Kidney stones
What the FAA's documents say about kidney stones, in plain words, with the FAA's own words one press away.
FAA term: Kidney Stone(s) (Nephrolithiasis, Renal Calculi) or Renal Colic
Short version
The FAA's table sorts it into four rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AThe most recent event or diagnosis was five or more years ago, with no symptoms or current problems, kidney function back to normal, and no ongoing treatment or surveillance needed. | Examiner issues | Examiner can issue |
| Row BA single stone that passed, less than five years ago with no complications. The table's condition for ISSUE is that the single stone passed or is in the bladder with no further problems, and imaging such as a KUB verifies no retained stones. | Examiner issues | Examiner can issue |
| Row CMultiple or retained stones with no symptoms, less than five years ago with no complications. The table's note says to use this row for incidental findings. | Worksheet | CACI |
| Row DAll others. The row names complications, symptoms, and an underlying cause for recurrent stones. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Kidney stones
- Row A · Examiner can issue
The most recent event or diagnosis was five or more years ago, with no symptoms or current problems, kidney function back to normal, and no ongoing treatment or surveillance needed. The table says ISSUE, and has the examiner summarize this history in Block 60.
Most recent event/diagnosis 5 or more years ago. No symptoms or current problems. Renal function has returned to normal. No ongoing treatment or surveillance needed. ISSUE Summarize this history in Block 60.
- Row B · Examiner can issue
A single stone that passed, less than five years ago with no complications. The table's condition for ISSUE is that the single stone passed or is in the bladder with no further problems, and imaging such as a KUB verifies no retained stones. The table says ISSUE, and has the examiner summarize this history in Block 60.
Single stone that passed Less than 5 years ago with no complications … If a single stone passed or is in the bladder with no further problems and imaging (such as a KUB) verifies no retained stones: ISSUE Summarize this history in Block 60.
- Row C · CACI
Multiple or retained stones with no symptoms, less than five years ago with no complications. The table's note says to use this row for incidental findings. The table sends the examiner to the CACI worksheet for retained kidney stones, and has the examiner annotate Block 60.
Multiple or Retained asymptomatic stone(s) Less than 5 years ago with no complications … Note: Use this for incidental findings. … See CACI worksheet Follow the CACI – Retained Kidney Stone(s) Worksheet. Annotate Block 60
- Row D · Special Issuance
All others. The row names complications, symptoms, and an underlying cause for recurrent stones. The examiner defers and submits the information to the FAA for a possible Special Issuance.
All others Complications Symptomatic Underlying cause for recurrent stones … DEFER Submit the information to the FAA for a possible Special Issuance.
- A note on the table, 1
The table lists what complications include, in its own terms.
Complications include: Hydronephrosis (chronic). Metabolic/underlying condition requiring treatment/surveillance/monitoring Procedures (3 or more for kidney stones within the last 5 years) Renal failure or obstruction (acute or chronic). Sepsis or recurrent urinary tract infections due to stones
- A note on the table, 2
The table says metabolic evaluations and imaging should be performed as clinically indicated by the treating physician, and that acceptable imaging includes a KUB, an ultrasound, an IVP, or CT or MRI as clinically appropriate per the treating physician.
Metabolic evaluations and imaging should be performed as clinically indicated by the treating physician. Acceptable imaging includes KUB, ultrasound, IVP, or CT/MRI as clinically appropriate per the treating physician.
The FAA pathways for kidney stones
- How this pathway works: Examiner can issueNo special pathwayRow A
- How this pathway works: CACIConditions AMEs Can IssueRow C
- How this pathway works: Special IssuanceAuthorization for Special Issuance of a Medical CertificateRow D
- How this pathway works: AASIAME Assisted Special IssuanceAfter the FAA decides
Which exam
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: The progress note from the treating doctor or specialist
The note the examiner reviews, and what it verifies.Within 90 days before the examOne question insideA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
It verifies
- No symptoms
- Stable: no increase in the number or size of the stones
- Unlikely to cause a sudden incapacitating event
No history of complications
- Not: Chronic hydronephrosis
- Not: A metabolic or underlying condition
- Not: 3 or more procedures in the last 5 years
- Not: Renal failure or obstruction
- Not: Sepsis
- Not: Recurrent urinary tract infections (UTIs) due to stones
After surgery
- Off pain medication
- A full recovery
- A full release from the surgeon
Show the FAA's words: The progress note from the treating doctor or specialist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is: Asymptomatic;
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is:
Stable (no increase in number or size of stones);
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is:
Unlikely to cause a sudden incapacitating event;
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is:
No history of complications (including chronic hydronephrosis; metabolic/underlying condition; procedures (3 or more in the last 5 years); renal failure or obstruction; sepsis; or recurrent UTIs due to stones.)
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is:
If surgery has been performed, the airman: Is off pain medication(s); Has made a full recovery; and Has a full release from the surgeon;
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
Step 2: The worksheet's criteria
Your current or recommended treatment, causes of recurrence, and a single stone event.No current or recommended treatment. Supportive treatment to decrease recurrence is allowed, with no side effects.
Supportive treatment allowed
- Hydration
- Medications such as thiazides, allopurinol or potassium citrate
The worksheet's other criteria
- No underlying cause for stone recurrence
After a single stone event
If follow-up imaging shows no further stones, your AME notes it on the exam form (Block 60), and no further follow-up is required unless there is a change in condition.
Show the FAA's words: The worksheet's criteria
Current or recommended treatment
[ ] None
Supportive treatments such as hydration or medications (such as thiazides, allopurinol, or potassium citrate) to decrease recurrence (with no side effects) are allowed.
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA
Is there an underlying cause for stone recurrence? [ ] No
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
After a single stone event - if follow up imaging verifies no further stone(s) present, annotate this in Block 60. No further follow up is required unless there is a change in condition.
FAA source: CACI – Retained Kidney Stone(s) Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The table says ISSUE, and has the examiner summarize this history in Block 60.
Row BExaminer issuesExaminer can issue
The table says ISSUE, and has the examiner summarize this history in Block 60.
Row CWorksheetCACI
The table sends the examiner to the CACI worksheet for retained kidney stones, and has the examiner annotate Block 60.
Row DDefers to the FAASpecial Issuance
The examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
The most recent event or diagnosis was five or more years ago, with no symptoms or current problems, kidney function back to normal, and no ongoing treatment or surveillance needed. The table says ISSUE, and has the examiner summarize this history in Block 60.
Most recent event/diagnosis 5 or more years ago. No symptoms or current problems. Renal function has returned to normal. No ongoing treatment or surveillance needed. ISSUE Summarize this history in Block 60.
- Row B · Examiner can issue
A single stone that passed, less than five years ago with no complications. The table's condition for ISSUE is that the single stone passed or is in the bladder with no further problems, and imaging such as a KUB verifies no retained stones. The table says ISSUE, and has the examiner summarize this history in Block 60.
Single stone that passed Less than 5 years ago with no complications … If a single stone passed or is in the bladder with no further problems and imaging (such as a KUB) verifies no retained stones: ISSUE Summarize this history in Block 60.
- Row C · CACI
Multiple or retained stones with no symptoms, less than five years ago with no complications. The table's note says to use this row for incidental findings. The table sends the examiner to the CACI worksheet for retained kidney stones, and has the examiner annotate Block 60.
Multiple or Retained asymptomatic stone(s) Less than 5 years ago with no complications … Note: Use this for incidental findings. … See CACI worksheet Follow the CACI – Retained Kidney Stone(s) Worksheet. Annotate Block 60
- Row D · Special Issuance
All others. The row names complications, symptoms, and an underlying cause for recurrent stones. The examiner defers and submits the information to the FAA for a possible Special Issuance.
All others Complications Symptomatic Underlying cause for recurrent stones … DEFER Submit the information to the FAA for a possible Special Issuance.
The CACI worksheet's criteria
Progress note
It verifies
- No symptoms
- Stable: no increase in the number or size of the stones
- Unlikely to cause a sudden incapacitating event
No history of complications
- Not: Chronic hydronephrosis
- Not: A metabolic or underlying condition
- Not: 3 or more procedures in the last 5 years
- Not: Renal failure or obstruction
- Not: Sepsis
- Not: Recurrent urinary tract infections (UTIs) due to stones
After surgery
- Off pain medication
- A full recovery
- A full release from the surgeon
Your current or recommended treatment for kidney stones
Supportive treatment allowed
- Hydration
- Medications such as thiazides, allopurinol or potassium citrate
The worksheet's other criteria
- No underlying cause for stone recurrence
After a single stone event
If follow-up imaging shows no further stones, your AME notes it on the exam form (Block 60), and no further follow-up is required unless there is a change in condition.
Show the FAA's words: the CACI worksheet's criteria for Kidney stones
- No symptoms
FAA criterion: the progress note verifies that the condition causes no symptoms.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is: Asymptomatic;
- Stable, with no increase in the number or size of the stones
FAA criterion: the progress note verifies the condition is stable, meaning no increase in the number or size of the stones.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is: … Stable (no increase in number or size of stones);
- Unlikely to cause a sudden incapacitating event
FAA criterion: the progress note verifies the condition is unlikely to cause a sudden incapacitating event.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is: … Unlikely to cause a sudden incapacitating event;
- If surgery has been performed, off pain medication, a full recovery and a full release from the surgeon
FAA criterion, where surgery has been performed: the progress note verifies the pilot is off pain medication, has made a full recovery, and has a full release from the surgeon.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is: … If surgery has been performed, the airman: Is off pain medication(s); Has made a full recovery; and Has a full release from the surgeon;
- No history of complications
FAA criterion: the progress note verifies no history of complications. The worksheet lists what that includes, in its own terms.
The treating physician's current, detailed Clinical Progress Note verifies that the condition is: … No history of complications (including chronic hydronephrosis; metabolic/underlying condition; procedures (3 or more in the last 5 years); renal failure or obstruction; sepsis; or recurrent UTIs due to stones.)
- No underlying cause for stone recurrence
FAA criterion: the worksheet asks whether there is an underlying cause for stone recurrence, and the acceptable answer on it is no.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA … Is there an underlying cause for stone recurrence? [ ] No
- Current or recommended treatment
FAA criterion: under current or recommended treatment the worksheet's box is None. The worksheet then states separately that supportive treatments such as hydration or medications to decrease recurrence (with no side effects) are allowed, and names thiazides, allopurinol and potassium citrate as examples of those medications.
Current or recommended treatment … [ ] None … Supportive treatments such as hydration or medications (such as thiazides, allopurinol, or potassium citrate) to decrease recurrence (with no side effects) are allowed.
- Imaging after a single stone event
After a single stone event, the worksheet says that where follow-up imaging verifies no further stones, the examiner annotates that in Block 60, and no further follow-up is required unless there is a change in condition.
After a single stone event - if follow up imaging verifies no further stone(s) present, annotate this in Block 60. No further follow up is required unless there is a change in condition.
If the examiner defersSpecial Issuance
The table's last row is All others. It names complications, symptoms, and an underlying cause for recurrent stones, and the table marks it DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note from a clinic visit with the treating urologist no more than 90 days before the exam, with the treatment plan and the prognosis.
- Item 2. Where an underlying cause is identified, a status report, which should include the diagnosis, the treatment plan, the prognosis and adherence to treatment for this condition.
- Item 3. A list of medications and any side effects.
- Item 4. Operative notes and the discharge summary, where there were any.
- Item 5. Copies of the imaging reports and lab results, where the treating physician has already done them.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's last row is All others. It names complications, symptoms, and an underlying cause for recurrent stones, and the table marks it DEFER.
All others Complications Symptomatic Underlying cause for recurrent stones … DEFER Submit the information to the FAA for a possible Special Issuance.
What the FAA lists to send
- Item 1
A current, detailed clinical progress note from a clinic visit with the treating urologist no more than 90 days before the exam, with the treatment plan and the prognosis.
Current, detailed Clinical Progress Note generated from a clinic visit with the treating urologist no more than 90 days before the AME exam with treatment plan and prognosis.
- Item 2
Where an underlying cause is identified, a status report, which should include the diagnosis, the treatment plan, the prognosis and adherence to treatment for this condition.
If underlying cause is identified, the status report should include diagnosis, treatment plan, prognosis and adherence to treatment for this condition;
- Item 3
A list of medications and any side effects.
List of medications and side effects (if any);
- Item 4
Operative notes and the discharge summary, where there were any.
Operative notes and discharge summary (if applicable);and
- Item 5
Copies of the imaging reports and lab results, where the treating physician has already done them.
Copies of imaging reports and lab (if already performed by treating physician)
After the FAA decides
AASIThe FAA publishes an AASI for this condition under the name Renal Calculi, which the table's own title gives: examiners may reissue under the provisions of an Authorization where the applicant provides what it lists.
Show the FAA's words: after the FAA decides
AME Assisted - All Classes - Renal Calculi … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
KIDNEY STONE(S) … (NEPHROLITHIASIS, RENAL CALCULI)
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.
Under an FAA Authorization, the table says later certificates follow the pilot's own Authorization letter.
Show the FAA's words: at later exams
Follow up Issuance Will be per the airman's authorization letter
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI's list for a reissue includes the Authorization the FAA granted.
Show the FAA's words: The Authorization granted by the FAA
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA;
A statement about the retained stone or stones
The AASI asks for a statement from the treating physician about where the retained stone or stones are, an estimate of size, and the likelihood of the stone becoming symptomatic.
Show the FAA's words: A statement about the retained stone or stones
A statement from your treating physician regarding the location of the retained stone(s), estimation as to size of stone, and likelihood of becoming symptomatic; and
Imaging and a metabolic work-up
The AASI asks for a current report of an appropriate imaging study, naming an IVP, a KUB, an ultrasound or a spiral CT scan, and a metabolic work-up, both performed within the last 90 days.
Show the FAA's words: Imaging and a metabolic work-up
A current report of appropriate imaging study (IVP, KUB, Ultrasound, or Spiral CT Scan) and provide a metabolic work-up, both performed within last 90 days.
What the Authorization letter comes with
The AASI says the Authorization letter comes with attachments that specify the information the treating doctors must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI says the examiner must defer to the AMCD or Region if the treating physician comments that the current stone has a likelihood of becoming symptomatic, if the retained stone or stones have moved when compared to previous evaluations, or if the stone or stones have become larger when compared to previous evaluations.
Show the FAA's words: When the examiner defers a reissue
The Examiner must defer to the AMCD or Region if: … If the treating physician comments that the current stone has a likelihood of becoming symptomatic; … If the retained stone(s) has moved when compared to previous evaluations; or … If the stone(s) has become larger when compared to previous evaluations.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
One passed stone with no complications
A single stone that passed less than five years ago with no complications has its own row. The table marks it ISSUE if the stone passed or is in the bladder with no further problems and imaging verifies no retained stones.
Show the FAA's words: good to know, 2
Single stone that passed Less than 5 years ago with no complications … If a single stone passed or is in the bladder with no further problems and imaging (such as a KUB) verifies no retained stones: ISSUE Summarize this history in Block 60.
Incidental stones use the CACI row
The table's note says to use the CACI worksheet row -- multiple or retained stones with no symptoms, less than five years ago with no complications -- for incidental findings.
Show the FAA's words: good to know, 3
Multiple or Retained asymptomatic stone(s) Less than 5 years ago with no complications … Note: Use this for incidental findings. … See CACI worksheet Follow the CACI – Retained Kidney Stone(s) Worksheet. Annotate Block 60
Three or more procedures is a complication
The table lists three or more procedures for kidney stones within the last five years as a complication, and complications fall in its All others row, marked DEFER.
Show the FAA's words: good to know, 4
Procedures (3 or more for kidney stones within the last 5 years) … All others Complications Symptomatic Underlying cause for recurrent stones … DEFER Submit the information to the FAA for a possible Special Issuance.
The first AASI is deferred to the FAA
When this is a first-time application for this AASI and the applicant has all the requisite medical information for a determination, the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Show the FAA's words: good to know, 5
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – Retained Kidney Stone(s) Worksheet, a PDF at the FAA, in a new tab
- AME Assisted Special Issuance, All Classes – Renal CalculiOpen to print: AME Assisted Special Issuance, All Classes – Renal Calculi, a page at the FAA, in a new tab
The sheet the examiner follows to reissue under an FAA Authorization.
AASI
- Retained Kidney Stone(s) Disposition TableOpen to print: Retained Kidney Stone(s) Disposition Table, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
Medication guidance
Medications Crosscheck lists as taken for kidney stones, each with its own page on what published FAA guidance says about it.
- Supportive treatment to decrease kidney stone recurrence
- Supportive treatment to decrease kidney stone recurrence
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.