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.

Kidney Transplantation


Related Terms

  • Renal Transplant

Specialists

  • Cardiovascular Internist
  • Critical Care Surgeon
  • General Surgeon
  • Internal Medicine Physician
  • Nephrologist
  • Oncologist

Comorbid Conditions

Factors Influencing Duration

In addition to complications associated with surgery, the principal factor influencing the length of disability is the onset of graft rejection. To prevent this, it is essential that individuals take antirejection drugs as prescribed. Changes in dose or formulation without physician knowledge or monitoring may lessen the drugs' effectiveness and increase the risk of rejection and disability. Office visits to check kidney function and check for possible rejection episodes must occur on a regular basis.

Development of any of the morbidities that commonly follow transplant (hypertension, cataracts, avascular necrosis, malignancy, urinary tract infection, pneumonia, steroid-induced diabetes mellitus, chronic hepatitis, peptic ulcer disease, diverticulitis, myocardial infarction, and cerebrovascular accident) also produce or prolong disability.

Medical Codes

ICD-9-CM:
55.69 - Kidney Transplant, Other

Overview

Kidney transplantation is a surgical procedure in which an individual whose kidneys have stopped functioning (chronic end stage renal failure disease) receives a new kidney (graft or donor kidney) to take over the task of cleansing the blood of waste materials. Graft kidneys may come from donors who are living or dead and who are related or unrelated to the recipient.

Important requirements for successful transplantation include a careful match between the recipient's and the donor's blood and tissue types. When the graft kidney comes from a living donor, it is most often from a close family member (parent, child, sibling). New laparoscopic techniques are making living donation more appealing to potential donors. Although all kidney transplants have a high success rate, donation from a well-matched family member is most successful of all.

Often recipients must wait until a suitable donor kidney is found, using dialysis treatments (peritoneal dialysis or hemodialysis) during the interim. When a kidney from a dead donor is located, time is usually short, and the operation must be performed promptly. For a successful transplant, the allowable time from when the donor's heart stops beating to the placement of the removed kidney into cold storage for transport is less than 30 minutes (Erogul). Kidney transplants are coordinated by the Organ Procurement and Transplantation Network, which is run by the United Network for Organ Sharing. This private nonprofit group maintains a database of both individuals awaiting transplants and potential kidney donors. There are currently 75,000 individuals on the waiting list for kidney transplantation (Erogul).

End stage renal disease (ESRD) is chronic kidney failure that has progressed to where kidney function is less than 10% of normal and the kidneys can no longer remove wastes from the blood or regulate the body's fluid balance (Patel). with no hope for recovery. To survive, the individual must either receive regular dialysis treatments or undergo kidney transplantation. The causes of chronic kidney failure and ESRD include diabetes, hypertensive nephrosclerosis, glomerular diseases, polycystic kidneys, hypertensive nephrosclerosis, renovascular disease, congenital and metabolic disorders, tubular and interstitial diseases, rheumatoid disease, and neoplasms. Many of these individuals are candidates for kidney transplant.

Source: Medical Disability Advisor



Reason for Procedure

Kidney transplantation is one of only two options for the treatment of ESRD. The other option is hemodialysis treatment. In the US, kidney transplantation is the preferred option, as it provides an individual with a healthy kidney that will function normally. Hemodialysis requires frequent treatment and results in a poorer outcome and greater expense over time.

Contraindications to kidney transplantation include recent malignancy, active infection, HIV infection, an uncontrolled psychiatric disorder, and active substance abuse. Advanced age is not a contraindication for receiving a kidney transplant, but the donor kidney must come from an individual younger than 75 years of age (Erogul).

Source: Medical Disability Advisor



How Procedure is Performed

Before the operation, both donor and recipient go through extensive tissue-matching tests. They also undergo a battery of cardiac function and renal function tests. Blood tests are performed to evaluate complete blood count (CBC), liver function, coagulation profile, and to test for infection (e.g., hepatitis, HIV, tuberculosis, and syphilis). If a recipient has a history of gallstones, they may a pre-transplant surgery may be necessary to undergo a pre-transplant surgery to remove the gallbladder (cholecystectomy), to reduce the risk of acute cholecystitis following the transplant (Kaufman).

With living donors, donor and recipient operations are scheduled at the same time, usually in adjacent operating rooms. The left kidney is ordinarily taken as the donor kidney, because it has a longer renal vein. The operation usually involves a laparoscopic approach, in which small incisions are made in the donor's back through the bed of the twelfth rib. Rarely, the operation enters through the donor's abdomen (anterior transperitoneal approach). Laparoscopic techniques are now being used that allow the removal of multiple renal arteries (when they are present) with the donor kidney, involve smaller incisions than an open approach, and reduce the donor's postoperative time in the hospital.

In the recipient, the operation involves an incision in the lower part of the abdomen with subsequent placement of the donor kidney. This location is chosen because the operation is both simpler and quicker than placing the kidney in its correct anatomical position. The individual’s own kidneys are left in place. The kidney artery and vein are connected to corresponding vessels in the abdomen, and the tube that carries the urine (ureter) is connected to the individual's bladder. The operation takes about 3 to 4 hours. Following transplantation, the recipient undergoes a 2-stage process of immunosuppression to help block tissue rejection and immune system responses. The first stage consists of intravenous antirejection agents to protect against early rejection until the graft has begun to function. The second stage is prolonged maintenance, a stage that may be lifelong in which immunosuppressive medications are taken daily for the rest of the individual’s life.

Source: Medical Disability Advisor



Prognosis

Overall, success of kidney transplantation is more successful with a living donor than with a cadaveric donor (Nadalo). The 1-year survival rate for individuals following living donor kidney transplantation is 98%, and t. The 5-year survival rate is approximately 91%. The 1-year survival rate for individuals receiving a cadaveric kidney is 945% (Kaufman). The 5-year survival rate is 91% for individuals receiving a living donor kidney, and 81% for those receiving a cadaveric kidney (Enogul).

The half-life of a kidney transplant graft from a living donor is 21.6 years, and from cadaveric donors is 13.8 years (Kaufman). The mortality rate for individuals on the waiting list for a replacement kidney is 6.3 deaths per 100 patient-years (Kaufman)., and the 5-year survival rate is 81% (Sinert).

Source: Medical Disability Advisor



Complications

Overall, complications at the time of surgery occur in up to 20% of cases (Nadalo). Most complications due to surgery involve the urinary tract, resulting in outcomes such as urinary obstruction of the tube through which urine flows from the kidney to the bladder (ureter) or an internal urine leak at the site of the graft, which may require surgical repair. Other complications include wound infection, sexual impotence, hydrocele formation, bleeding or blood clots, infection (including sepsis), accumulation of lymph fluid (lymphocele), or narrowing of the renal artery (renal artery stenosis). Blood clots resulting in acute arterial thrombosis occur in 1% of cases (Kaufman).

Graft rejection is a major concern following transplant. Acute rejection can take a matter of hours to days and typically occurs within the first few 1 to 3 months; it is typically caused by acute tubular necrosis, and occurs in 20% to 30% of cadaveric transplants (Kaufman). Chronic rejection generally takes longer and is accompanied by steady loss of renal function, occurring up to 2 years after transplantation (Kaufman). Rarely, hyperacute rejection may occur, in which the kidney is rejected within minutes to hours after transplantation, resulting in irreversible damage to the graft kidney which must then be removed (nephrectomy).

Antirejection drugs may cause side effects, such as anxiety, unwanted hair growth or hair loss, weight gain, increased blood sugar, trouble sleeping (insomnia), mood swings, tremors, nausea, vomiting, diarrhea, and high blood pressure. Immunosuppressive drugs also increase an individual's short- and long-term risk of infections and certain malignancies, especially lymphoma.


The primary causes of mortality following kidney transplant include coronary artery disease (about 30%), sepsis (27%), neoplasia (13%), and stroke (8%) (Sinert). Infection is the leading cause of death in the first year after transplantation with 40% to 80% of transplant recipients having at least one infection during that time (Erogul).
.
Recurrent renal disease recurs in 10% of transplant recipients, but accounts for less than 2% of graft losses (Kaufman).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Depending on the level of exertion required by the individual's job, there are few restrictions and accommodations to be placed on returning to work. Heavy lifting may need to be restricted for a short period. Special accommodations, if required, may be identified by the recipient's physician.

Source: Medical Disability Advisor



References

Cited

Erogul, Mert, and Richard H. Sinert. "Transplants, Renal." eMedicine. Eds. James Li, et al. 5 Dec. 2008. Medscape. 22 Sep. 2009 <http://emedicine.medscape.com/article/778255-overview>.

Kaufman, Dixon B. "Renal Transplantation (Medical)." eMedicine. Eds. Laura L. Mulloy, et al. 12 Jun. 2009. Medscape. 22 Sep. 2009 <http://emedicine.medscape.com/article/429314-overview>.

Nadalo, Lennard A., et al. "Kidney Transplantation, Surgical Complications." eMedicine. Eds. S. Perlmutter, et al. 1 Feb. 2007. Medscape. 22 Sep. 2009 <http://emedicine.medscape.com/article/378801-overview>.

Organ Procurement and Transplantation Network. "Transplants by Donor Type." Organ Procurement and Transplantation Network (OPTN). 11 Sep. 2009. United States Department of Health & Human Services. 22 Sep. 2009 <http://optn.transplant.hrsa.gov>.

Patel, Parul, and David Zieve. "End-stage Kidney Disease." MedlinePlus. 15 Nov. 2008. National Library of Medicine. 22 Sep. 2009 <http://www.nlm.nih.gov/medlineplus/ency/article/000500.htm>.

Source: Medical Disability Advisor






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