Renal Calculi

Guidance for medical examiners when assessing a patient for either a general topic or condition - Renal Calculi.

Aeromedical implications 

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
    • sarcoidosis
    • obesity
    • diabetes
    • 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

New cases

  • 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
  • Management
    • treatment
    • side-effects
    • monitoring
  • Follow-up plan.

Renewal

  • Low dose CT scan as per protocol

Indicative outcomes

  • 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

Favourable

  • CT KUB: calculus-free
  • Nephroscopic clearance and visual confirmation of clearance of all calculi 

Unfavourable

  • 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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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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