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.

Pyuria


Related Terms

  • Bacteriuria
  • Pus in the Urine

Differential Diagnosis

Specialists

  • Family Physician
  • Nephrologist
  • Urologist

Comorbid Conditions

  • Bacterial infection, excluding urinary tract
  • Endocarditis
  • Incontinence
  • Structural abnormalities of genitourinary tract

Factors Influencing Duration

The individual's response to and compliance with treatment of the underlying condition can influence length of disability. Complications of the causative disease will also influence duration.

Medical Codes

ICD-9-CM:
599.0 - Urinary Tract Infection, Site Not Specified; Pyuria

Overview

Pyuria is the presence of white blood cells (leukocytes) in the urine (6 to 10 or more neutrophils per high power field of unspun, voided mid-stream urine). Pyuria is not a diagnosis; it is a laboratory finding in many diseases, most commonly urinary tract infections (UTI). Pyuria usually indicates that bacteria have invaded the upper or lower urinary tract, invoking an inflammatory response of the lining of the urinary tract (urothelium) in that location. When pyuria occurs secondary to UTI, it is usually accompanied by bacteriuria (bacteria in the urine). Pyuria may also be found in the absence of infection (sterile pyuria) and is frequently asymptomatic. When pyuria lacks the presence of bacteria, its cause is unclear, although "silent" or unrecognized kidney infection may be suspected as well as tuberculosis, renal stones, Kawasaki disease, or cancer. Almost half of chronically incontinent individuals or those with indwelling catheters (primarily elderly long-term care patients), exhibit asymptomatic pyuria. However, urinary tract infection can also be asymptomatic in the elderly. In the absence of infection, asymptomatic pyuria is not usually treated.

Incidence and Prevalence: Urinary tract infection (UTI) is the most common bacterial infection found in people of all ages (Foxman). Consequently, the incidence of pyuria corresponds to the large numbers of people diagnosed with UTI, which is far more common among women than men under the age of 70 and increases in both men and women as they age. Among the elderly, the rate of UTI is only slightly higher among women compared to men (Foxman).

The overall prevalence of asymptomatic infection among the general population is estimated at 3.5%, and the prevalence increases with age in a linear trend. Other risk factors for asymptomatic infection include parity, diabetes in women, a history of UTI, and lower education. An estimated 4% to 10% of pregnant women are diagnosed with asymptomatic UTI (Foxman).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Urinary tract infection, especially urethritis, has an almost certain risk of being accompanied by pyuria. There are no known risk factors for asymptomatic pyuria other than chronic incontinence or urinary catheterization.

Source: Medical Disability Advisor



Diagnosis

History: Pyuria itself may be asymptomatic. The individual may, however, seek medical attention because of cloudy and foul-smelling urine or symptoms of UTI such as a frequent and/or urgent need to urinate (frequency and/or urgency) or discomfort on urination (dysuria).

Physical exam: Physical findings in pyuria depend on the underlying cause of the condition. Bladder infection (cystitis) can usually be diagnosed from the individual's history and symptoms. In general, there are no abnormal findings on physical examination. Individuals with a kidney infection (pyelonephritis) may have fever, tenderness in the region of the back over the kidneys (costovertebral angle), and kidney enlargement.

Tests: Pyuria is detected by urinalysis. The microscopic examination of urine as part of a routine urinalysis may actually be the first sign of pyuria in asymptomatic individuals. If pus is found, a urine culture is performed to determine whether bacterial infection is the underlying cause and to identify the causative organism. Symptoms will help determine whether the site of infection is the urethra, bladder, or kidney. Additional diagnostic tests may include a contrast study such as intravenous pyelogram (IVP), computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound imaging of the kidneys to help identify possible kidney abnormalities or underlying infection.

Source: Medical Disability Advisor



Treatment

Treatment, if any, depends on the underlying condition. Asymptomatic pyuria in the absence of infection (sterile pyuria) does not usually require treatment. Urinary tract infections are treated with antibiotics. Individuals who do not respond to a course of appropriate antibiotics (depending upon the infective organism identified in urine culture) may need further evaluation and treatment.

Source: Medical Disability Advisor



Prognosis

The probable outcome depends on the underlying cause of the pyuria. Asymptomatic pyuria may disappear spontaneously or remain without causing problems. Urinary tract infections generally clear promptly when treated with appropriate antibiotics; they can resolve without antibiotic therapy, but not as quickly, and recurrence and/or complications are more likely.

Source: Medical Disability Advisor



Complications

Potential complications depend on the underlying condition causing the pyuria. In cases of bladder infection, possible complications include progression of the infection to the upper urinary tract (ureters and kidneys). In cases of a kidney infection (pyelonephritis), generalized infection (sepsis) and kidney damage can result due to the infection.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Asymptomatic pyuria requires no restrictions or accommodations. In cases of pyuria due to UTI, necessary accommodations may include frequent restroom breaks.

Risk: If a benign condition or simple UTI, then no job would pose a risk to the individual.

Capacity: If a benign condition or simple UTI, then there would be no impact on a person's capacity.

Tolerance: If a benign condition or simple UTI, no work adjustments to enhance tolerance are needed.

Source: Medical Disability Advisor



Maximum Medical Improvement

1 month

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 underlying cause of the pyuria been identified?
  • Has a urine culture been performed to determine whether a bacterial infection is present?
  • Was specimen properly collected? Has contamination been ruled out?

Regarding treatment:

  • Since treatment, if any, depends on the underlying disease, has an underlying disease been identified?
  • Have urinalysis and culture ruled out the possibility of infection? When in doubt, have diagnostic tests been repeated?
  • Has culture and sensitivity been performed to identify the causative organism and to determine the most effective antibiotic to use? Have antibiotic-resistant organisms been ruled out?

Regarding prognosis:

  • If symptoms recur or persist despite treatment, have diagnostic tests been repeated?
  • Was initial infection unresolved?
  • Have antibiotic-resistant organisms been ruled out?
  • If an underlying cause is finally identified, what changes will this make in treatment plan?
  • Would individual benefit from evaluation by a specialist (urologist, internist, or nephrologist)?

Source: Medical Disability Advisor



References

Cited

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

Source: Medical Disability Advisor






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