Disability Doc

6.06 Nephrotic syndrome, with anasarca, persisting for at least 3 months despite prescribed therapy (see 6.00E5). With:

A. Serum albumin of 3.0 g per dL (100 ml) or less and proteinuria of 3.5 g or greater per 24 hours.

OR

B. Proteinuria of 10.0 g or greater per 24 hours.

Nephrotic syndrome - a general name for a group of diseases involving defective kidney glomeruli (filtration system) characterized by:

• Heavy proteinuria - large amount of protein in the urine
• Hypoalbuminemia – low albumin levels in the blood
• Varying degrees of edema –swelling

Anasarca - generalized massive edema (swelling) of soft tissues
Proteinuria - excess protein in the urine (most accurately measured with a 24 hour urine test)
Serum albumin - a major protein found in the blood that transports drugs and other substances, and is important for keeping fluid from leaking out of blood vessels into the tissues

In nephrotic syndrome, damaged kidneys leak albumin into the urine. Albumin normally helps keep fluid from leaking out of blood vessels into the soft tissues of the body. When albumin is lost (hypoalbuminemia), fluid leaks out of the blood vessels and cause swelling (edema).

“Serum albumin” is found in a blood test and “proteinuria,” as it pertains to this listing, is found in a 24 hour urine test.

Anasarca must be “persisting for at least 3 months despite prescribed therapy” to meet either Listing 6.06 A. or B.

SSA will evaluate complications of nephrotic syndrome including:

• Orthostatic hypotension (blood pressure drops with changes in body position such as moving from lying to standing)
• Recurrent infections (increased the risk of infections)
• Venous thrombosis (increased risk of blood clots forming in veins)

The longitudinal medical record should include a description of prescribed therapy, response to therapy, side effects of therapy, and expected duration of treatment.

Treatment may involve diuretics to control swelling and blood pressure medications to control high blood pressure. Corticosteroids, such as prednisone, can cause thinning of bone (osteoporosis) and skin; cataracts; destruction of hip and/or shoulder joints due to avascular necrosis (AVN); infections, diabetes, muscle wasting, rounding of faces; and psychiatric disturbances.

Anasarca may cause shortness of breath and be associated with congestive heart failure if not controlled.

Causes of nephrotic syndrome include:

• Glomerulonephritis (inflammation of glomeruli)
• Toxins, drugs, chemicals
• Infections
• Diabetes Mellitus
• Hypertension
• Systemic Lupus Erythematosis
• Multiple Myeloma
• Hodgkin’s Lymphoma