Ratings of the genitourinary system—diagnoses

KIDNEY CONDITIONS (NEPHROLOGY) DISABILITY BENEFITS

Many individuals today are experiencing kidney inconveniences. Constant kidney diseases are a genuine condition that can bring about expanded uses on medications and specialist's expenses, decline estimation of life, and early mortality.

Nephrology

Nephrology is the part of inner medication that manages the investigations, functioning of the human kidney and its diseases. The main concern of it is the distinguishing and treatment of various kidney diseases.

What can cause kidney diseases?

Your way of life is the fundamental driver of experiencing difficulties in your kidneys. One should prioritize considering their food consumption. The majority of the individuals today really like to eat instant food like noodles, espresso, and anything that can be made without delay. But they need to realize that those junk foods have substance that can destroy your kidneys. It has deposits that will stay in your kidneys for so long. We should not disregard your drunkard and soft drink consumption. That type of food has solid substance that can contribute numerous undesired components to be put away in your kidneys.

What are the symptoms of kidney failure?

Various symptoms can create if kidney disease isn't discovered early or it deteriorates notwithstanding treatment.

Symptoms leading to kidney diseases can include:

• weight reduction and low appetite
• swollen lower legs, feet or hands – because of water maintenance
• blood in urine
• an expanded need to urinate – especially around evening time
• trouble resting (a sleeping disorder)
• irritated skin
• muscle cramps
• feeling wiped out
• migraines
• erectile malfunction in men

Occurring of these symptoms is commonly known as kidney infection. It can also lead to kidney failure if not treated timely.

Preventive measures for kidney diseases

• Maintain with your glucose
• Diabetes expands your danger for coronary illness and kidney disappointment. That is only one motivation to Maintain with your glucose.
• Maintain your pulse
• Hypertension can build your danger for coronary illness just as kidney failure.
• Keep a solid weight
• Obesity can also build danger for conditions related with kidney disappointment, for example, diabetes and hypertension.
•  Maintain a heart-solid eating routine
• A heart-solid eating routine — one low in sugar and cholesterol and high in fiber, entire grains, and foods grown from the ground — forestalls weight acquire.
•  Decrease salt admission
• Eating a lot of salt is related with hypertension.
•  Drink enough water
• Drying out lessens blood stream to your kidneys, which can harm them. Which is why adequate amounts of water needs to be consumed.
• Breaking point liquor
• Liquor expands your circulatory strain. The additional calories in it can make you put on weight, as well.
•  Try not to smoke
• High intake of calming drugs, for example, headache medicine, ibuprofen, and naproxen, decrease the measure of blood stream to your kidneys, which can hurt them.
• Exercise consistently

Kidney, abscess of: 

A kidney abscess can be defined as the localized collection of pus in any part of the renal tissues leading to the spread of infection and other complications. It may appear as a complex lesion or intrarenal fluid collection layered by the inflammatory cells.

Based on the anatomic location of the abscess in the kidney, it can be categorized into three types,

1. Perinephric Abscess: A perinephric abscess is a collection of pus in the perinephric fat (layer of fat surrounding the kidneys) and fascia surrounding the kidney.
2. Renal Cortical Abscess: It is a term to describe the collection of pus in the renal cortex.
3. Corticomedullary Abscess: A corticomedullary abscess is a collection of pus in the space joining the renal medulla and cortex.

Studies report that kidney abscesses resulting from focal infection usually result in abscesses in the medulla, whereas the hematogenous spread from a remote site will result in a cortical abscess. Either type can crack into the perinephric space causing a perinephric abscess.

Causes 

The following are the causes of a kidney abscess: 

• Abscess on the skin
• Inflammation of the kidneys
• Kidney disease
• Post-Surgery complications to the urinary tract, reproductive organs
• Drugs that were administered intravenously
• Few patients with high levels of blood glucose encounter renal abscess

Symptoms

Renal abscess is a rare occurrence that usually presents with the following symptoms:

• Fever and chills
• Abdominal pain that radiates down the groin
• Severe backache and tenderness
• Sudden weight loss
• Pain during urination
• Blood in the urine
• Sweating at night

Diagnosis

Diagnostic tests include:

• Complete Blood Count: This will reveal the increased number of white blood cells (leukocytosis).
• Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP): Values are elevated, indicating active infection.
• Blood Culture: Reveal the growth of organisms in the blood.
• Gram Staining: Done to understand whether the organism causing the infection is gram-positive or negative.
• Urine Test: Reveals the presence of causative bacteria and pus in the urine.
• X-ray: This is the least advisable, as small abscesses are hard to appreciate in X-ray.
• Kidney Ultrasound: Kidney ultrasound helps visualize the abscess.
• Computerized Tomography (CT scan): CT scan is the most preferred method to diagnose kidney abscesses.

Nephritis, chronic: 

Chronic Nephritis is a long-term kidney condition that involves inflammation and damage to the kidney tissues. It is often characterized by the presence of scar tissue in the kidneys, which can interfere with their ability to function properly. Over time, chronic nephritis can lead to permanent kidney damage and potentially life-threatening complications.

Causes 

Sometimes, the disease runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later.

Symptoms

Signs and symptoms of glomerulonephritis may vary depending on whether you have the acute or chronic form and the cause. You may notice no symptoms of chronic disease. Your first indication that something is wrong might come from the results of a routine urine test (urinalysis).

Glomerulonephritis signs and symptoms may include:

• Pink or cola-colored urine from red blood cells in your urine (hematuria)
• Foamy or bubbly urine due to excess protein in the urine (proteinuria)
• High blood pressure (hypertension)
• Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
• Urinating less than usual
• Nausea and vomiting
• Muscle cramps
• Fatigue

Diagnosis

In some cases, a doctor may detect nephritis during a routine blood or urine test.

Finding protein in the urine can indicate that the kidneys are not working correctly. A blood test that measures a waste product in the blood called creatinine can also provide information on the health of the kidneys.

However, a biopsy is the best way to check for nephritis. For this procedure, a doctor will remove a piece of the kidney with a needle and send it to a laboratory for analysis.

Pyelonephritis, chronic: 

The phrase 'chronic pyelonephritis' (CP) is not really one diagnosis. It is meant to mean the long-term damage done by recurrent urine infection to the drainage system of the kidney. But it has come to be a 'fallback diagnosis', i.e. when doctors are not sure of the cause of kidney failure, and the kidney has scars on its surface, they call it CP.

Causes and Risk Factors

The urinary tract consists of the kidneys, a pair of ureters that lead to the urinary bladder, and the urethra that leads urine to the urinary outlet. Any obstruction in this tract can cause stagnation and retrograde of urine which is toxic for the body tissues.

Sometimes, the cause of CP is unclear, but the two main mechanisms of CP development are:

• An obstruction in the urinary tract: such as stones or other organs that enlarge and obstruct the passageway of urine.
• Reflux nephropathy (because of an obstruction or a urinary tract anomaly): is a disease of the kidney caused by the reflux of urine in the urinary tract and back to the kidney.

Symptoms 

CP is asymptomatic in its early stages. The usual symptoms are similar to that of kidney infection or chronic kidney disease, like:

• Burning sensation while peeing
• Difficulty in peeing
• Flank pain (on one side of the affected kidney) or back and abdominal pain
• Needing to urinate during the night
• History of recurrent UTIs since childhood
• Ankle swelling
• Tiredness, fatigue
• Itching

Children with CP may report these symptoms, too:

• Fever
• Nausea
• Lethargy
• Failure to thrive
• High blood pressure
• Tenderness on the sides
• If CP has progressed to late stages, the patient will experience renal insufficiency and hypertension.

Diagnosis

Blood creatinine may be raised if it has led to chronic kidney disease. Urine tests may show infection and low to moderate levels of protein. Other tests include;

• kidney ultrasound or IVP (intravenous pyelogram - a special x-ray) showing scarring,
• nuclear medicine scan,
• computed tomography (CT),
• micturating cystourethrogram (MCU). This will usually not be necessary.

Kidney, tuberculosis of: 

Renal tuberculosis (renal TB) or tuberculosis of the kidney is a type of extra-pulmonary tuberculosis that affects the kidney. Extra-pulmonary tuberculosis refers to tuberculosis that affects an organ outside the lungs. Other sites of extra-pulmonary tuberculosis are the pleura (the covering of the lungs), the lymph nodes, the fallopian tube in females and the epididymis in males, the bone marrow, and the hindbrain.

Renal tuberculosis may affect either one or both kidneys. The inner part of the kidney called the medulla is usually affected, though the infection usually starts from the cortex which is the outer part. Renal tuberculosis is sometimes a part of the tuberculosis that affects the entire genitourinary tract. 

Causes 

Renal or kidney tuberculosis is caused by Mycobacterium tuberculosis and is one of the most common forms of TB. It usually develops in adults, but it is also possible to have kidney TB in children.

Kidney TB is more likely to develop in those with pulmonary tuberculosis. This is because lung TB can spread to the kidneys by lymphatic or hematogenous means. Moreover, if the bacilli have been displaced from the lung by anti-TB drugs, they can spread to the kidneys through the bloodstream.

Symptoms 

There are no early symptoms of kidney tuberculosis, and most people have no signs or symptoms until they have been diagnosed. The clinical symptoms of urogenital TB are insidious and can be difficult to diagnose and treat. Symptoms can include: 

• Persistent fever
• Weight loss
• Night sweats
• Dysuria
• Sterile pyuria
• Hematuria
• Flank or abdominal pain
• Nocturia

These symptoms can also be associated with a genital mass or pelvic tenderness, obstructive urination, and abdominal colic. In addition, patients may develop interstitial nephritis and acid-fast bacilli, which tests can identify.

Diagnosis 

Renal tuberculosis is difficult to diagnose since not too many physicians will suspect the condition. However, it is important to diagnose it since the patient can recover completely with the right treatment.

Tests used to diagnose renal tuberculosis include the following:

Blood tests

Blood tests that should be done include the following:

• A full blood count and ESR (erythrocyte sedimentation rate) which may indicate the presence of an infection. The ESR should be repeated on a monthly basis after starting treatment to test for the response to the treatment
• Renal function tests, which include measurement of blood urea, uric acid and creatinine to test the functioning of the kidneys
• Tests to evaluate calcium metabolism in case of calcium deposits in the kidney

Tuberculin skin test

• In this test, a small amount of tubercular protein is injected into the skin of the inner forearm. A firm red bump (induration) appears after 2 to 3 days if the person has been previously exposed to M tuberculosis. The test is positive in around 80% cases of renal tuberculosis.

Urine tests

The following urine tests may be done to diagnose renal tuberculosis:

• A urine routine examination which may show the presence of pus cells and red blood cells
• Urine culture on specific media that promote the growth of mycobacteria. It should be done on three to five early morning urine samples. It takes 4 to 8 weeks for the results to be available
• The culture can be done on a specific liquid medium, which like the polymerase chain reaction (PCR) provides quicker results resulting in early detection of the infection

Imaging tests

Imaging tests of the urinary system that may be used in the diagnosis of renal tuberculosis include the following:

• Intravenous pyelogram / Intravenous urogram: In this imaging test, a dye is injected into the blood which is filtered by the kidneys, and passes through and delineates the urinary tract. It can detect structural and functional problems caused by tuberculosis on the urinary tract. The test should be repeated after three to four months after starting treatment to check if any surgical treatment is needed
• CT scan, which is useful in assessing advanced disease of the kidney
• X-ray, which may show the presence of calcium deposits
• Ultrasound, to monitor response to treatment

Note: Rate any residual disability of infection within the appropriate body system as indicated by the notes in the evaluation criteria. As applicable, consider the long-term health effects potentially associated with infectious diseases as listed in §3.317(d) of this chapter, specifically Brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), Malaria, Mycobacterium Tuberculosis, Nontyphoid Salmonella, Shigella, Visceral Leishmaniasis, and West Nile virus.

Nephrosclerosis, arteriolar: 

Arteriolar Nephrosclerosis is a condition that affects the small arteries in the kidneys, causing them to narrow and harden. This can lead to reduced blood flow to the kidneys, which can result in damage to the kidney tissues. 

Causes

The causes of arteriolar nephrosclerosis include:

• Chronic high blood pressure
• Diabetes
• Aging
• Smoking
• High cholesterol levels

Symptoms

Symptoms of arteriolar nephrosclerosis include:

• High blood pressure
• Proteinuria (the presence of excess protein in the urine)
• Edema (swelling), particularly in the ankles and legs
• Fatigue and weakness
• Decreased urine output

Diagnosis

Diagnosis of arteriolar nephrosclerosis typically involves a combination of medical history, physical examination, laboratory tests (such as urine and blood tests), and imaging studies (such as ultrasound or CT scans) to evaluate kidney function and identify any structural abnormalities. A kidney biopsy may also be performed to confirm the diagnosis and rule out other possible causes of kidney damage.

Nephrolithiasis

Nephrolithiasis or Kidney stones are strong and hard masses. Kidney stones mostly start in your kidneys

Diet, overabundance body weight, some ailments, and certain enhancements and meds are among the numerous reasons for kidney stones. Kidney stones can influence any piece of your urinary tract — from your kidneys to your bladder.

Passing kidney stones can be very difficult, however the stones typically cause no lasting harm in the event that they're perceived at initial stage. Contingent upon your circumstance, you may require just to take torment medicine and drink heaps of water to pass a kidney stone. In different occasions — for instance, if stones become stopped in the urinary tract, are related with a urinary infection or cause entanglements — medical procedure might be required.

Your doctor may prescribe preventive treatment to lessen your danger of intermittent kidney stones in case you're at expanded danger of creating them once more.

Indications

A kidney stone as a rule won't cause manifestations until it moves around inside your kidney or passes into your ureters — the cylinders associating the kidneys and the bladder. On the off chance that it gets stopped in the ureters, it might obstruct the progression of pee and cause the kidney to expand and the ureter to fit, which can be extremely excruciating. By then, you may encounter these signs and indications:

• Extreme, sharp torment in the side and back, beneath the ribs
• Torment that emanates to the lower abdomen and crotch
• Torment that comes in waves and varies in force
• A constant need to pee, peeing more regularly than expected
• Queasiness and retching
• Fever and chills if an infection has occurred

When To See A Specialist

Look for guaranteed clinical consideration if you experience:

• Torment joined by sickness and regurgitating
• Agony joined by fever and chills
• Blood in your pee
• Trouble passing pee

Nephrolithiasis: 

Nephrolithiasis, also known as kidney stones or renal calculi, is a condition where hard deposits made of minerals and salts form inside the kidneys. These stones can affect any part of the urinary tract, from the kidneys to the bladder. 

Causes

Kidney stones are common. Some types run in families. They often occur in premature infants. There are different types of kidney stones. The cause of the problem depends on the type of stone.

• Stones can form when urine contains too much of certain substances that form crystals. These crystals can develop into stones over weeks or months.
• Calcium stones are most common. They are most likely to occur in men between ages 20 to 30. Calcium can combine with other substances to form the stone.
• Oxalate is the most common of these. Oxalate is present in certain foods such as spinach. It is also found in vitamin C supplements. Diseases of the small intestine increase your risk for these stones.
• Calcium stones can also form from combining with phosphate or carbonate.

Other types of stones include:

• Cystine stones can form in people who have cystinuria. This disorder runs in families. It affects both men and women.
• Struvite stones are mostly found in men or women who have repeated urinary tract infections. These stones can grow very large and can block the kidney, ureter, or bladder.
• Uric acid stones are more common in men than in women. They can occur with gout or chemotherapy.
• Other substances, such as certain medicines, also can form stones.

The biggest risk factor for kidney stones is not drinking enough fluids. Kidney stones are more likely to occur if you make less than 1 liter (32 ounces) of urine a day.

Symptoms

A kidney stone usually will not cause symptoms until it moves around within the kidney or passes into one of the ureters. The ureters are the tubes that connect the kidneys and bladder.

If a kidney stone becomes lodged in the ureter, it may block the flow of urine and cause the kidney to swell and the ureter to spasm, which can be very painful. At that point, you may experience these symptoms:

• Severe, sharp pain in the side and back, below the ribs
• Pain that radiates to the lower abdomen and groin
• Pain that comes in waves and fluctuates in intensity
• Pain or burning sensation while urinating
• Other signs and symptoms may include:
• Pink, red or brown urine
• Cloudy or foul-smelling urine
• A persistent need to urinate, urinating more often than usual or urinating in small amounts
• Nausea and vomiting
• Fever and chills if an infection is present

Pain caused by a kidney stone may change for instance, shifting to a different location or increasing in intensity as the stone moves through your urinary tract.

Diagnosis

The healthcare provider will perform a physical exam. The belly area (abdomen) or back might feel sore.

Tests that may be done include:

• Blood tests to check calcium, phosphorus, uric acid, and electrolyte levels
• Kidney function tests
• Urinalysis to see crystals and look for red blood cells in urine
• Examination of the stone to determine the type

Stones or a blockage can be seen on:

• Abdominal CT scan  
• Abdominal x-rays
• Kidney ultrasound
• Retrograde pyelogram

Hydronephrosis: 

Hydronephrosis is a condition in which one or both kidneys become swollen due to incomplete emptying of the urinary tract. It can be sudden or chronic, partial or complete, one-sided or bilateral. It can occur anywhere along the urinary tract from the opening of the kidneys to the ureters (draining the kidneys to the bladder), the bladder, and the urethra (draining the bladder). Problems with any of these structures may cause impaired emptying of the urinary system and back up of fluid and pressure.

If only one of the kidneys is affected, the condition is called unilateral hydronephrosis. If both kidneys are affected, it is called bilateral hydronephrosis.

Hydronephrosis may result in decreased kidney function. If not treated right away, permanent damage to the kidney or kidneys may occur, resulting in kidney failure.

Causes 

Hydronephrosis is usually caused by another underlying illness or risk factor. Causes of hydronephrosis include, but are not limited to, the following illnesses or risk factors:

• Kidney stone
• Congenital blockage (a defect that is present at birth)
• Blood clot
• Scarring of tissue (from injury or previous surgery)
• Tumor or cancer (examples include bladder, cervical, colon, or prostate)
• Enlarged prostate (noncancerous)
• Pregnancy
• Urinary tract infection (or other diseases that cause inflammation of the urinary tract)

Symptoms

Normally, urine flows through the urinary tract with minimal pressure. Pressure can build up if there’s an obstruction in the urinary tract. After urine builds up for an extended period, your kidney can enlarge.

Your kidney may become so engorged with urine that it starts to press on nearby organs. If it’s left untreated for too long, this pressure can cause your kidneys to lose function permanently.

Mild symptoms of hydronephrosis include urinating more frequently and an increased urge to urinate. Other potentially severe symptoms you may experience are:

• pain in the abdomen or flank
• nausea
• vomiting
• pain when urinating
• incomplete voiding, or bladder emptying
• a fever

Interrupting the flow of urine increases your chances of getting a urinary tract infection (UTI). This is why UTIs are one of the most common complications of hydronephrosis. Some signs of a UTI include:

• cloudy urine
• painful urination
• burning with urination
• a weak urine stream
• back pain
• bladder pain
• a fever
• chills

If you see signs of hydronephrosis, schedule an appointment with your doctor to talk about your symptoms. Untreated UTIs may lead to more serious conditions such as pyelonephritis, an infection of the kidney, and sepsis, an infection in the bloodstream or blood poisoning.

Diagnosis

A urine test can reveal whether your child has a UTI. Other tests may be necessary, including:

• Kidney and bladder ultrasound: 
• Specialized X-ray of the urinary tract system 
• Nuclear scan

Ureterolithiasis: 

Ureterolithiasis is a condition where a hard deposit made of minerals and salts forms inside the ureter, which is the tube that connects the kidney to the bladder. This condition is also known as "stones in the ureter". Ureterolithiasis is a type of kidney stone, which is a hard object made from chemicals in the urine. 

Causes

Causes of ureterolithiasis include:

• High levels of calcium, oxalate, and phosphorus in the urine, can lead to stone formation.
• Certain foods increase the likelihood of developing kidney stones, especially in individuals predisposed to stone formation.
• Obesity, which is associated with an increased risk of kidney stones.

Four types of kidney stones: calcium oxalate, uric acid,  struvite, and cystine.

• Struvite stones can form in response to a urinary tract infection.
• Uric acid stones may develop in individuals who experience excessive fluid loss.

Symptoms

The common symptoms of kidney stones include: 

• Sharp, cramping pain in the back and side.
• Pain that radiates from the back or side to the lower abdomen or groin.
• Blockage of urine flow due to a lodged stone in the ureter, causing kidney swelling and ureter spasms.
• Pain or burning sensation during urination (dysuria).
• Urgent and frequent need to urinate.
• Presence of blood in the urine (hematuria).
• Feeling sweaty or experiencing cold sweats.
• Severe pain that comes and goes in waves (renal colic).
• Nausea or vomiting.
• Cloudy or foul-smelling urine.

Diagnosis 

Diagnosis of ureterolithiasis involves the following tests:

• History and physical exam
• Complete blood count (CBC)
• Basic metabolic panel (BMP)
• Urinalysis
• Renal ultrasound
• Radiographs
• CT scan of the abdomen and pelvis
• Stone composition evaluation
• 24-hour urine collection
• Cultures

Ureter, stricture of:

Bladder, fistula of:

Note: In cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, an evaluation of 30 percent will be assigned for the service-connected testicular loss. Testis, undescended, or congenitally undeveloped is not a ratable disability.

Note: Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.

Note: The 100 percent evaluation shall be assigned as of the date of hospital admission for transplant surgery and shall continue with a mandatory VA examination one year following hospital discharge. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.