DI 34226.005 Genitourinary Listings from 09/06/05 to 12/08/14
106.00 GENITOURINARY IMPAIRMENTS (Effective Date: 09/06/05)
A.What impairments do these listings cover?
1. We use these listings to evaluate genitourinary impairments resulting from chronic
renal disease and congenital genitourinary disorders.
2. We use the criteria in 106.02 to evaluate renal dysfunction due to any chronic
renal disease, such as chronic glomerulonephritis, hypertensive renal vascular disease,
diabetic nephropathy, chronic obstructive uropathy, and hereditary nephropathies.
3. We use the criteria in 106.06 to evaluate nephrotic syndrome due to glomerular
4. We use the criteria in 106.07 to evaluate congenital genitourinary impairments
such as ectopic ureter, extrophic urinary bladder, urethral valves, and neurogenic
B.What do we mean by the following terms in these listings?
1. Anasarca is generalized massive edema (swelling).
2. Creatinine is a normal product of muscle metabolism.
3. Creatinine clearance test is a test for renal function based on the rate at which creatinine is excreted by
4. Glomerular disease can be classified into two broad categories, nephrotic and nephritic. Nephrotic conditions
are associated with increased urinary protein excretion and nephritic conditions are
associated with inflammation of the internal structures of the kidneys.
5. Hemodialysis, or dialysis, is the removal of toxic metabolic byproducts from the blood by diffusion in an artificial
6. Nephrotic syndrome is a general name for a group of diseases involving defective kidney glomeruli, characterized
by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and varying degrees of edema.
7. Neuropathy is a problem in peripheral nerve function (that is, in any part of the nervous system
except the brain and spinal cord) that causes pain, numbness, tingling, and muscle
weakness in various parts of the body.
8. Parenteral antibiotics refer to the administration of antibiotics by intravenous, intramuscular, or subcutaneous
9. Peritoneal dialysis is a method of hemodialysis in which the dialyzing solution is introduced into and
removed from the peritoneal cavity either continuously or intermittently.
10. Proteinuria is excess protein in the urine.
11. Renal means pertaining to the kidney.
12. Serum albumin is a major plasma protein that is responsible for much of the plasma colloidal osmotic
pressure and serves as a transport protein.
13. Serum creatinine is the amount of creatinine in the blood and is measured to evaluate kidney function.
C. What evidence do we need?
1. We need a longitudinal record of your medical history that includes records of
treatment, response to treatment, hospitalizations, and laboratory evidence of renal
disease that indicates its progressive nature or of congenital genitourinary impairments
that documents their recurrent or episodic nature. The laboratory or clinical evidence
will indicate deterioration of renal function, such as elevation of serum creatinine,
or changes in genitourinary function, such as episodes of electrolyte disturbance.
2. We generally need a longitudinal clinical record covering a period of at least
3 months of observations and treatment, unless we can make a fully favorable determination
or decision without it. The record should include laboratory findings, such as serum
creatinine or serum albumin values, obtained on more than one examination over the
3. When you are undergoing dialysis, we should have laboratory findings showing your
renal function before you started dialysis.
4. The medical evidence establishing the clinical diagnosis of nephrotic syndrome
must include a description of the extent of edema, including pretibial, periorbital,
or presacral edema. The medical evidence should describe any ascites, pleural effusion,
or pericardial effusion. Levels of serum albumin and proteinuria must be included.
5. If a renal biopsy has been performed, the evidence should include a copy of the
report of the microscopic examination of the specimen. However, if we do not have
a copy of the microscopic examination in the evidence, we can accept a statement from
an acceptable medical source that a biopsy was performed, with a description of the
6. The medical evidence documenting congenital genitourinary impairments should include
treating physician records, operative reports, and hospital records. It should describe
the frequency of your episodes, prescribed treatment, laboratory findings, and any
surgical procedures performed.
D. How do we consider the effects of treatment? We consider factors such as the:
1. Type of therapy.
2. Response to therapy.
3. Side effects of therapy.
4. Effects of any post-therapeutic residuals.
5. Expected duration of treatment.
E. What other things do we consider when we evaluate your genitourinary impairment under
1. Chronic hemodialysis or peritoneal dialysis (106.02A). A report from an acceptable medical source describing the chronic renal
disease and the need for ongoing dialysis is sufficient to satisfy the requirements
2. Kidney transplantation (106.02B). If you have undergone kidney transplantation, we will consider you to
be disabled for 12 months following the surgery because, during the first year, there
is a greater likelihood of rejection of the organ and recurrent infection. After the
first year post transplantation, we will base our continuing disability evaluation
on your residual impairment(s). We will include absence of symptoms, signs, and laboratory
findings indicative of kidney dysfunction in our consideration of whether medical
improvement (as defined in §§404.1594(b)(1) and (c)(1) and 416.994a, as appropriate)
has occurred. We will consider the:
a. Occurrence of rejection episodes.
b. Side effects of immunosuppressants, including corticosteroids.
c. Frequency of any renal infections.
d. Presence of systemic complications such as other infections, neuropathy, or deterioration
of other organ systems.
3. Nephrotic syndrome (106.06). The longitudinal clinical record should include a description of prescribed
therapy, response to therapy, and any side effects of therapy. In order for your nephrotic
syndrome to meet 106.06A or B, the medical evidence must document that you have the
appropriate laboratory findings required by these listings and that your anasarca
has persisted for at least 3 months despite prescribed therapy. However, we will not
delay adjudication if we can make a fully favorable determination or decision based
on the evidence in your case record. We may also evaluate complications of your nephrotic
syndrome, such as orthostatic hypotension, recurrent infections, or venous thromboses,
under the appropriate listing for the resultant impairment.
4. Congenital genitourinary impairments (106.07).
a. Each of the listings in 106.07 requires a longitudinal clinical record showing
that at least three events have occurred within a consecutive 12-month period with
intervening periods of improvement. Events include urologic surgical procedures, hospitalizations, and treatment with parenteral
antibiotics. To meet the requirements of these listings, there must be at least 1
month (that is, 30 days) between the events in order to ensure that we are evaluating
b. Diagnostic cystoscopy does not satisfy the requirement for repeated urologic surgical
procedures in 106.07A.
c. In 106.07B, systemic infection means an infection requiring an initial course of parenterally administered antibiotics
occurring at least once every 4 months or at least 3 times a year.
d. In 106.07C, appropriate laboratory and clinical evidence document electrolyte disturbance.
Hospitalizations are inpatient hospitalizations for 24 hours or more.
F. What does the term “persistent” mean in these listings? Persistent means that the longitudinal clinical record shows that, with few exceptions, the
required finding(s) has been at, or is expected to be at, the level specified in the
listing for a continuous period of at least 12 months.
G. How do we evaluate impairments that do not meet one of the genitourinary listings?
1. These listings are only examples of common genitourinary impairments that we consider
severe enough to prevent you from doing any gainful activity or that result in marked
and severe functional limitations. If your severe impairment(s) does not meet the
criteria of any of these listings, we must also consider whether you have an impairment(s)
that satisfies the criteria of a listing in another body system.
2. If you have a severe medically determinable impairment(s) that does not meet a
listing, we will determine whether your impairment(s) medically equals a listing,
or, in the case of a claim for SSI payments, functionally equals the listings. (See
§§404.1526, 416.926, and 416.926a.) When we decide whether a child receiving SSI payments
continues to be disabled, we use the rules in §416.994a.
106.01 Category of Impairments, Genitourinary Impairments
106.02 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 106.00E1).
B. Kidney transplantation. Consider under a disability for 12 months following surgery; thereafter, evaluate
the residual impairment (see 106.00E2).
C. Persistent elevation of serum creatinine to 3 mg per deciliter (dL) (100 ml) or greater, over at least 3 months.
D. Reduction of creatinine clearance to 30 ml per minute (43 liters/24 hours) per 1.73 m2 of body surface area over at least 3 months.
106.06 Nephrotic syndrome, with anasarca, persisting for at least 3 months despite prescribed therapy. (See
A. Serum albumin of 2.0 g/dL (100 ml) or less.
B. Proteinuria of 40 mg/m2/hr or greater.
106.07 Congenital genitourinary impairments (see 106.00E4) resulting in one of the following:
A. Repeated urologic surgical procedures, occurring at least 3 times in a consecutive
B. Documented episodes of systemic infection requiring an initial course of parenteral
antibiotics, occurring at least 3 times in a consecutive 12-month period (see 106.00E4).
C. Hospitalization (see 106.00E4d) for episodes of electrolyte disturbance, occurring
at least 3 times in a consecutive 12-month period.