7502 - Nephritis, chronic

DBQ: Link to Index of DBQ/Exams by Disability for DC 7502

Definition

Inflammatory process involving the kidney.

Etiology

Inflammation results from invasion of bacteria or their toxins; streptococcal infections; medications; sickle cell disease; tuberculosis; diphtheria; septicemia; or toxic substances, e.g., lead and mercury; and obstructions to flow of urine. Various parts of the renal tissues may be affected.

Signs & Symptoms

Signs and symptoms include: hypertension, swelling, excess serum proteins in the urine, abnormally low plasma proteins, elevated concentration of fatty substances in the plasma, and blood in the urine.

Tests

Urinalysis is done to investigate for protein, blood, cylindruria, and fibrous red blood cell material (casts). Blood urea nitrogen (BUN) levels and serum creatinine levels are usually increased due to renal insufficiency. Radiological examinations and ultrasound show small kidneys. Kidney biopsy may be helpful in certain situations.

Treatment

Control of hypertension with drugs and a low-salt diet; reduction of edema with diuretic drugs; use of antibiotics to control infection; dialysis for total or partial kidney shutdown; and potential candidacy for kidney transplantation.

Residuals

Some patients acquire end-stage renal disease (ESRD) indicating the need for renal replacement or transplantation.

Special Considerations

  • May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See 38 CFR 3.350(i)(1) – Total plus 60% and – Special Monthly Compensation (SMC).

  • This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309(a) [chronic disease].

  • The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date.  38 CFR 3.951(a)

Notes

  • When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

  • 38 CFR 4.115 Nephritis - Albuminuria alone is not nephritis, nor will the presence of transient albumin and casts following acute febrile illness be taken as nephritis. The glomerular type of nephritis is usually preceded by or associated with severe infectious disease; the onset is sudden, and the course marked by red blood cells, salt retention, and edema; it may clear up entirely or progress to a chronic condition. The nephrosclerotic type, originating in hypertension or arteriosclerosis, develops slowly, with minimum laboratory findings, and is associated with natural progress. Separate ratings are not to be assigned for disability from disease of the heart and any form of nephritis, on account of the close interrelationships of cardiovascular disabilities. If, however, absence of a kidney is the sole renal disability, even if removal was required because of nephritis, the absent kidney and any hypertension or heart disease will be separately rated. Also, in the event that chronic renal disease has progressed to the point where regular dialysis is required, any coexisting hypertension or heart disease will be separately rated.