Update to NASA's Clinical Practice Guideline for Renal Stone Surveillance in U.S. Astronauts

BACKGROUND: For the past 9 years all NASA astronauts received specialized renal ultrasound screening for precursors to renal stones, our so called “mineralized renal material” (MRM), to reduce the possibility of sending a person to space with a renal stone that could cause morbidity and threaten mission objectives. A recent analysis of this data shows no increased incidence of clinical or sub-clinical renal stones associated with spaceflight; thus, our clinical practice guideline has been updated.

OVERVIEW: Astronauts previously received a renal ultrasound screening at selection and at every annual recertification exam. In total, 73 individuals have been scanned and 282 total studies have been performed as of April 2023.This data shows no observed statistical change seen in MRM burden pre-to postflight, therefore a reduction in the frequency of the screening exams is appropriate.

DISCUSSION: Data presented in this panel have shown no direct correlation between spaceflight and development of MRM or renal stones in astronaut kidneys out to at least 6 months of spaceflight. The MRM burden does not seem to change appreciably over time and so far, has no demonstrated correlation to external factors. Therefore, we find it appropriate, in lieu of yearly exams, to reduce the frequency of screening to: initial selection, first annual exam after selection, and pre/postflight. This balances the screening frequency of our astronauts, against the potential for unnecessary medical procedures, while still serving the purpose of risk reduction.