Guidance for medical examiners when assessing a patient for either a general topic or condition - Renal Calculi.
Effect of aviation on condition
- Low fluid intake, especially in hot conditions
Effect of condition on aviation
- Overt incapacitation from severe pain and vomiting
- Distraction due to treatment and symptoms
- High recurrence rate of calculi
Effect of treatment on aviation
- Post-lithotripsy symptoms
Approach to medical certification
Based on the condition
- Absence of calculi in any part of the collecting system, determined by:
- low-dose CT scan
- via renoscopy `
- ultrasound ONLY acceptable for confirming clearance of ureteric stones in applicants under 35yrs with BMI 24 or less
- Identification of high risk stone-formers:
- genetic (e.g. Renal tubular acidosis), familial and early onset renal calculi
- recurrent episodes of renal colic or calculi despite preventative measures
- evidence of parenchymal calcification or Randall’s plaques.
- primary hyperparathyroidism
- gastric bypass procedures and inflammatory bowel disease
- gout with persistently acid urine.
Based on treatment
- Renoscopic confirmation of stone clearance (assuming good visualisation)
- Preventative strategies in place (fluids / allopurinol / citrate / thiazides etc)
Risk assessment protocol - information required
- Confirmed diagnosis
- Clinical status and symptoms
- Investigations conducted
- pre and post episode ultrasound and CT scan reports
- results of metabolic studies
- stone analysis if available
- Follow-up plan.
- Low dose CT scan as per protocol
- Unrestricted certification is only possible for pilots who have no stones in the collecting system
- Parenchymal calcification and Randall’s plaques are considered to increase the risk of calculus formation
- High risk stone-formers will require imaging more frequently
- CT KUB: calculus-free
- Nephroscopic clearance and visual confirmation of clearance of all calculi
- Any calculi in the collecting system (irrespective of location)
- Ureteric obstruction
- High risk stone-former where risks are not actively managed
Pilot and controller information
- Acute colic mandates grounding and must be reported to the DAME
- If CT is required, low dose CT imaging greatly reduces radiation exposure
- Any calculus passed should be submitted for laboratory analysis. This assists the specialist in advising how to reduce the risk of recurrence
- If treatment is required, the most effective method should be discussed with the specialist. Lithotripsy is associated in some circumstances with a higher need for follow-up procedures and does not guarantee clearance of calculi - a pre-requisite for certification
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The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.