2006 ICD-9 codes - 4 of 7


Mesentery pertains to epithelial cells supporting the digestive organs.

Sclerosing mesenteritis - This is an uncommon mesenteric disease with fewer than 300 cases reported. Patients most frequently report symptoms and signs of abdominal pain, abdominal mass, or symptoms related to bowel obstruction. However, many patients have no symptoms, and the disease is discovered incidentally. Likewise, laboratory tests, including imaging studies, are also considered nonspecific.

The definitive diagnosis thus requires a biopsy. The disease may present as a single mass, multiple masses, or as diffuse thickening of the mesentery. The majority of reported cases have involved the small bowel mesentery, sole involvement of the mesocolon has been well documented in approximately 20% of cases. Other rare intra-abdominal sites that have been involved are the mesoappendix, peripancreatic area, omentum, and pelvis.

Chronic Renal disease code 585 is replaced by more specific codes with six stages.

585.1 Chronic kidney disease, Stage I
585.2 Chronic kidney disease, Stage II (mild)
585.3 Chronic kidney disease, Stage III
585.4 Chronic kidney disease, Stage IV (severe)
585.5 Chronic kidney disease, Stage V
585.6 End stage renal disease
585.9 Chronic kidney disease, unspecified

First we need to consider, what do kidneys do? The kidneys:

  1. Remove toxic waste products
  2. Remove excess water and salts
  3. Play a part in controlling your blood pressure
  4. Produce erythropoietin (epo for short) which stimulates red cell production from the bone marrow - you get anemic without this
  5. Help to keep calcium and phosphate in balance for healthy bones
  6. Maintain the blood in a neutral (non-acid) state

Web links.

http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/CRFLong.html

http://www.kidney.org/professionals/kdoqi/guidelines_ckd/toc.htm

http://www.kidney.org/professionals/kdoqi/history.cfm

In the last few years a useful classification of renal failure has been developed. It is based on GFR - glomerular filtration rate. This can be measured, or predicted from age, weight, and blood tests etc.


The KDOQI stages (Kidney/Dialysis Outcomes Quality Initiative) of kidney disease are:

Stage

GFR

Description

Treatment stage

1

90+

Normal kidney function but urine or other abnormalities point to kidney disease

Observation, control of blood pressure

2

60-89

Mildly reduced kidney function, urine or other abnormalities point to kidney disease

Blood pressure control, monitoring, find out why.

3

30-59

Moderately reduced kidney function

More of the above, and probably diagnosis, if not already made.

4

15-29

Severely reduced kidney function

Planning for endstage renal failure - more info.

5

14 or less

Very severe, or endstage kidney failure (sometimes call established renal failure)

See treatment choices for endstage renal failure.

At stages 1-3 kidney disease there are generally minor symptoms and the patient may not be aware of any problem at all.

Stage 2 kidney disease is a tricky area, because normal GFR falls with age, and therefore many normal older people may fall into this category. Equations used to predict GFR (rather than real measurements) may also give falsely low results in people with near-normal function.

At stage 4 the patient feels unwell.


Despite this, at stages 1-3 you:
· Are at risk of going on to get more severe kidney disease
· Are at increased risk of getting heart disease or other illnesses affecting arteries.
It is known that you can reduce both of these risks by careful monitoring and treatment. This page includes information about this and is particularly relevant to stages 2-4.

Two "unspecified" urinary obstruction codes have been added.

599.60  Urinary obstruction, unspecified
599.69  Urinary obstruction, not elsewhere classified

          ICD-9 Test 4

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