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.

Nephrotic Syndrome


Related Terms

  • Proteinuria

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Endocrinologist
  • Hematologist
  • Immunologist
  • Infectious Disease Internist
  • Medical Toxicologist
  • Nephrologist
  • Oncologist
  • Pharmacologist

Comorbid Conditions

Factors Influencing Duration

Disability may be influenced by the severity and extent of disease, the underlying cause, the response to therapy, and the presence of complications.

Medical Codes

ICD-9-CM:
581.0 - Nephrotic Syndrome with Lesion of Proliferative Glomerulonephritis
581.1 - Nephrotic Syndrome with Lesion of Membranous Glomerulonephritis
581.2 - Nephrotic Syndrome with Lesion of Membranoproliferative Glomerulonephritis
581.3 - Nephrotic Syndrome with Lesion of Minimal Change Glomerulonephritis
581.81 - Nephrotic syndrome in diseases classified elsewhere
581.89 - Nephrotic Syndrome with Other Specified Pathological Lesion in Kidney, Other; Exudative Nephritis; Interstitial (Diffuse) (Focal) Nephritis
581.9 - Nephrotic Syndrome with Unspecified Pathological Lesion in Kidney; Glomerulonephritis with Edema; Nephrosis; Renal Disease with Edema

Overview

Nephrotic syndrome is a kidney condition characterized by very high levels of protein in the urine (proteinuria), low levels of protein in the blood (hypoalbuminemia), swelling due to fluid accumulation (edema), fat in the urine (lipiduria), and high levels of cholesterol and triglycerides in the blood (hypercholesterolemia and hypertriglyceridemia). Nephrotic syndrome occurs when there is damage of the ball-shaped networks of specialized capillaries in the kidney (glomeruli) that normally filter waste and excess water from the blood to create urine, which travels from the kidney to the bladder. In nephrotic syndrome, protein molecules leak through the glomeruli into the urine.

In affected individuals, a protein in the blood called glomerular permeability factor may affect the ability of the glomeruli to selectively filter out waste. Glomerular permeability factor can cross the placenta, so that a baby born to a woman with nephrotic syndrome may have the same condition for a few days. Persistence of glomerular permeability factor in the blood of an individual with nephrotic syndrome may cause the disease to recur after kidney transplant.

Incidence and Prevalence: There is substantial variation in the frequency of this condition in different geographical regions of the US. The condition is more common in the southern US than in northern states. Often nephrotic syndrome occurs secondary to other diseases, including diabetes mellitus, hence, it commonly affects the same groups most likely to contract diabetes, which include blacks, Native Americans, and Hispanics.

Estimated rate of diabetic nephropathy with nephrotic syndrome is at least 50 cases per million population; the rate is higher than this figure since the rate of end-stage kidney disease from diabetes has reached 100 cases per million population in some countries. In children, nephrotic syndrome may occur at a rate of 20 cases per million children (Cohen).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Nephrotic syndrome has many causes. The most common cause in adults is primary kidney disease. Often nephrotic syndrome occurs secondary to other diseases, including diabetes mellitus; amyloidosis, a condition in which an abnormal protein collects in the tissues and organs; or an inflammatory autoimmune disease (systemic lupus erythematosus [SLE]). High blood pressure (hypertension), cancer, toxic exposure to heavy metals, reactions to carbon tetrachloride, poison ivy, snake venom, or other toxins; and adverse drug reactions can also cause nephrotic syndrome. Infections with various bacteria, hepatitis C virus and other viruses, or other microorganisms are also linked to nephrotic syndrome. Nephrotic syndrome may result from the use of medications that are toxic to the kidneys (nephrotoxic), the chronic abuse of pain medications, pregnancy, congestive heart failure, and vesicoureteral reflux. A compromised immune system (e.g., HIV/AIDS) or heroin addiction also predisposes individuals to developing nephrotic syndrome. Finally, there are many cases of nephrotic syndrome in which the cause cannot be identified (idiopathic).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms include persistent, worsening edema. In the early stages, edema might be most noticeable in the legs and feet after standing for long periods; it may be quite noticeable around the eyes when the individual first wakes up (dependent position). Later, edema may be constantly present. A bloated or tight feeling in the abdomen may be present as a result of fluid buildup in the abdomen (ascites). Individuals may also complain of shortness of breath (dyspnea), fatigue, a vague feeling of bodily discomfort (malaise), or loss of appetite (anorexia). Other symptoms include blood in the urine (hematuria), change in urinary frequency or viscosity, and the appearance of foam in the toilet after urinating (caused by the high protein content of the urine). Some individuals also report weight gain related to fluid retention.

Physical exam: The exam may reveal marked edema in the legs and face, and ascites. Exertion may cause dyspnea due to fluid retention in the respiratory tract (laryngeal edema, pleural effusion, pulmonary edema). Hypertension is often noted, but the blood pressure may fall abnormally when the individual sits or stands up after lying down (orthostatic hypotension). The skin may have a streaked or banded appearance (striae), and the fingernails may develop white lines (Muehrcke lines). Eye examination with an ophthalmoscope (funduscopic examination) often reveals abnormally shiny retinae.

Tests: The physician usually orders a standard urinalysis as well as a 24-hour urine collection. The standard urinalysis shows abnormal levels of protein, sugar (glucose), blood, amino acids, fats, potassium, and sodium; the urine may appear foamy. Microscopic examination of the urine may reveal small cylinder-shaped clumps of cells and debris (casts). Kidney (renal) function can be determined by evaluation of a 24-hour urine collection. Blood tests show decreased levels of the protein, albumin (hypoalbuminemia), excessive fat (hyperlipidemia) and high cholesterol (hypercholesterolemia). Other blood chemistries (sodium, calcium, potassium) may be abnormal.

In cases in which the suspected cause is primary kidney disease, a sample of kidney tissue may be removed for microscopic examination (kidney biopsy), which helps determine the type of kidney disease and the extent of kidney damage.

Source: Medical Disability Advisor



Treatment

Treatment depends on the underlying condition causing the nephrotic syndrome. However, some therapies are common to nephrotic syndrome regardless of the underlying cause. Dietary changes include a low-sodium, low-fat diet; increased protein is of no proven value. Nutritional supplements (especially vitamin D and iron) are often prescribed. Individuals who have diabetes or who are overweight may be instructed to reduce caloric intake. Anti-inflammatory medications (corticosteroids) are given. Drugs that increase urination (diuretics) are given to reduce edema. Hypertension may be treated with pressure-reducing (antihypertensive) medication. Medication to reduce protein in the urine (ACE inhibitors) may also be prescribed. If nephrotic syndrome fails to respond to these treatments, immunomodulators such as cyclosporin A, or immunosuppressants such as mycophenolate may be helpful in some individuals.

Individuals with nephrotic syndrome are often given vaccines against certain lung infections (pneumonia and viral influenza) because nephrotic syndrome appears to diminish the body's natural immunity. Individuals are also instructed to report illnesses promptly to the physician, so treatment can begin immediately.

Source: Medical Disability Advisor



Prognosis

The prognosis varies considerably, depending on the underlying cause of nephrotic syndrome. If the underlying cause has been identified and is treatable, the prognosis is excellent, and the individual can expect complete resolution of symptoms. Elderly individuals are more likely to have a poor outcome.

If the underlying cause is not treatable, such as with many types of primary kidney disease, the prognosis is poor. Symptoms may be controlled with medication. Some individuals will experience a period during which symptoms lessen or disappear (remission). However, relapses after remission are common, and require repeated treatment. If kidney failure develops, regular kidney dialysis and/or a kidney transplant may prolong life.

Source: Medical Disability Advisor



Complications

Complications include progression to end-stage kidney (renal) disease, renal failure necessitating dialysis, increased risk of coronary artery disease and heart attacks (myocardial infarction), blood clots (thrombosis), increased risk of infections, and decreased levels of adrenocortical or thyroid hormones.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations vary considerably, depending on the underlying cause of nephrotic syndrome, the severity of symptoms, and the individual's job requirements. Extended leave of absence may be required while the individual recovers. Jobs that are physically demanding or require prolonged standing should be avoided, and reassignment to a sedentary, slow-paced position may be helpful. Individuals with severe kidney disease may be permanently disabled.

Risk: Risk of worsening impaired circulation and edema in the lower extremities that could contribute to thrombosis may be reduced by decreasing job duties performed while standing. Individuals with nephrotic syndrome are vulnerable to infection and should avoid close contact with others who may potentially expose them to infection. Depending on the underlying cause, these restrictions may be permanent. Work-related activities should not pose a risk to individuals with nephrotic syndrome. 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 preclusion from heavy or very heavy work.

Capacity: Individuals with advanced nephrotic syndrome 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 factors include the amount and location of fluid retention and the associated discomfort. 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:

  • Has the diagnosis of nephrotic syndrome been confirmed?
  • Has testing included 24-hour urine collection and analysis and appropriate blood tests?
  • Have other conditions with similar symptoms been eliminated as possibilities? Has the underlying cause been determined?
  • If primary kidney disease is suspected as the underlying cause, has kidney biopsy been done?

Regarding treatment:

  • If the underlying cause has been identified, can it be treated? If so, is it being treated?
  • Have other treatments or medications been considered?
  • Is individual compliant with diet and medication regime?
  • Is he or she dependent on kidney dialysis?
  • Has a kidney transplant been considered?

Regarding prognosis:

  • Are complications present?
  • Does individual have comorbid conditions needing specific treatment?
  • Has individual developed end-stage renal disease?
  • Is individual elderly?

Source: Medical Disability Advisor



References

Cited

Cohen, Eric P. , et al. "Nephrotic Syndrome." eMedicine. 9 Dec. 2014. Medscape. 27 Apr. 2015 <http://emedicine.medscape.com/article/244631-overview>.

Source: Medical Disability Advisor






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