C. Persistent elevation of serum creatinine to 4 mg per deciliter (dL) (100 ml) or greater or reduction of creatinine clearance to 20 ml per minute or less, over at least 3 months, with one of the following:

3. Persistent fluid overload syndrome with:
a. Diastolic hypertension greater than or equal to diastolic blood pressure of 110 mm Hg;
OR
b. Persistent signs of vascular congestion despite prescribed therapy (see 6.00B5);

Blood and urine tests required for this listing must be documented in the medical records on more than one occasion over a period of at least three months.

Creatinine - normal product of muscle metabolism.
Serum creatinine - amount of creatinine in the blood, which measures renal function; determined by a blood sample
Creatinine clearance test - test for renal function based on the rate at which creatinine is excreted by the kidney; determined by a blood sample with a 24 hour urine sample

A specific assessment of an individual's overall residual function cannot be directly correlated with a set abnormality of serum creatinine or creatinine clearance alone. An individual with a serum creatinine less than 4 mg/dl may not have significant loss of function; however, as the creatinine begins to exceed 4 mg/dl, complications of chronic kidney disease and loss of the individual’s overall level of function increases.

Fluid overload syndrome - excessive sodium (salt) and water retention in the body that cannot be adequately removed by the diseased kidneys
Vascular congestion - fluid overload of blood vessels

Signs of vascular congestion:

• Ascites - excess fluid in the abdomen
• Pleural effusions – fluid around the lungs
• Pulmonary edema – fluid inside the lungs
• Pericardial effusion – fluid surrounding the heart
• Diastolic hypertension - elevated diastolic blood pressure (the bottom number of a blood pressure reading)
  

Symptoms of vascular congestion include:

• Dyspnea - shortness of breath
• Fatigue
• Weakness

Medical records should show external and/or internal body swelling (edema) with diagnostic tests consistent with persistent fluid overload and repeated elevated blood pressure readings.

Imaging studies, such as a chest X-ray (CXR), Chest CT, Abdominal CT, and ultrasounds can detect internal body fluid overload showing such conditions as pulmonary edema, pleural effusions, and ascites.

This listing is only concerned with the diastolic (bottom) blood pressure reading of 110 mm. or above. (e.g. 180/110).

This listing does not require a specific degree of vascular congestion, but the intent of this listing is that it should be significant enough to prevent substantial gainful activity.

This condition is commonly associated with hypertension (high blood pressure) and congestive heart failure.