Nephrology for the Family Physician - O.I. Bakaliuk 2003

Fundamentals of medical and labor expertise in kidney diseases

Kidney diseases, particularly GN, PN, and DN, are among the major causes of disability.

Medical evaluation for these forms of pathology requires a comprehensive approach that takes into account both medical and social factors.

Medical criteria include: the nosological form, the clinical course (acute, chronic), the phase (complete or incomplete remission, exacerbation), frequency of exacerbations, specific features and severity of renal functional impairment (urinary and nephrotic syndromes, renal Hypertension, RF), involvement of other Organs and systems (hypertensive Heart disease, arrhythmias, Heart Failure), presence of complications (acidosis, electrolyte imbalances, Osteoporosis, anemia), and comorbid conditions.

Among social factors, the patient's occupation, working conditions, length of service, education, place of residence, age, and sex are of key importance in determining work capacity.

Since the degree of permanent disability is determined by specialized commissions (MSEK), we will focus in more detail on the principles of assessing temporary disability in common kidney diseases.

Temporary disability is primarily established for acute kidney diseases (GN, PN, newly diagnosed DN, amyloidosis, Renal tuberculosis), a relapsing (paroxysmal) course of chronic illness, and The Need for inpatient Treatment with highly potent agents (glucocorticoids, immunosuppressants, anticoagulants), among other conditions.

Legislation does not set strict limits for temporary disability in specific forms of pathology, although optimal durations exist for most kidney diseases. These are determined guided by prospective clinical and occupational prognoses.

If a patient is able to return to their previous job without changing positions (favorable prognosis), temporary disability is granted for the entire duration of the illness. The main contraindications for returning to the previous workplace in patients with kidney diseases include: intense physical exertion, work in high or low temperatures, high- and ultra-high-frequency electromagnetic fields, high humidity, drafts, vibration, constant contact with nephrotoxic substances, and jobs performed predominantly while standing. Under such conditions, job reassignment is indicated. The patient may be transferred to another job without a significant drop in qualification. Such placement is carried out based on the Conclusion of the medical advisory commission (MAC) of a healthcare facility. If reassignment results in a loss of professional qualification, grounds arise to refer the patient to the MSEK.

In cases of an unfavorable prognosis (when the patient cannot return to their previous workplace), temporary disability is granted only for the period required to assess the functional state of systems and organs, after which the patient is referred to the MSEK.

Legislation mandates the referral to the MSEK of patients who have been ill for an extended period—no later than 4 months from the onset of continuous temporary disability, or 5 months of temporary disability with interruptions over the last 12 months.

Patients with renal tuberculosis must be referred to the MSEK no later than 10 months of temporary disability (continuous or with interruptions).

If the MSEK commission finds no grounds for establishing a disability group, the sick leave is extended for a specified period on a general basis. In kidney diseases, extending temporary disability beyond 4 months is possible in cases of acute GN, the first Exacerbation of chronic GN, severe PN at the onset of the disease, or significant improvement in the patient's condition by the time documents are submitted to the MSEK.

Indications for determining permanent disability in patients with kidney diseases are based on General Principles.

Group I disability is established for severe impairments of renal function (stage III-IV CRF) where the patient requires constant external care, undergoes hemodialysis, or has an absolutely unfavorable short-term life prognosis (stage IV CRF, incurable Renal Tumors with metastases).

Group II disability requires significant impairments of renal function (frequent exacerbations or a continuous relapsing course, renal hypertension complicated by hypertensive heart disease and stage II heart failure, stage II-III CRF) that do not necessitate constant external care, but make it impossible to perform work under normal industrial conditions.

Group III disability is determined in cases of significant renal functional impairment (frequent exacerbations or continuous relapsing course, stage I-II CRF, renal hypertension with hypertensive heart disease and stage I heart failure) that lead to a loss of professional qualification (when placement in an equivalent job is impossible), a significant reduction in The Scope of work and earnings, or cause employment difficulties for low-skilled workers.