Gastrointestinal & Genitourinary
Nephropathy / Kidney Disease
Insight:
- Strongly related to insulin-treated diabetics of 15 years or more
First Stage is persistent proteinuria
- A UA indicating proteinuria may indicate some degree of renal dysfunction
Considerations:
- For a UA indicating proteinuria, consider additional testing
- Evaluate on a case-by-case basis to determine whether the driver is likely to experience syncope, dyspnea, collapse, or congestive heart failure
Waiting Period: The FMCSA handbook does not designate a specific waiting period for this condition
Certification Interval: The FMCSA handbook does not designate a specific certification interval for this condition
View the 2009 Medical Expert Opinions for Chronic Kidney Disease
Dialysis
Insight:
- Needed when an individual’s kidneys lose 85% to 90% of their function
Hemodialysis:
- Individual goes to a clinic for treatments multiple times a week
- Uses a machine which is sometimes called an artificial kidney
Peritoneal dialysis:
- Uses the lining of the abdomen (peritoneal membrane) to filter the blood
- Usually done daily in the home or any other clean place
- Can be done intermittently while awake or continually at night
Considerations:
- Does the driver experience symptoms pre- or post-dialysis, such as excessive fatigue, muscle cramps, hypotension, or cognitive impairment?
- Is the driver compliant with the dialysis schedule?
- Does the work schedule interfere with the dialysis schedule?
- Has treatment been shown to be adequate, effective, safe, and stable?
- Consider using the Dialysis Clearance Letter
Waiting Period: The FMCSA handbook does not designate a specific waiting period for this condition
Certification Interval: The FMCSA handbook does not designate a specific certification interval for this condition
Kidney Transplants
Insight:
- Individuals will usually return to normal lifestyle
- Anti-Rejection Medications:
- Tacrolimus (Prograf)
- Cyclosporine
- CellCept
Consider certifying they driver if:
- They have returned to full duty with no limitations
- They tolerate medications/treatment
Waiting Period: The FMCSA handbook does not designate a specific waiting period for this condition
Certification Interval: The FMCSA handbook does not designate a specific certification interval for this condition
Urinalysis (UA)
Normal Values:
- Specific gravity – 1.005 to 1.030 (avg. normal being 1.020)
- Protein – negative
- Blood – negative
- Sugar – negative
Specific Gravity:
- Decreased with chronic renal disease, excessive hydration
- Increased with diabetes, dehydration, excessive sweating, vomiting
Glucose:
- Trace amounts are normal and can be around 140mg/dl within two hours after eating
- Elevated with diabetes, hyperthyroidism, pregnancy, chronic liver disease, hypopituitarism
Protein:
- Low levels in the urine are normal
- Often the earliest sign of diabetic kidney damage
- Elevated from kidney infections and stones, renal thrombosis, diabetes, pre-eclampsia, multiple myeloma, hepatic diseases
Blood in urine can be caused by:
- Strenuous exercise
- UTI
- Kidney stones
- Blood clotting disorders
- Anticoagulant therapy
- Menstruation
Hernia
Insight:
- An inguinal hernia examination should be conducted on all males.
Considerations:
- Consider further testing if the hernia causes pain or discomfort, or if the condition suggests it might interfere with safe driving
- Do not certify the driver if they have a condition that is a danger to driving
- Do not certify the driver if a hernia repair has been recommended but not performed.
Waiting Period: No waiting period applies to this condition
Certification Interval: The FMCSA handbook does not designate a specific certification interval for this condition