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Chronic Kidney Disease

Introduction

In this free educational guide on Chronic Kidney Disease, we provide you with a general discussion about this severe medical condition, and review what evidence or tests are needed to help prove that you are eligible for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI).

For your general knowledge about this medical condition, we have included in this guide helpful information about what the disease is, symptoms, diagnosis, common treatment, and where you can find more help and information for this medical condition. This guide may also provide information about current legal issues that may be of value to you. This guide is not intended as legal advice or as a legal opinion.

After reading this guide, if you still have questions or would like to discuss your case with us, please call Chad Brown Law at (800) 556-9115. We are here to help you get the benefits you deserve.

1. What is Chronic Kidney Disease?

Chronic kidney disease (also called chronic renal failure, chronic kidney failure, or chronic renal insufficiency) describes the process of your kidneys gradually losing their ability to function. The function of the kidneys is to filter waste and excess fluid in the blood, and excrete this excess in your urine. When your kidneys do not work right, waste builds up in the blood and makes you sick.

1a. Understanding Chronic Kidney Disease

Chronic kidney disease slowly gets worse over time. In the early stages, there may be no symptoms. The loss of function is gradual and usually takes months or years to occur. It may be so slow that symptoms do not appear until kidney function is less than one-tenth of normal.

Kidney filtration rate is one method of assessing how well your kidneys are functioning. To calculate your rate, doctors use a blood creatinine test. There are five stages of kidney disease, that range from Stage 1 being some kidney damage but normal blood test results to Stage 5, end-stage kidney/renal disease or kidney failure, which is the significant or total loss of kidney function. Once a person has Stage 5 chronic kidney disease, kidney dialysis (a machine is used to filter your blood) or a kidney transplant is necessary for your survival.

There are things you can do to slow or stop the damage to your kidneys. Taking medicines and making some lifestyle changes can help you manage your disease and feel better.

1b. Causes of Chronic Kidney Disease and Preventions

Chronic kidney disease occurs when there is significant damage done to the kidneys, usually through another health condition. The two most common causes of kidney disease are high blood pressure and diabetes. Many other diseases and conditions can damage the kidneys, including:

  • A narrowed or blocked artery in the kidneys
  • Autoimmune disorders (such as lupus and scleroderma)
  • Birth defects of the kidneys (such as polycystic kidney disease)
  • Certain toxic chemicals
  • Injury or trauma
  • Kidney stones and infection
  • Reflux nephropathy (in which the kidneys are damaged by the backward flow of urine into the kidneys)
  • Some pain medications and other drugs (such as cancer drugs)
  • Other kidney diseases

If you have any of the following conditions, you are at higher-than-normal risk of developing chronic kidney disease. With any of these conditions, your kidney function may need regular monitoring.

  • A family history of kidney disease
  • Amyloidosis
  • Diabetes mellitus type 1 or type 2
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Liver disease
  • Lupus
  • Sickle cell disease
  • Vascular diseases such as arteritis, vasculitis, or fibro-muscular dysplasia

2. Common Medical Terms Associated with Chronic Kidney Disease

Anemia – A lack of red blood cells and a common condition in people with kidney disease, as their damaged kidneys cannot filter blood cells to supply the body.

Chronic kidney disease – A condition in which a patient’s kidneys are damaged to the point where they can no longer properly filter blood, often leading to serious illness and death.

Dialysis – The standard treatment for patients with chronic kidney disease. There are several types of dialysis, the most common being hemodialysis where a machine removes the blood from a patient’s body and runs it through a filter. Within the machine, solutions are added to remove harmful substances, much like the kidneys would do naturally. Once filtered, the cleaned blood is returned to the patient’s body.

Edema – Swelling of bodily tissues caused by a buildup of excess fluids. This is a common symptom of kidney disease because the kidneys are a vital part of your body’s fluid regulation system.

Kidney failure – When your kidneys are damaged and fail to remove waste from your bloodstream, the buildup of these toxins can cause several other health conditions to develop. As the damage progresses, so does the buildup, and in turn the kidneys will no longer be able to filter your blood or assist in fluid regulation, resulting in failure of the kidneys.

3. Chronic Kidney Disease Symptoms

 

Once chronic kidney disease has set in, you may experience the following signs or symptoms:

  • Constant fatigue
  • Feeling overly sleepy or having difficulty sleeping
  • Chest pain
  • Unexpected weight loss
  • Headaches
  • Difficulty thinking or remembering (cognitive difficulty)
  • Swelling in the extremities or puffiness in the face (edema)
  • High blood pressure
  • Unusual itching, easy bruising or bleeding, and pale skin
  • Loss of appetite with or without nausea or vomiting
  • Shortness of breath
  • Urinating less than normal
  • Restless legs or numbness in your hands or feet

Complications of Chronic Kidney Disease

  • Anemia – People with anemia feel weak and dizzy upon standing or walking and often appear pale due to a lack of red blood cells in their circulatory system. This is because the kidneys, which are involved in cleaning the blood, produce a hormone (erythropoietin) that is required to produce new red blood cells as old ones are filtered out.
  • Bone disease (osteodystrophy) – Some of the harmful substances your kidneys filter can build up over time and lead to bone disease. Your kidneys help remove excess amounts of calcium, phosphate, and vitamin D, all of which can lead to bone disease.
  • Electrolyte imbalance – Another complication that occurs when the kidneys cannot filter out harmful waste products. Potassium, phosphate, and acids are some of these waste products that can build up and cause an electrolyte imbalance. This condition can cause muscle weakness, an irregular heartbeat, and other complications.
  • Fluid buildup (edema) – As chronic kidney disease progresses and kidney function gets worse, the kidneys become unable to regulate fluids and salt that build up in the body. One severe type of edema, pulmonary edema, occurs in the lungs and can lead to heart failure.
  • Heart disease – As the kidneys lose the ability to clean and filter your blood, it can speed up the hardening of your arteries. When arteries harden, your risk of stroke, heart failure, and heart attacks increases. Death from heart disease is the most common cause of death among patients with chronic kidney disease.
  • Uremic syndrome – The buildup of waste products in your blood stream due to kidney failure can lead to toxic levels of these substances causing further health conditions. Common side effects are fatigue, nausea and vomiting, difficulty sleeping, and loss of appetite. If untreated, the toxic levels of harmful substances in your body can affect other parts of your body including your gastrointestinal, nervous, and cardiovascular systems.

You should consult with your doctor if you are experiencing any of the signs and symptoms of chronic kidney disease, or if you have any of the complications of kidney disease. Diagnosing one of the complications listed above may result in your doctor monitoring your blood pressure and kidney functions to detect the disease in its early stages. Remember that you have a right to ask about your risks and request additional tests if you believe you are a candidate for developing kidney disease.

Call 911 immediately if you have been diagnosed with chronic kidney disease and develop any of the following symptoms:

  • Rapid heart rate (more than 120 beats per minute)
  • Slow heart rate (less than 50 beats per minute)
  • Sudden chest pain
  • Severe muscle weakness
  • Shortness of breath
  • Severe fatigue
  • Uncontrolled

4. How is Chronic Kidney Disease Diagnosed?

There are several tests necessary to determine if you have developed chronic kidney disease, such as:

  • Biopsy – Your doctor will take a small sample of your kidney tissue by using a long, thin needle inserted through your lower back and into your kidney. Local anesthesia will be used to numb the insertion site. The tissue sample will be sent to a pathologist for analysis.
  • Blood tests – Blood samples will be tested for the level of waste products that are normally processed by the kidneys. High levels of creatinine and urea in your blood can be a sign of kidney disease.
  • Imaging tests – An ultrasound can show the size and structure of your kidneys to determine if they are misshapen or swollen. Your doctor may also use X-ray, CT scans, and MRIs to look at other aspects of your kidney function.
  • Urine tests – Urine samples can reveal any abnormalities in the fluid regulation and waste product removal processes that could signify kidney damage or kidney disease.

Doctors recommend that certain high-risk groups undergo kidney disease-specific testing on a regular basis. High-risk groups include people with diabetes or uncontrolled high blood pressure. Early diagnosis of chronic kidney disease is your best chance of catching the disease before it progresses to kidney failure and will give you a better chance at controlling your symptoms and slowing progression.

5. What is the Common Treatment for Chronic Kidney Disease?

There are several types of chronic kidney disease, some of which can be treated and some that cannot. The cause of your kidney disease will determine whether or not treatment will be effective. Unfortunately, chronic kidney disease is mostly incurable, and can only be slowed down and managed. Most patients undergo treatment and procedures in order to reduce the symptoms and improve quality of life while slowing the progression of kidney failure.

Treatment of chronic kidney disease first focuses on slowing down and controlling the progression of the disease. The type of treatment will depend on the cause of the kidney damage. Treating or controlling an underlying condition that causes kidney damage, such as high blood pressure, is also not guaranteed to prevent or slow kidney damage that has already begun.

Even so, treating underlying conditions that damage your kidneys is the first step most doctors take to address the progression and control of chronic kidney disease. Your doctor may use the following measures to reduce your kidney damage and risk of kidney disease progression:

  • Treating high blood pressure: High blood pressure is a common symptom and result of kidney disease. Medication can be used to lower and control your blood pressure, but your blood work must be monitored frequently at first to ensure the medications are not adversely affecting your kidney function and electrolyte levels. You may also be put on a fluid pill and a low-salt diet to help reduce your blood pressure to a level at or below 13/80 mmHg.
  • Lowering your cholesterol levels: Your doctor may prescribe statin drugs to help lower and maintain your cholesterol levels. Chronic kidney disease can cause high levels of bad cholesterol (LDL) and low levels of good cholesterol (HDL) which in turn can increase your risk of heart disease.
  • Treating anemia: Chronic kidney disease can impair the kidneys from producing the hormone erythropoietin which can in turn cause anemia. Your doctor may prescribe hormone supplements, sometimes with iron supplements, in order to relieve the fatigue and weakness often caused by anemia.
  • Reducing swelling: Damaged kidneys cannot regulate your body’s fluid levels as well and may lead to swelling in your legs, arms, and feet. Your doctor may prescribe medications known as diuretics that help remove excess fluid and reduce swelling so you avoid complications like edema.
  • Protecting your bones: Bone damage can occur when toxic substances harmful to bone build up to dangerous levels because the damaged kidneys are not eliminating them. Vitamin D and calcium supplements may be prescribed to lower your risk of fractures and help strengthen your bones. You may also need to take medication that lowers the amount of phosphate in your blood. This helps protect your blood vessels from calcium deposits (calcification) that can occur due to bone damage.
  • Low-protein diet: Eating protein in excess amounts can cause a buildup of the waste products that your kidneys are responsible for eliminating. To reduce the strain on your kidneys, your doctor may put you on a low-protein diet. A dietitian may be recommended to help you develop a healthy diet plan that still includes the required amount of protein along with a balance of other necessary nutrients.

If you have diabetes, there are additional considerations you will need to make regarding your kidney health. Controlling your blood sugar levels is very important, as consistently high levels can damage the blood vessels in the kidneys, leading to further kidney damage and impaired function.

If treatment fails to slow the progression of your kidney damage and you go into partial or full kidney failure, you will have two treatment options: dialysis or a kidney transplant.

Dialysis treatment involves filtering your blood through a machine that takes over the waste removal role of your kidneys. For this type of treatment to be effective, you must undergo the process at least three times a week. Most patients have the process done at a dialysis center or hospital dialysis wing, although you may be able to undergo dialysis at home if you meet the requirements.

A kidney transplant is where your damaged kidneys are replaced by a single, healthy kidney. The new kidney comes from a donor (living or deceased) whose blood and tissue types match your own. After the transplant, close monitoring is required to ensure your body does not reject the new kidney. You will have to take anti-rejection medication for the rest of your life to prevent this from happening in the future. The single kidney takes over the functions of both of your kidneys.

Once your doctor has determined a treatment plan to immediately address your kidney damage or failure, lifestyle changes can also help you reduce the damage and progression. Some of the changes you can make to improve your kidney and overall health include:

  • Quitting smoking
  • Avoiding alcohol
  • Losing excess weight
  • Maintaining a healthy diet

You should also make sure you are up-to-date on important vaccinations, including:

  • Flu (influenza) vaccine
  • H1N1 (swine flu) vaccine
  • Pneumonia vaccine
  • Hepatitis A vaccine
  • Hepatitis B vaccine

6. Chronic Kidney Disease – What has to be proven for you to be considered disabled by Social Security?

Social Security maintains a list of medical conditions that are so severe they automatically mean that you are disabled. This list of conditions are ones that are expected to be permanent, or expected to result in death, or have a certain length of time that it must last. Each medical condition on this list has a complete description of what symptoms or conditions have to be present with your medical condition for you to “meet the listing”. The complete medical listing for chronic kidney disease is found on this Social Security Administration website and is listed below for discussion:

http://www.socialsecurity.gov/disability/professionals/bluebook/6.00-Genitourinary-Adult.htm

If you do not “meet” this listing, you may still be considered disabled if you are not able to do your past relevant work, or you are not able to do any other work that you may have the education or experience to do.)

6a. Social Security’s Rules for Chronic Kidney Disease

“6.02 Impairment of renal function, due to any chronic renal disease that has lasted or can be expected to last for a continuous period of at least 12 months. With:

A. Chronic hemodialysis or peritoneal dialysis (see 6.00E1).

OR

B. Kidney transplantation. Consider under a disability for 12 months following surgery;
thereafter, evaluate the residual impairment (see 6.00E2).

OR

C. Persistent elevation of serum creatinine to 4 mg per deciliter (dL)(100 ml) or greater or reduction of creatinine clearance to 20 ml per minute or less, over at least 3 months, with one of the following:

1. Renal osteodystrophy (see 6.00E3) manifested by severe bone pain and appropriate medically acceptable imaging demonstrating abnormalities such as osteitis fibrosa, significant osteoporosis, osteomalacia, or pathologic fractures; or

2. Persistent motor or sensory neuropathy (see 6.00E4); or

3. Persistent fluid overload syndrome with:

a. Diastolic hypertension greater than or equal to diastolic blood pressure of 110 mm Hg; or

b. Persistent signs of vascular congestion despite prescribed therapy (see 6.00B5);

4. Persistent anorexia with weight loss determined by body mass index (BMI) of less than 18.0, calculated on at least two evaluations at least 30 days apart within a consecutive 6-month period (see 5.00G2).

6b. Chad Brown’s Explanation of Social Security’s Rules

For you to “meet the listing” and thereby qualify for Social Security disability benefits, you must have weakening kidney function due to any chronic renal disease that has lasted or can be expected to last for a continuous period of at least 12 months. With:

A. Chronic hemodialysis or peritoneal dialysis (Dialysis is a process where your blood is filtered three times a week by a machine because your kidneys have failed). A report from an acceptable medical source describing the reason for kidney failure and the need for continuing dialysis is sufficient to satisfy this requirement.

OR

B. A kidney transplant(s). You are considered disabled for 12 months following a kidney transplant; thereafter, your kidney functioning levels determine if you are still disabled.

OR

C. A specific blood test reading for your serum creatinine (This test determines the level of your kidney functioning); or a certain test reading that measures the level of creatinine that is excreted out of the kidneys (again, a test that measures kidney functioning); both tests show steady or declining levels of poor kidney functioning over at least a 3-month period, with ONE of the following:

1. Renal osteodystrophy (a bone deterioration disease due to poor kidney functioning with bone loss, bone pain, bone fractures, etc.); or

2. Continuous motor or sensory neuropathy (loss of nerve sensations, numbness, and pain) of 12 months or more; or

3. Fluid overload syndrome (Water and sodium retention due to poor kidney functioning) with:

a. Continuous “bottom” blood pressure reading of 110 or more; or

b. Continuous signs of congestive heart failure, fluid build-up in lungs, etc. or

4. Persistent weight loss and body mass index of less than 18, at least two readings taken at least 30 days apart for 6 months.

7. Internet Resources for Chronic Kidney Disease

For a description of how Social Security makes its disability decisions, go to this Chad Brown Law website:

For other general information about Social Security and Supplemental Security Income disability programs and how the law firm of Chad Brown Law can help you, visit:

http://chadbrownlaw.com/

For a complete listing of conditions that Social Security considers disabling, go to Social Security’s website at:

http://www.socialsecurity.gov/disability/professionals/bluebook/AdultListings.htm

For more information on chronic kidney disease, go to the Mayo Clinic’s website at:

http://www.mayoclinic.org/diseases-conditions/kidney-disease/basics/definition/con-20026778

eMedicineHealth has extensive information on chronic kidney disease. Visit them at:

http://www.emedicinehealth.com/chronic_kidney_disease/article_em.htm

8. Community Resources for Chronic Kidney Disease

For local resources and support for chronic kidney disease, visit National Kidney Foundation’s North Carolina chapter at:

http://www.kidney.org/site/208//index.cfm

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(704) 992-3002

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Wilkesboro, NC 28697

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