Hematuria

[Guest burrito]

Hey

I was diagnosed with Benign Familial Hematuria, aka Thin-Basement-Membrane Nephropathy, years ago (I'm 18). I was tested and found that my kidneys are completely healthy. It only shows up intermittently. As far as the rest of me goes, I am healthy, and I'm not affected in any other way.

So, I just got back from my DODMERB for my ROTC scholarship, and my urine test came back with a positive on blood: 2+ and 8-12 RBC/HPF. I wasn't that surprised, but I found a list of conditions that are disqualifying for FC1, and "progressive or recurrent hematuria" is one of them. My question is, would my situation be considered disqualifying and, if it is, are there waivers available? I am healthy otherwise, and if I didn't have this on my DODMERB, I'm fairly sure it would go through without any problems (my doc said that they'll probably want more testing, but I'm not counting on getting the scholarship quite yet).

I could be worrying too much, but I'd really like to know so I can decide whether to pursue military aviation or not.

Sorry for the long post, but thanks for any help.

[Guest F16PilotMD]

This is a disqualifying condition. You will require a waiver.

Waiver Guide:

CONDITION: Hematuria

I. Overview. Gross hematuria is relatively common - one out of every 1000 visits to the emergency room is prompted by a patient’s discovery of gross hematuria. Asymptomatic microscopic hematuria is even more common, with a prevalence of 1.2% to 5.2% in young adult males and as high as 13% in community population-based studies. Hematuria itself is not necessarily aeromedically significant. Discovering the underlying process, if any, causing the hematuria is the key to a proper aeromedical disposition. Hematuria may be essentially a normal variant, or it may be a sign of life-threatening disease. In 6 major studies of microscopic hematuria, between 1% and 12.5% had a neoplastic etiology and between 3.5% and 16.5% had calculi as the etiology (Fracchia et al). Most sources recommend evaluation of microscopic hematuria of greater than 3-5 RBC/hpf. In one study of 161 aviators with asymptomatic microscopic hematuria, no evident pathology developed over a mean follow-up period of 7.6 years (Froom et al).

The differential diagnosis of asymptomatic hematuria without proteinuria or casts includes neoplasm, calculi, infection, trauma (including exercise), analgesic and sickle cell nephropathies. Bleeding into the urinary tract from a source between the urethra and the renal pelvis results in no protein, cells or casts. Hematuria at the beginning or end of the stream usually indicates a urethral or prostatic source.

The differential diagnosis of hematuria with proteinuria or casts is extensive, and includes nephron damage and many forms of glomerulonephritis.

II. Aeromedical Concerns. Hematuria by itself is unlikely to be aeromedically significant. However, this sign must be evaluated fully. Calculi can cause extreme pain, lead to urinary tract infection and obstruction. Urinary neoplasms are often slow growing but must be diagnosed and treated early to optimize survival and function. Glomerular disease must be evaluated and renal function assessed to determine proper treatment and to address worldwide deployability (e.g. renal reserve, ability to tolerate dehydration, etc.).

III. Information Required for Waiver Submission. The initial evaluation of persistent hematuria should include examination of external urethra and prostate, repeat urinalysis after discontinuing exercise, and urine cultures. BUN, creatinine CBC, and 24-hour urine for creatinine and protein should be obtained. If no etiology is determined on this initial workup, consultation with a urologist should be obtained to rule out collecting system disease. If no structural etiology is found, consultation with a nephrologist should also be obtained. Tests which may be requested by these consultants include:

IVP

renal ultrasound

cystoscopy

coagulation studies, urine cytology

CT

renal arteriography

renal biopsy

The amount of information required for waiver submission depends on the individual case. For instance, if exam, urine cultural, renal function, and blood count were normal, and the microscopic hematuria disappeared while the aviator refrained from exercise, no further workup would be required.

IV. Waiver Considerations. Waiver criteria include documentation of complete evaluation by urology and nephrology (if indicated), 24 hour urine creatinine clearance and protein, and demonstrating the absence of significant renal disease, calculi or neoplasm.

There are 223 aviators in the USAF waiver file with the diagnosis of hematuria. Of these, 119 were waivered and 4 were disqualified. The disqualifications were all for worsening of renal function (increasing proteinuria) or renal biopsy results consistent with significant renal disease.

There are 35 aviators in the Aeromedical Consultation Service database who were diagnosed with hematuria while on active duty (including ANG and AFR) since August 1991. This was the cause for grounding in 11. Of these, 10 were recommended for waiver and one was treated and returned to flying duties without waiver.

[Guest doctidy]

Bring all your documentation. Thin basement membrane nephropathy is a diagnosis of exclusion...meaning there is no test for it. We look for all the other causes and if nothing is positive, say it must be thin basement membrane nephropathy.

You'll need a waiver.

[Guest burrito]

Alright, I was pretty sure I would need a waiver..thanks for the responses.

So, provided all the military's testing comes back normal (I'm pretty confident it will), is it a relatively easy waiver to get? I can't imagine a benign kidney condition affecting my ability to function as a pilot/nav, but I'm no expert. I know that hematuria could mean some pretty bad things, and perhaps these are the things they're afraid of.

I've talked to by dad, who is an internist, and he says he consulted with a nephrologist and thats when I had all the tests done - renal ultrasound, creatinine clearance, 24-hr total protein, complement test, FANNA, and other routine blood work were done and were all normal. Would I have to be completely retested by the military or would they accept the diagnosis as written on my record?

This is an awesome resource for guys like me who can't really get definitive answers from anywhere else, and I appreciate the time you guys take to answer.

[Guest doctidy]

It'll be an easy waiver.

Some medical problems are disqualifying not because they actually affect your ability to perform the job but because they will progress and thus limit the payback from the million dollar investment the AF puts into you. ie - some "benign" kidney conditions progress to kidney failure!