball-shaped networks of specialized capillaries (glomeruli) that filter impurities from the blood and then excrete them with fluid as urine. Most of the cases progress to chronic renal failure (CRF).

Incidence and Prevalence: Glomerulosclerosis affects individuals of all ages; however, is most common in those aged 18 to 45 years. In adults, the condition is observed in 20% to 30% of patients with nephrotic syndrome. Incidence is 3 to 7 times higher in young black men as compared with whites (24 cases and 5 cases per million population, respectively). Incidence of secondary glomerulosclerosis in individuals addicted to heroin is 30 times higher.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The cause of glomerulosclerosis is often unknown (idiopathic). Reflux nephropathy, a condition in which urine flows from the bladder backward into the kidney, causes a small number of cases of glomerulosclerosis. Diabetes, obesity, HIV/AIDS, glomerulonephritis, and sickle cell disease can also cause glomerulosclerosis. The disease may also be associated with certain prescription or illegal drugs.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report increased or decreased urine output (oliguria or polyuria), swelling due to fluid accumulation (edema) in the eyes, feet, and hands, foamy urine, unintentional weight gain; and poor appetite (anorexia). Symptoms of chronic renal failure and associated fluid overload may develop as the disorder progresses, including nausea and vomiting, unintentional weight loss or weight gain, general ill feeling (malaise), fatigue, headache, generalized itching (pruritus), nocturnal urination (nocturia), easy bruising or bleeding, decreased alertness, confusion, muscle twitching or cramps, decreased sensation in the hands or feet (paresthesia), excessive thirst, and seizures.

Physical exam: The exam may reveal high blood pressure (hypertension), and swelling due to edema.

Tests: Tests may include a urinalysis that reveals protein in the urine (proteinuria), with or without small amounts of blood (hematuria); when examined under a microscope, the urine may contain fat. Blood testing reveals low blood protein (hypoproteinemia), and a rise in blood cholesterol (hypercholesterolemia). A renal biopsy may reveal scarring of parts of a glomerulus (focal) or of only some of the glomeruli (segmental). An immunofluorescence microscopy may show deposits of one of the glycoproteins that function as antibodies, immunoglobulin IgM.

Source: Medical Disability Advisor



Treatment

Scarred glomeruli cannot be repaired; this condition may be chronic and lifelong. The goal of treatment is to slow progression of the condition and control the symptoms associated with nephrotic syndrome and chronic renal failure. Long-term corticosteroid therapy may induce complete or partial remission in 30 to 60% of individuals. Immunosuppressive medications (such as cyclosporine or mycophenolate) may induce remission when corticosteroids only produce slight improvement or relapse occurs. Several drugs, as well as drug doses and combinations are tried to find the optimal treatment for each individual. Underlying diabetes must be controlled. Hypertension is usually controlled by medication such as angiotensin-converting enzyme (ACE) inhibitors or with combination antihypertensive drug therapy. Treatment of high cholesterol and triglyceride levels, also common with this disorder, may be recommended to reduce the potential for developing atherosclerosis, and can be achieved with medication (statins). To lighten the waste load on the kidneys, a low-protein, low-cholesterol, and low-saturated-fat diet is generally recommended; low-sodium diets may help control edema. Kidney dialysis or a kidney transplant may be necessary if renal failure develops.

Source: Medical Disability Advisor



Prognosis

Although the time course is variable, kidney failure (end-stage renal disease [ESRD]) develops 6 to 8 years after the onset of proteinuria, eventually requiring external cleansing of the blood (dialysis) or a kidney transplant. Less than 15% of individuals with non-nephritic proteinuria progress to end-stage renal disease in 10 years compared with more than 50% of those with persistent nephritic syndrome. Renal functional deterioration is even more rapid (2 to 3 years) in the presence of massive proteinuria (greater than 10 to15 g/day) (Rao). Spontaneous remission occurs in fewer than 5% of individuals with glomerulosclerosis.

Source: Medical Disability Advisor



Complications

Complications include nephrotic syndrome, chronic renal failure, end-stage renal disease with a need for dialysis, malnutrition, and enhanced susceptibility to infections.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations depend on the severity of the condition, underlying disease, treatment required, and the nature of the work responsibilities. An individual who has received the diagnosis of glomerulosclerosis and is under treatment to slow its progression may be able to work for years until kidney failure sets in.

Risk: Work-related activities should not pose a risk to individuals with chronic glomerulosclerosis. Exceptions would be industries with exposures to known kidney toxins. However, for safety reasons work restrictions may be appropriate for individuals with mental cloudiness or dizziness and for those who develop hypertensive encephalopathy. Concomitant presence of poorly controlled hypertension, heart failure, or ascites may require a preclusion from heavy or very heavy work.

Capacity: Individuals with advanced chronic glomerulosclerosis may have decreased capacity secondary to dyspnea, renal failure, severe anemia, or CHF. Physician-prescribed work limitations may be appropriate for individuals with these complications. Objective testing with stress ECHO would be helpful.

Tolerance: Tolerance may be affected by malaise and fatigue caused by disease-related sleep impairments, altered dialysis schedules, or the uremic effects on the blood.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 days.

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:

  • Does individual have diabetes mellitus or reflux nephropathy? Hypertension?
  • Does individual abuse intravenous drugs?
  • Does individual experience oliguria or polyuria, edema in the feet or abdomen, foamy urine?
  • Were signs of chronic renal failure present, such as nausea and vomiting, unintentional weight loss, malaise, fatigue, headache, generalized itching (pruritus), nocturia, easy bruising or bleeding, decreased alertness, confusion, muscle twitching or cramps, decreased sensation in the hands or feet, excessive thirst, and seizures?
  • Was nephrotic syndrome ruled out?
  • Was the diagnosis confirmed with a renal biopsy and immunofluorescence microscopy?

Regarding treatment:

  • Was individual given a trial of corticosteroids and/or immunosuppressive medications? Were they helpful?
  • If individual is diabetic or hypertensive, are these conditions under good control?
  • Is individual on medications to control blood lipids, if needed?
  • Is individual compliant with the dietary restrictions, i.e., low-protein, low-cholesterol, and low-saturated-fat diet?
  • Is kidney dialysis necessary?
  • Is a kidney transplant being considered?

Regarding prognosis:

  • Does individual have any underlying conditions such as diabetes, hypertension, or HIV/AIDS that may affect recovery?
  • Have any complications developed such as nephrotic syndrome, chronic renal failure, end-stage renal disease, malnutrition, and enhanced susceptibility to infections?

Source: Medical Disability Advisor



References

Cited

Rao, Sreepada T.K., et al. "Focal Segmental Glomerulosclerosis." eMedicine. 12 Feb. 2015. Medscape. 22 Apr. 2015 <http://emedicine.medscape.com/article/245915-overview>.

Source: Medical Disability Advisor






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