Answers for Pilots: Kidney Stones

If you’ve ever had a kidney stone, you know the pain can be sudden, intense, and incapacitating. While there’s no guaranteed way to prevent kidney stones, staying well hydrated can help minimize their likelihood. Though dehydration can be a problem throughout the year, summer is a particular challenge. As temperatures and humidity climb and you become more active outdoors, it’s important to increase the amount of water you drink. While kidney stones are fairly common, and a history of a single stone can have little impact on your next medical, a second or subsequent stone requires a special issuance medical certificate.

Here are the details: The FAA allows for recertification following the diagnosis and successful treatment of kidney stones. If you are reporting them on your medical application for the first time, you will need to provide the aviation medical examiner the following two reports from your treating physician (usually a urologist):

1. A summary of your history of stones, including the date of diagnosis, a metabolic evaluation, method of treatment, current status, and prognosis for recurrence. Determining factors include the site and location of the stones, any complications such as blood in the urine, repeated bouts of kidney infection, or the need for therapy. Any underlying disease will be considered. The likelihood of sudden incapacitating symptoms is a primary concern.
2. A report of any one of these recent tests (within 90 days): Spiral CT, ultrasound, KUB, sonogram, or IVP. If this is the first occurrence and if the reports confirm the absence of stones, and there are no other complications, the medical examiner may issue the certificate in the office.

However, a retained stone or a history of recurring stones is disqualifying and the AME should defer the application to the FAA for a decision. Recertification with a retained stone may be possible if there is reasonable evidence that the stone is not likely to move. Depending upon the size and chemical makeup of the stone, any movement can result in rapid and potentially incapacitating pain. Your urologist should provide a written opinion as to the likelihood for incapacitation.

After initial certification by FAA staff doctors, subsequent renewals qualify for AME Assisted Special Issuance (AASI). This allows the medical examiner to issue an airman medical certificate after the FAA has conducted the initial review of the medical records. The AASI form is online here.