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.

Pyelonephritis, Acute


Related Terms

  • Acute Kidney Infection
  • Upper Urinary Tract Infection

Differential Diagnosis

Specialists

  • Family Physician
  • Internal Medicine Physician
  • Nephrologist
  • Urologist

Comorbid Conditions

Factors Influencing Duration

Factors that may influence length of disability include the individual's age and general health, job requirements, infection with drug-resistant organisms, and drug allergies that prevent use of appropriate antibiotics.

Medical Codes

ICD-9-CM:
590 - Infections of Kidney
590.1 - Acute Pyelonephritis, without Lesion of Renal Medullary Necrosis
590.10 - Pyelonephritis, Acute, without Lesion of Renal Medullary Necrosis
590.8 - Pyelonephritis or Pyonephrosis, Other, Not Specified as Acute or Chronic
590.80 - Pyelonephritis, Not Specified as Acute or Chronic, Unspecified; Pyelitis NOS; Pyelonephritis NOS
590.81 - Pyelitis or Pyelonephritis in Diseases Classified Elsewhere

Overview

Acute pyelonephritis is an infection of the kidney involving the renal pelvis. Acute pyelonephritis most commonly results from the spread of an infection in the lower parts of the urinary tract (the urethra and bladder) up through the tubes (ureters) that connect the bladder to the kidneys, or through the bloodstream. Bacteria most often responsible for acute pyelonephritis include Escherichia coli (responsible for 80% of urinary tract infections in younger persons), Proteus, Klebsiella, and Staphylococcus saprophyticus (Colgan; Cjaja). Acute pyelonephritis may also be caused by bladder catheterization or surgery, from a blood infection such as sepsis or endocarditis, or, rarely, from lymphatic infection. Difficulty emptying the bladder (neurogenic bladder), or urinary tract obstruction or stricture, increases the risk of acute pyelonephritis. Congenital weakness of the juncture between the bladder and ureter (vesicoureteral junction) may lead to vesicoureteral reflux, in which urine backs up from the bladder into the ureters and kidneys, predisposing an individual to acute pyelonephritis.

Individuals who are sexually active, have diabetes mellitus with poor blood glucose control, have immunosuppression, or have recent instrumentation/catheterization of the urinary tract are at greater risk for acute pyelonephritis.

Incidence and Prevalence: In the US, the incidence of acute pyelonephritis each year is 250,000, resulting in 200,000 hospital admissions (Colgan). The incidence of acute pyelonephritis is highest among otherwise healthy women aged 15 to 29, followed by infants and older persons (Czaja). However, acute pyelonephritis also occurs although much less frequently among men, children, and pregnant women; these groups account for only a small percentage of cases.

Source: Medical Disability Advisor



Causation and Known Risk Factors

This condition affects females approximately 4 times more frequently than males although this difference appears to diminish at older ages (Caja). Females have a shorter urethra with closer proximity to the vagina and rectum, allowing bacteria increased access. Females also lack an antibacterial secretion produced in males. The peak incidence of acute pyelonephritis in females occurs from age 15 to age 35 and over 50; the peak incidence in males occurs in the very young (0-4) and the very old (over 85) (Caja).

Patients with acute pyelonephritis are predominantly managed in the outpatient setting, particularly those cases occurring among young women (Caja). The overall incidence of acute pyelonephritis in pregnant women is 1% to 2% (Foxman).

Source: Medical Disability Advisor



Diagnosis

History: The individual may report symptoms that develop rapidly over a few hours or within 1 to 2 days. Symptoms may include high fever (101° F to 104° F [38.3° C to 40° C]), chills, pain in the flank or lower back, increased frequency of urination, pain and burning sensation when urinating (dysuria), getting up to urinate at night (nocturia), nausea and vomiting, loss of appetite (anorexia), and general fatigue (malaise). The urine may appear bloody (hematuria) or cloudy with a fishy odor. Some individuals may note only diffuse abdominal pain with nausea, vomiting, and diarrhea. The elderly may experience only altered mental state or vague abdominal pain.

Physical exam: The exam may reveal generalized muscle tenderness as well as pain and tenderness when pressure is applied to the sides of the abdomen or flank and/or lower back (costovertebral angle tenderness). Fever and other symptoms may also be confirmed during a physical examination. When the infection is severe (sepsis), low blood pressure and rapid heart rate (tachycardia) may also be present. If a pelvic exam is performed, findings are usually normal.

Tests: A sample of urine collected in midstream ("clean catch" sample) should be cultured to determine the number and species of bacteria present. In the laboratory, the isolated bacteria will be exposed to several antibiotics, and the sensitivity will be reported to the physician to aid in treatment. The urine sediment is examined microscopically for red blood cells (hematuria) and pus (white blood cells) in the urine (pyuria). Other routine urine tests determine whether it is abnormally concentrated or diluted. A blood culture may reveal the presence of bacteria in the blood (bacteriemia). In some cases, a kidney x-ray (intravenous pyelogram [IVP]), computed tomography (CT) scan, or ultrasound may be indicated. CT and ultrasound studies are particularly useful when the diagnosis is unclear or the condition is complicated, or when there is an underlying condition predisposing to acute pyelonephritis. X-ray of the kidney may reveal kidney stones (calculi), tumors, or cysts in the kidney or in the urinary tract. Kidneys may also appear asymmetrical, indicating severe inflammation. In some cases, urine specimens may be obtained directly from the ureter for culture through an invasive ureteral catheterization procedure. Other tests may include voiding cystourethrogram or kidney (renal) biopsy.

Source: Medical Disability Advisor



Treatment

Since acute pyelonephritis is typically due to a urinary tract infection, the primary treatment is with antibiotics. Treatment is usually begun urgently while awaiting culture results. The urine culture and sensitivity allows the type of bacteria causing the infection to be identified so the antibiotics prescribed can be specific to that organism. If the organism is not identified, a broad-spectrum antibiotic is prescribed. Bacteria are usually eliminated from the urine within 2 to 3 days of treatment, but antibiotics are continued for a course of 7 to 14 days to make certain the infection has been eradicated. A follow-up culture is obtained 7 days after the end of antibiotic therapy. Urologic consultation, ultrasound, x-ray studies of the urinary tract (intravenous pyelogram), or cystoscopy may be recommended in women who have had 2 recurrent episodes of acute pyelonephritis and in men following a single episode of acute pyelonephritis.

Treatment may be as an outpatient or rarely as an inpatient. Hospitalization may be recommended for the elderly, individuals with underlying medical conditions such as diabetes or known genitourinary tract abnormalities, or individuals who are pregnant. Inability to maintain oral intake of fluids or medications and severe illness with high fever, severe pain, or altered mental status may necessitate hospitalization. Initial treatment for the first 8 to 12 hours may be performed in an emergency setting. During this time, fluids and antibiotics are administered directly into a vein (intravenous), the first 1 to 2 doses of antibiotics are given, medications to treat nausea may be given, and the physician reevaluates the individual. If the individual responds well, treatment can be continued as an outpatient.

In addition to antibiotics, an analgesic for pain relief and antipyretic medication for fever reduction are also often prescribed. The individual is also instructed to force fluids in an effort to clear out the bacterial infection. Individuals experiencing infection as a result of obstruction or vesicoureteral reflux are typically less responsive to antibiotic treatment. In these cases, surgery may be necessary to relieve the obstruction by insertion of a nephrostomy tube or transurethral stone extraction, for example, or to correct a structural problem.

Source: Medical Disability Advisor



Prognosis

With proper treatment and follow-up care, most individuals recover quickly and completely, and extensive permanent damage is rare. Individuals with coexisting renal disease and older age are at risk of developing severe disease and complications (chronic pyelonephritis). Without treatment, symptoms may disappear. However, residual infection usually remains, and symptoms are likely to recur, possibly with greater severity. The mortality rate from acute pyelonephritis is 730 per 100,000 cases in women and 1,650 per 100,000 cases in men (Foxman).

Source: Medical Disability Advisor



Complications

Complications that may be associated with acute pyelonephritis include kidney (renal) damage or failure, localized infection (abscess), overwhelming generalized infection (sepsis), and shock. Diabetics may develop a life-threatening form of nephritis called emphysematous pyelonephritis, in which kidney tissues are distended by gases given off by the organism producing the infection. Repeated acute pyelonephritis, combined with underlying structural or functional abnormalities of the kidneys, may lead to kidney scarring and shrinkage (chronic pyelonephritis), with decreased kidney function. The onset of acute pyelonephritis during pregnancy can lead to premature labor and low-birth-weight infants (Ramakrishnan).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Rest is necessary to allow elimination of infection and restoration of physical strength. Individuals with sedentary work may return within days, but individuals with work that requires physical exertion or heavy lifting may need up to 2 weeks to fully recover (Colgan). Usually, no work restrictions and accommodations are required upon recovery.

Risk: No job would place an individual at increased risk of acute pyelonephritis development.

Capacity: Acute pyelonephritis will not affect capacity in the long run.

Tolerance: Variation in return to work will depend on how severe the infection was, if there was a delay in seeking treatment or a delay in the institution of treatment.

Source: Medical Disability Advisor



Maximum Medical Improvement

1 week after completing treatment

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:

  • Did history suggest acute pyelonephritis?
  • Did symptoms develop rapidly over a few hours or within 1 to 2 days?
  • Was there a high fever (>101° F [38.3° C]), shaking chills, and pain in the flank, and/or lower back?
  • Were there urinary symptoms, such as increased frequency of urination or pain and a burning sensation upon urination?
  • Were there complaints of nausea and vomiting, decreased appetite (anorexia), and general fatigue?
  • Was there blood in the urine?
  • Was urine cloudy, blood-tinged, or foul smelling with a fishy odor?
  • Did physical examination suggest acute pyelonephritis because of flank or abdominal tenderness, generalized muscle tenderness, fever, or other typical signs?
  • Did urinalysis reveal red or white blood cells or a positive Gram stain?
  • Was urine or blood culture positive for bacteria?
  • If symptoms did not improve or worsened within 48 to 72 hours, was a kidney x-ray (intravenous pyelogram) or renal ultrasound performed?
  • Were abnormalities revealed with x-ray or ultrasound (kidney stones or calculi, tumors, or cysts) in the kidney or urinary tract?
  • Did kidneys appear asymmetrical, indicating severe inflammation?
  • Was ureteral catheterization performed to obtain urine specimens from the ureter?
  • Did ureteral urine culture reveal bacteria?
  • Are additional tests needed, such as voiding cystourethrogram, abdominal CT, or kidney biopsy?

Regarding treatment:

  • Is infection being treated with appropriate antibiotics?
  • Are drug-resistant organisms or drug allergies complicating treatment?
  • Is fluid intake adequate?
  • Is hospitalization needed for intravenous fluids and/or antibiotics?
  • Are complications being treated appropriately?
  • Is individual following recommendations to get adequate rest?

Regarding prognosis:

  • Did infection resolve with antibiotic treatment?
  • Did individual take the entire course of antibiotics as recommended?
  • Did symptoms recur after completion of antibiotics?
  • Have there been other episodes of acute pyelonephritis?
  • Did complications occur, such as renal damage, abscess, papillary necrosis, or sepsis?
  • Did emphysematous pyelonephritis occur in a diabetic?

Source: Medical Disability Advisor



References

Cited

Colgan, William R. , and J. R. Johnson. "Diagnosis and Treatment of Acute Pyelonephritis in Women." American Family Physician 84 (2011): 519-526.

Czaja, C. A. , et al. "Population-Based Epidemiologic Analysis of Acute Pyelonephritis." Clinical Infectious Diseases 45 (2007): 273-280.

Foxman, B. "Epidemiology of Urinary Tract Infections: Incidence, Morbidity, and Economic Costs." American Journal of Medicine 113 Suppl 1A (2002): 5s-13s.

Foxman, B. , K. L. Klemstine, and P. D. Brown. "Acute Pyelonephritis in Us Hospitals in 1997: Hospitalization and in-Hospital Mortality." Annals of Epidemiology 13 (2003): 144-150.

Ramakrishnan, Kalyanakrishnan, and Dewey C. Scheid. "Diagnosis and Management of Acute Pyelonephritis in Adults." American Family Physician. 1 Mar. 2005. American Academy of Family Physicians (AAFP). 8 Jun. 2013 <http://www.aafp.org/afp/20050301/933.html>.

Source: Medical Disability Advisor






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