Polycystic Kidney Disease

[Buddy Spike]

Couldn't find anything via search.

I was diagnosed with Stage 1 Polycystic Kidney Disease earlier this week. My kidney function is normal and my blood pressure is good, but I have over a dozen cysts in and on both kidneys.

I discovered it during a BFM flight (pain) and it got worse a few days later, which led to the CT Scan and ultimate diagnosis. I'm also in the middle of a transfer from the Navy Reserve to AF.

1) Assuming the MRI/MRA is good and I have no signs of aneurysm or neural cysts, what are my odds of continuing to fly fighters? Has anyone gone through that waiver process here? How long does it take?

2) WRT the transfer - assuming NAMI approves a waiver, would AFRC require its own waiver or can they translate the waiver and accept it?

3) If the worst should happen and the MRI/MRA shows something bad, would that be eligible for line of duty (since it was discovered on active orders and the symptoms started during flight, no previous history)? And if so, would I have to seek a medical retirement?

Obviously I don't want to go anywhere near question three, but I'm just trying to get smart on this. This entire thing really blindsided me. I had no history of kidney problems and my labs came back good.

Thanks in advance.

 

[matmacwc]

Here is the waiver guide, I'll PM you with some more info.  As far as I can tell, it is waiverable to fly but I bet that might take some time.

wiaver guide.pdf

[deaddebate]

If you're flying the same or similar airframe/platform, you'll need to pass AF FCII standards IAW AFI 48-123 para 6.24.7.1.  Yes, you will need a separate AF Waiver.  The condition is listed in the AF waiver Guide under "Kidney Disease, Chronic."  Thankfully, the FCII waiver is very achievable.

For FCII and Trained, Kidney Disease stages 1-3 are waive-able and all exams can be accomplished locally, Stage 4 requires a TDY to WPAFB (ACS) and waiver is unlikely.  Stage 5 is not waive-able.  You will need a recent Nephrology consult.

Contact your Navy FS and coordinate with an AF FS to discuss the AF-approved Hypertension and Pain medications available to you, and make sure you are taking the right meds.  You need to demonstrate control on these medications for the waiver to pass.  The list is known as the "Official Air Force Aerospace Medicine Approved Medications," last updated on 30 May 2015.

Separate of all this is the (non-flying) Accession/Retention standard for the Air Force.  I believe you are very lucky that you are currently serving, and you must not have a break in service in your conversion to the AF.  AFI 48-123 para 4.2.1. would not apply to you because you are already Commissioned.  Therefore, DODI 6130.03 (Accession) does not apply, just the normal retention standard of the Medical Standards Directory, which states:

J11 - Cystic kidney (polycystic kidney), when renal function is impaired, or when ongoing specialty f/u more than annually is required.

Because you are well controlled and at the earliest stages, I think you might get away with not needing an MEB also.  Either way, your Recruiter will probably need to push a waiver for you and it will similarly probably be approved.  Get your gaining unit to write a nice memorandum of support, including some statement of needing Pilots to meet mission requirements and that you are excellently qualified among their applicants.  Those letters do help.

If unfortunately your condition and prognosis is poor, you MUST get any LOD benefits through the Navy.  The Air Force Reserve would deny your LOD because the Navy owned you at the time of diagnosis and development.  Are you AD Navy or Reserve Navy?

Finally, I looked for similar cases in the AF flying waiver system and your chances are very good.

[Buddy Spike]

If unfortunately your condition and prognosis is poor, you MUST get any LOD benefits through the Navy.  The Air Force Reserve would deny your LOD because the Navy owned you at the time of diagnosis and development.  Are you AD Navy or Reserve Navy?

 

Finally, I looked for similar cases in the AF flying waiver system and your chances are very good.

Great information, thank you! I am currently Navy Reserve, but I was on orders when the diagnosis happened.

I'm up for ultrasound, MRI, MRA on Wednesday. Do you know what the waiver process is if it shows any intracranial cysts? Does that make it a whole new ball game?

Thanks again. This is great information.

[deaddebate]

After reading more about the condition, I realized you're actually referencing autosomal dominant polycystic kidney disease (ADPKD).  I thought you had a generic cystic kidney disease rather than the genetic disorder.  Waiver approval is very good if you are otherwise healthy (with hypertension as a known co-morbidity and necessary treatment).  The information from my previous post remains relevant and accurate, other than as follows as outlined under "Congential Urinary Anomalies":  You may also see a Urologist in addition to a nephrologist.  Any history of kidney stones or chronic UTIs must be very carefully scrutinized.

If you have intracranial cysts as a complication of the ADPKD, that would probably be concurrently considered as a separate condition related to "Subarachnoid Hemorrhage, Non-Traumatic."  You would likely need a Neuro consult and associated additional testing, and be referred to ACS at WPAFB for further consideration.

[Buddy Spike]

Thanks for the clarification.

I found the NAMI waiver guide and it says:

AEROMEDICAL CONCERNS

:

Polycystic disease may be associated with hypertension, berry

aneurysms of the cerebral arteries, renal stones, infection or hematuria. Simple retention cysts in the

renal cortex may be susceptible to trauma. Medullary sponge kidneys can be associated with hematuria

and formation of calculi. Large polycystic kidneys are not compatible with high performance flying

because G forces cause the kidney to pull on the pedicle that may result in bleeding.

WAIVER:

A waiver is considered

if renal function is normal and the aviator remains asymptomatic.

INFORMATION REQUIRED

:

1.Nephrology consultation is required, together with confirmation by CT scan or MRI that there is no

coexisting berry aneurysm.

2.Annual submission with 24 hour urine collection for determination of creatinine clearance is

required.

Emphasis mine. Does that mean they will consider a waiver for all flying, or just non high performance flying? Will the AF be the same? 

Also, what is considered "asymptomatic"? Kidney pain kicked off this whole thing. Is that a symptom or are they referring to renal function and hypertension?

[deaddebate]

I got a bit more information from discussion with some peers, and I should retract my optimism.  Assuming the Navy would not give you a waiver because you are not asymptomatic due to the pain, your chances of staying in fighters in the Air Force are diminished.  You also almost certainly will need an MEB/Fitness For Duty, either before you leave the Navy or as soon as you arrive in the AF.  Your best chance is probably to pursue RPA.  Whether the Navy would consider you for non-high performance airframes is a question for your Navy FS.

Edited September 23, 2015 by deaddebate

[Buddy Spike]

Thanks for the info!

The MRA and ultrasound came back negative for aneurysms and kidney stones respectively. We're going to start the waiver process this week.

My Navy FS did say that he talked to his AF counterpart and he said that even if the Navy issues the waiver, the AF side is far less likely. Does that jive with your discussion with your peers? My FS pointed out that NAMI could be a bit more lenient since I'm already on flying status in the Navy Reserve.

 

Thanks again

[deaddebate]

words

That seems right, but it's too speculative. You won't know until you officially ask the question in the form of a waiver request to the AF. I'm still very pessimistic, unfortunately.

[Buddy Spike]

Navy waiver was denied this week and recommended Medical Retention Review Board. It did hint to the possibility of considering an appeal pending the results of the MRR. The fight continues.