K

KIDNEY

[Congenital Malformations of the Kidney]{.underline}

Many malformations of the kidney occur, varying from those incompatible
with life to those that are relatively benign. The malformations may
consist of number (one or three kidneys), size, form (fusion or
duplication of one or more segments) and position.

In assessing the risk involved with the particular malformation, it is
important to learn the symptoms that led to its discovery.
Hydronephrosis, infection and calculi occur more frequently in malformed
kidneys than in otherwise normal ones.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  -------------------------------------------- --------------------------
  Polycystic kidneys                           R

  Other conditions -- may involve one or both  
  kidneys (duplication of kidney, pelvis or    
  ureter, etc.)                                

  Unilateral impairments                       

  No obstruction to urinary flow               0

  Others                                       Refer to Section Chief

  Bilateral impairments                        

  Fused kidney, horseshoe kidney, medullary    75
  sponge kidney                                

                                               

  Agenesis or congenital absence, one kidney,  0
  other kidney normal                          

                                               

  Cysts                                        

  Present                                      

  Polycystic disease ruled out                 Rate for urinary
                                               abnormalities

  Operated                                     Rate as Nephrectomy
  -------------------------------------------- --------------------------

[End Stage Renal Disease (ESRD)]{.underline}

ERSD results when progressive disease has damaged the kidneys to such an
extent that renal function tests are grossly abnormal and death will
eventually supervene in the absence of treatment. Dialysis may be used
on a permanent basis or temporarily while awaiting transplant.

The best cases of renal transplant are those who have been given a
well-matched kidney from a living related donor (of course, the optimum
is a transplant from an identical twin). In addition, normal renal
function, urinalysis and blood pressure, minimal medication and an
absence of serious rejection episodes are important.

Underwriting Requirements

An APS (VA Form 29-8158) is required.

  -------------------------------------------------- --------------------
  Chronic dialysis                                   R

  Kidney transplant                                  

  Within 1 year                                      R

  Thereafter, best cases\*                           R-350
  -------------------------------------------------- --------------------

\*Cases involving identical twins, etc. may be considered more
favorably.

[Glomerulonephrities (Bright's Disease), Pyelonephritis, Nephrotic
Syndrome]{.underline}

Acute glomerulonephritis (GN), or the acute nephritic syndrome, is
manifested by the abrupt onset of hematuria, proteinuria, impaired renal
function, edema and hypertension. Most cases follow streptococcal or
other infections, or are associated with a variety of systemic diseases.
Cases of post-streptococal GN often resolve spontaneously without
residuals. Some forms of acute GN such as IgG-IgA nephritis (Berger's
disease) have a much greater tendency to progress.

Chronic GN is a progressive stage of acute glomerular disease which has
failed to resolve or stabilize. Commonly it is asymptomatic and about
half the people with chronic GN may have advanced renal insufficiency
but no clear history of renal disease. Chronic GN is characterized by
abnormal renal function, albuminuria, abnormal urine sediment and small
kidneys.

Acute pyelonephritis is usually a symptomatic bacterial infection which
is treated with antibiotics and heals without residual. Chronic
pyelonephritis may result from a variety of factors. However the
etiology may be obscure, even with renal biopsy, urinary findings may
not be helpful until late stages, and the disease may progress slowly to
end stage renal disease.

The chronic nephritic syndrome is manifested by the excretion of large
amounts of protein in the urine. Secondary effects of this are low serum
albumin, edema, hyperlipidemia and hypercoagulability. While the
nephritic syndrome may follow acute GN, most cases are either related to
systemic diseases such as diabetes or systemic lupus erythematous or are
idiopathic.

Underwriting Requirements

An APS (VA Form 29-8158) is required.

  --------------------------------------------- -------------------------
  Acute GN                                      

  No complications, normal urine                

  Last attack                                   

  Within 1^st^ year                             20

  2^nd^ year                                    10

  3^rd^ year                                    0

  After 3 years                                 0

  Recurrent                                     

  Within 1^st^ year                             125

  2^nd^ year                                    75

  3^rd^ year                                    50

  After 3 years                                 0

  In combination with ratable hypertension      Sum debits

  Single attack, with subsequent ratable urine  Rate as chronic GN

  Recurrent attacks with subsequent ratable     Rate as chronic GN
  urine                                         

                                                

  Chronic GN                                    

  Normal kidney function tests, i.e. BUN,       225
  creatinine and creatinine clearance; blood    
  pressure and/or urinary findings requiring    
  less than 100 debits, total rating            

  Abnormal kidney function tests, i.e. BUN,     R
  creatinine and creatinine clearance; blood    
  pressure and/or urinary findings requiring    
  100 debits or more, total rating              

                                                

  Nephritic syndrome                            Rate as chronic GN

                                                

  Pyelonephritis                                

  Single episode                                0

  Others                                        Rate as acute GN,
                                                recurrent or chronic GN
  --------------------------------------------- -------------------------

[Hydronephrosis]{.underline}

Hydronephrosis is a dilation of the kidney pelvis, sometimes involving
the ureter, which is caused by obstruction in the urinary tract. Common
causes of unilateral obstruction are urethral stones, stricture, or
aberrant blood vessels compressing the ureter. Bilateral hydronephrosis
is often due to prostatic hypertrophy.

Underwriting Requirements

An APS (VA Form 29-8158) is required.

  --------------------------------------------- -------------------------
  Present                                       

  One kidney, other kidney normal               R-55

  Both kidneys or with prior nephrectomy        R-275

  History -- hydronephrosis no longer present   

  Not operated                                  0

  Operated                                      RFC

  Urine or kidney function tests abnormal       Rate as present
  --------------------------------------------- -------------------------

[Kidney Stone, Calculus, Nephrolithiasis]{.underline}

Stones are of varying size and may be single or multiple. Small stones
may be passed down the ureter resulting in severe pain (renal colic) and
hematuria. Larger stones cannot be passed spontaneously and remain in
the kidney pelvis. They may contribute to infection, obstruction and if
very large (staghorn calculus) may cause destruction of the kidney,
requiring nephrectomy.

Most stones can be seen by x-ray and silent stones are frequently found
while doing procedures for unrelated complaints. Stones which enter the
bladder can be passed spontaneously. Others may require cystoscopy,
lithotripsy or open surgery. Multiple or recurrent stones may indicate a
metabolic problem.

Underwriting Requirements

An APS (VA Form 29-8158) is required.

  --------------------------------------------- -------------------------
  Present                                       

  Large, multiple or unknown                    

  Unilateral                                    200

  Bilateral                                     R-275

  Small (1 cm or less), unilateral or bilateral 0

  History (including removal by surgery or      0
  other methods)                                

  Chronic stone former                          Refer to stone present

  Combination of urinary calculus with blood    
  pressure or abnormal urine                    

  Elevated blood pressure, albumin or casts     Sum debits

  RBC's, WBC's requiring debit                  Rate as stone present,
                                                large
  --------------------------------------------- -------------------------

[Nephrectomy]{.underline}

Nephrectomy is the surgical removal of a kidney. Tumor, stone, infection
and injury are the usual causes.

Underwriting Requirements

An APS (VA Form 29-8158) is required.

  --------------------------------------------- -------------------------
  For congenital abnormalities, solitary cyst,  
  benign tumor, stone, injury or infection      

  Urine normal                                  0

  Urine abnormal                                Rate for urinary
                                                abnormalities

  For tuberculosis or cancer                    See specific disorder
  --------------------------------------------- -------------------------

[Renal Hypertension]{.underline}

Stenosis of the renal arteries leads to elevated blood pressure. Surgery
is directed at relieving the stenosis. Occasionally nephrectomy is
required.

Underwriting Requirements

An APS (VA Form 29-8158) is required.

  --------------------------------------------- -------------------------
  Present or history                            Rate for blood pressure

  --------------------------------------------- -------------------------

[Renal Tubular Acidosis (RTA)]{.underline}

RTA has varied manifestations and may be congenital, acquired or
secondary to other significant diseases. Prognosis depends on the
response to treatments and the nature of the underlying disease. In one
form kidney stones are common.

Underwriting Requirements

An APS (VA Form 29-8158) is required.

  --------------------------------------------- -------------------------
  Present                                       

  Controlled on treatment, stable               50

  Others                                        R-100

  History                                       0
  --------------------------------------------- -------------------------