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7504
§ 4.115b Ratings of the genitourinary system—diagnoses.

Chronic pyelonephritis

Persistent or recurring bacterial infection of the kidney and its drainage system, causing inflammation and potential scarring.

What the rating means

Chronic pyelonephritis is rated under diagnostic code 7504. VA does not use a separate rating formula for this condition. Instead, VA rates it as either renal dysfunction or urinary tract infection, whichever is predominant. If your symptoms overlap between those two areas, only the predominant one is used. If you have distinct disabilities whose symptoms do not overlap, they may be rated separately.

Under renal dysfunction, ratings of 100%, 80%, 60%, 30%, and 0% are possible based on your glomerular filtration rate (GFR) measured over at least three consecutive months in the past year. Under urinary tract infection, a 30% rating applies if you need drainage by stent or nephrostomy tube, more than two hospitalizations per year, or continuous intensive management. A 10% rating applies for one to two hospitalizations per year or suppressive drug therapy lasting six months or longer. A 0% rating applies for recurrent infection not requiring hospitalization but requiring suppressive drug therapy for less than six months. If your urinary tract infection has caused poor renal function, VA rates that as renal dysfunction.

Evidence that helps

For renal dysfunction ratings, laboratory records showing GFR, estimated GFR (eGFR), or creatinine-based GFR calculations are central. VA accepts these when calculated by a medical professional. Records should document values measured at least three consecutive months during the past 12 months. Results showing RBC casts, WBC casts, granular casts, structural kidney abnormalities, or an albumin-to-creatinine ratio of 30 mg/g or higher are relevant to the 0% level.

For urinary tract infection ratings, hospital admission records showing how many times per year you were hospitalized for infection matter, as do records of stent or nephrostomy tube placement, nephrostomy tube care, or documentation of continuous intensive management. Pharmacy and treatment records showing suppressive drug therapy, including how long it lasted, support the 10% and 0% levels. Statements from you or those who know you describing how frequent infections affect your work, daily activities, or ability to leave home can help show the severity and frequency of your symptoms.

Secondary conditions

Conditions that are often caused or made worse by this one. If you have any of these, they may be claimable as secondary service connection.