Review of the Natural History of Renal Stones in U.S. Astronauts

BACKGROUND: The formation of renal stones in astronauts may pose a considerable threat to crew health and to the completion of mission objectives. Although a history of prior renal stones is an exclusion criterion for initial selection, there have been reported cases of renal stones that have developed after selection. This led to the establishment, nine years ago, of a standardized protocol to screen for the development of renal stones pre-and post-spaceflight in all active astronauts.

OVERVIEW: Literature regarding stone makeup, size, location, time to passage, and outcomes were reviewed, as well as incidence of renal stones in astronaut analog populations such as military pilots and the general population. The Lifetime Surveillance of Astronaut Health (LSAH) database was queried and as of 2015 there have been 22 crew members who have reported 36 renal stone events from a population of 357 astronauts, with an incidence of 0.32 events per year. This compares favorably to the incidence of 0.37 to 0.46events per year in commercial pilots.

DISCUSSION: The physiologic changes associated with spaceflight have been thought to present an increased risk for the development of stones, including hypercalciuria, decreased urine pH, and reduced urine volume. NASA’s screening program, based on a rigorous ultrasound method, has now provided nine years of clinical data used to reduce the risk of flying an astronaut with a renal stone that could threaten health and mission objectives. This work and data from the ultrasound screening program was used to update the clinical practice guideline for renal stone surveillance and treatment, and other NASA documents and programs that track this risk.