Statement of Principles concerning nephrolithiasis No. 178 of 1995 (Cth)

Instrument No.178 of 1995

Statement of Principles

concerning

NEPHROLITHIASIS

ICD CODE: 274.11, 592.0

Veterans’ Entitlements Act 1986
subsection 196B(2)

1.         Being of the view that there is sound medical-scientific evidence that indicates that nephrolithiasis and death from nephrolithiasis can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans’ Entitlements Act1986 (the Act), that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting nephrolithiasis or death from nephrolithiasis with the circumstances of that service, are:

(a)       being a prisoner of war of the Japanese before the clinical onset of signs or symptoms of nephrolithiasis; or

(b)       suffering from hypercalciuria before the clinical onset of signs or symptoms of nephrolithiasis; or

(c)       suffering from hyperuricaemia before the clinical onset of signs or symptoms of nephrolithiasis; or

(d)       suffering from hypercalcaemia before the clinical onset of signs or symptoms of nephrolithiasis; or

(e)       suffering from hyperuricosuria before the clinical onset of signs or symptoms of nephrolithiasis; or

(f)        suffering from hyperoxaluria before the clinical onset of signs or symptoms of nephrolithiasis; or

(g)       suffering from Type 1 renal tubular acidosis before the clinical onset of signs or symptoms of nephrolithiasis; or

(h)       suffering from cystinuria before the clinical onset of signs or symptoms of nephrolithiasis; or

(j)        suffering from a urinary tract infection involving the bacterial enzyme urease before the clinical onset of signs or symptoms of nephrolithiasis; or

(k)       suffering from caliceal diverticulum before the clinical onset of signs or symptoms of nephrolithiasis; or

(m)      suffering from an ureteropelvic junction obstruction before the clinical onset of signs or symptoms of nephrolithiasis; or

(n)       suffering from a retrocaval ureter before the clinical onset of signs or symptoms of nephrolithiasis; or

(o)       suffering from horseshoe kidney before the clinical onset of signs or symptoms of nephrolithiasis; or

(p)       suffering from an ureteral obstruction before the clinical onset of signs or symptoms of nephrolithiasis; or

(q)       undergoing an ileal resection before the clinical onset of signs or symptoms of nephrolithiasis; or

(r)        having had treatment with acetazolamide, sulphonamide or triamterene drugs, uricosuric drugs or other drugs known to play a role in calculogenesis in the urinary tract where:

(i)        the treatment occurred for at least 90 days before the clinical onset of signs or symptoms of the nephrolithiasis; and

(ii)       the clinical onset of signs or symptoms of nephrolithiasis occurred either while treatment was continuing or within 180 days after cessation of treatment; or

(s)       suffering from polycystic kidney disease before the clinical onset of signs or symptoms of nephrolithiasis; or

(t)        suffering from a urinary diversion before the clinical onset of signs or symptoms of nephrolithiasis; or

(u)       inability to obtain appropriate clinical management for nephrolithiasis.

2.         Subject to clause 3 (below) at least one of the factors set out in paragraph 1(a) to 1(u) must be related to any service rendered by a person.

3.         The factor set out in paragraph 1(u) applies only where:

(a)       the person's nephrolithiasis developed before a period, or part of a period, of service to which the factor related; and

(b)       the relationship suggested between the nephrolithiasis and the particular service of a person is a relationship set out in paragraph 8(1)(e), 9(1)(e), 70(5)(d), or 70(5A)(d) of the Act.

4.         For the purposes of this Statement of Principles:

“caliceal diverticulum” means a cystic cavity that communicates with a minor calix through a narrow neck, attracting ICD code 593.89;

“cystinuria” means a hereditary condition of persistent excessive urinary excretion of cystine and three other dibasic amino acids: lysine, ornithine and arginine, attracting ICD code 270.0;

“horseshoe kidney” means a congenital abnormality of the kidneys whereby the lower poles of normally positioned kidneys are fused, attracting ICD code 753.3;

“hypercalcaemia” generally means biochemical evidence of an elevated total serum calcium attracting ICD code 275.4;

“hypercalciuria” means an excretion of an excessive amount of calcium in the urine, attracting ICD code 275.4;

“hyperoxaluria” means an excretion of an excessive amount of oxalate in the urine, attracting ICD code 271.8;

“hyperuricaemia” means an excess of uric acid or urates in the blood, attracting ICD code 790.6;

“hyperuricosuria” means the excretion of an excessive amount of uric acid in the urine, attracting ICD code 791.9;

“ICD code” means a number assigned to a particular kind of injury or disease in the tenth edition of the International Classification of Diseases 9th Revision, effective date of 1 October 1993, copyrighted by the US Commission on Professional and Hospital Activities, and having the Library of Congress number 77-94472;

“ileal resection” means the surgical removal of the lower small intestine;

“nephrolithiasis” (also known as renal calculi) means a condition marked by the presence of kidney stones that consist of calcium salts (predominantly oxalate or phosphate), uric acid, cystine or struvite (the triple salt of magnesium, ammonium and phosphate); attracting ICD code 274.11 or 592.0;

“other drugs known to play a role in calculogenesis in the urinary tract” means one of the following drugs:

allopurinol

phenazopyridine hydrochloride

nitrofurantoin

flumequine

oxytetracycline

ditizoate

glifanan

piridoxilate;

“polycystic kidney disease” means the adult form of polycystic kidney disease being an hereditary tubular disorder of cortex and medulla of the kidneys whereby these parts of the kidneys are filled with thin walled, spherical cysts which enlarge these organs and impair their function and attracting ICD code 753.1;

“retrocaval ureter” means an entrapment of the right ureter posterior to the inferior vena cava, attracting ICD code 753.4;

“Type 1 renal tubular acidosis” means a metabolic acidosis resulting from an impairment of the distal tubules such that the kidney does not lower urine pH normally, attracting ICD code 588.8;

“ureteral obstruction” means a ureteral stricture, obstruction of the ureterovesical junction, ureteral diverticula or ureterocoeles attracting ICD code 599.6.  The ureteral obstruction may be caused by the entry of a bullet, shrapnel or surgical apparatus;

“ureteropelvic junction obstruction” means an obstruction of the ureteropelvic junction, attracting ICD code 593.3 or 593.4;

“urinary diversion” means a surgical procedure, such as ureterosigmoidostomy, or ileal conduit diversion in which the ureter is transposed from its usual position;

“urinary tract infection involving the bacterial enzyme urease” means an infection with bacteria, usually Proteus species, that possess the enzyme urease which degrades urea to ammonia and carbon dioxide.

Dated this       Twenty-fifth            day of              May          1995

The Common Seal of the    )

Repatriation Medical Authority                   )

was affixed to this instrument   )

in the presence of:   )

KEN DONALD

CHAIRMAN