Trace proteinuria, now FAA wants information

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Michael Uleski

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I got caught up in a mess this spring when my AME had legal issues and it required a new medical in 60 days. I was considerably overweight (not outside of the 40bmi, but closer than I cared for) and I wanted to do something about it before my appointment. I started a pretty strenuous diet and exercise plan a few weeks before the appointment. I lost a good bit of weight (23 pounds) prior to my appointment.

Of course the topic of OSA came up but the AME did not think it would be an issue. He did mention that there were trace amounts of protein in my urine, but he believed it was most likely due to my exercise regimen (I did a six mile run/walk just before my appointment), and to mention it to my PCP to have checked again in the future.

Today I got a letter again from the FAA that they require additional information related to a current urological history and clinical treating physician relating to the treatment and history of the condition.

I have not had to go to the Dr. in quite a while so I do not have a treating physician, and also no history of the issue. I have no symptoms, no signs of pre-diabetes or diabetes.

I am currently down 50 pounds now and continuing my diet and exercise plan with a 1500 cal per day diet with weight training and a daily 6 mile run/walk.

What would be the best course of action to have this corrected? My wife recently started with a new PCP and I was going to do the same when required, but do I need to be referred to a urologist?
 
1. Congratulations and continued success on your weight loss.

2. You really should have a PCP that you see at least once a year whether you think you need it or not. It’s not just the plane that needs an annual inspection.

3. If you want to fly, doing what the FAA says is not optional.

4. PCP first. They can run a panel of tests so a specialist such as a urologist might not be required.

5. Good luck.
 
As a retired Nephrologist I can assure you that trace proteinuria as an isolated finding is of no concern, and I’m astounded the FAA is addressing it.
Would suggest returning to your AME for a repeat after at least 24hrs of no strenuous activity, ad lib hydration, and no intercurrent illnesses/developments.
Would avoid a PCP evaluation - no telling where that would lead (in my experience, nowhere good)
IF your AME (or the FAA) insists on further evaluation then a clearance by a Nephrologist (not urologist) would be in order.
 
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wrbix said:
As a retired Nephrologist I can assure you that trace proteinuria as an isolated finding is of no concern, and I’m astounded the FAA is addressing it.
Would suggest returning to your AME for a repeat after at least 24hrs of no strenuous activity, ad lib hydration, and no intercurrent illnesses/developments.
Would avoid a PCP evaluation - no telling where that would lead (in my experience, nowhere good)
IF your AME (or the FAA) insists on further evaluation then a clearance by a Nephrologist (not urologist) would be in order.
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I sent him an email to see if he would be able to provide the actual test strip result, but I do not know if he will be able to provide that information or if I have to request my records through OK City. I only have 60 days though, so time is not on my side.

I want to make sure I am not moving forward on a path that turns what seems to be a minor, and most likely transient issue into something more because of the way it is handled.

I was going to get some home urine test strips that have a protein component to see if I can get a baseline before moving forward. Would you recommend this? Or any certain type of strip that would be best, or most accurate?

Thank you for the information. I was more worried about weight issues and never thought that by working on that it would effect something else in a negative way.
 
I don’t think that self interpreting trace proteinuria would in any way help your case. I would initiate a discussion w your AME to see if he/she could resubmit a negative result.
Re your weight issues - there is an association between proteinuria and obesity but don’t think that’s really relevant here - again, I’m astounded anyone at the FAA is raising trace proteinuria as a concern....possible we are miscommunicating here?
 
Guide for Aviation Medical Examiners

Decision Considerations - Aerospace Medical Dispositions
Item 57. Urine Test
Glycosuria or proteinuria is cause for deferral of medical certificate issuance until additional studies determine the status of the endocrine and/or urinary systems. If the glycosuria has been determined not to be due to carbohydrate intolerance, the Examiner may issue the certificate. Trace or 1+ proteinuria in the absence of a history of renal disease is not cause for denial.

The Examiner may request additional urinary tests when they are indicated by history or examination. These should be reported on FAA Form 8500-8 or attached to the form as an addendum.
 
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After he saw the results he mention that my urine was positive for protein, only a trace amount, but to mention it to my PCP just as a heads up as he could not provide any diagnosis as to why.

He emailed me back and is going to send me the result submitted when he gets back to his office this week.

I was going to get the home test strips just to get an idea if there is an issue before going to my PCP.
 
Many years ago I had trace amounts of protein in the urine test as a result of having had sex the night before the exam. AME noted such, was never an issue.
 
wrbix said:
Guide for Aviation Medical Examiners

Decision Considerations - Aerospace Medical Dispositions
Item 57. Urine Test
Glycosuria or proteinuria is cause for deferral of medical certificate issuance until additional studies determine the status of the endocrine and/or urinary systems. If the glycosuria has been determined not to be due to carbohydrate intolerance, the Examiner may issue the certificate. Trace or 1+ proteinuria in the absence of a history of renal disease is not cause for denial.

The Examiner may request additional urinary tests when they are indicated by history or examination. These should be reported on FAA Form 8500-8 or attached to the form as an addendum.
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This is what has me confused, he issued my certificate (3rd class) and never mentioned anything further about deferral, just to mention it to my PCP to see if it was transient due to my recent exercise and associated dehydration (had to lose some pounds somehow...).

I plan on waiting to see what he submitted to the FAA that started this before moving to the next step.
 
Now I’m really confused.....AME issued your medical, but now FAA wants clarification of trace proteinuria?
Makes no sense to me.
Please let us know if/when you get clarification.

Could some mention of kidney stones or other UROLOGICAL disorder have appeared in your history?
 
wrbix said:
Now I’m really confused.....AME issued your medical, but now FAA wants clarification of trace proteinuria?
Makes no sense to me.
Please let us know if/when you get clarification.

Could some mention of kidney stones or other UROLOGICAL disorder have appeared in your history?
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None. No history of any issues, nothing even mentioned, discussed, or noted on my application or during the exam. Only the urine test during the appointment.
 
I can assure you that trace proteinuria is completely permissible. So I am wondering if the problem is at Dr. Kurrle's end or where the difficulty lies. I would simply go back and test again, "trace, OR negative...."
 
bbchien said:
I can assure you that trace proteinuria is completely permissible. So I am wondering if the problem is at Dr. Kurrle's end or where the difficulty lies. I would simply go back and test again, "trace, OR negative...."
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Am I correct that going by the information provided by wrbix that the result had to have been “trace or 1+”, otherwise he would have deferred the issuance that day?

I did go back to the same practice that is now being run by Dr. Sherman. I’m starting to feel like a pawn being used for other reasons by the FAA...
 
Michael Uleski said:
Am I correct that going by the information provided by wrbix that the result had to have been “trace or 1+”, otherwise he would have deferred the issuance that day?

I did go back to the same practice that is now being run by Dr. Sherman. I’m starting to feel like a pawn being used for other reasons by the FAA...
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Trace or negative. 1+ requires detailed "workup".
 
bbchien said:
Trace or negative. 1+ requires detailed "workup".
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What is required with the detailed "workup"? Is this something he is able to do or would I need to look for my PCP or specialist for that? And again, no history or symptoms so I would be starting from scratch.
 
bbchien said:
See prior post @ 1:59 AM. If you continue to be positive, get to a nephrologist.
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Will do. I bought some 10test strips off of Amazon that came in today. Results for protein on 2 different strips was definitively negative (not even trace) and all other parameters looked to be in check. I know it isn't conclusive by any stretch, but made me feel better about the situation.

Also, my wife reminded me that we had, uh...relations... that afternoon as I had to work night shift after my medical appointment and we had been trying for #2. Plus a 1 hour run in the Florida heat 2 hours before my appointment. Seems I may have set myself up for this one, but I had no clue these would have caused any downstream issues for an FAA medical.

I am going to do a few more dip stick checks and contact my AME to see if he would be willing to redo the test in the office and clear this issue up before I would have to contact a doctor.

Thank you for the advice so far everyone. Hopefully this will turn into nothing more than updating the FAA with a new test result.
 
You wrote 3 or 4 times that the AME suggested follow up to determine if there was an issue. Did you do that? He may have been anticipating the FAA asking for that.
 
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Lindberg said:
You wrote 3 or 4 times that the AME suggested follow up to determine if there was an issue. Did you do that? He may have been anticipating the FAA asking for that.
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I spoke with him today. He mentioned the result during the exam only to give heads up for my PCP to double check during my next physical for my health insurance this fall, not that he believed it was an issue, or would be an issue with the FAA.

He checked my record and the test was submitted as a 1+. He told me to come back in tomorrow to retest.

Dr. Bruce, he was unsure if a retested/resubmitted negative result would satisfy the FAA. Do I still need to schedule a full workup with a “treating physician” since the initial result was 1+, even if the retest is negative or trace?

Thank you in advance.
 
There are so many variables. I, too, had a trace of protein show up in one test years ago, but thankfully my provider was savvy enough to ask me about recent sexual activity. Turns out, it also influences PSA readings, as does strenuous workouts or other severe-ish physical activity. I'm a pretty active guy (in all respects... ;)) ... and my PCP was concerned about an elevated PSA reading a few years ago... a bit over 5. Sent me to a urologist who got a reading of 4.6. I asked about possible causes, was told about sexual or strenuous activity, so I took it easy for a couple days and retested. 2.8 . So.....remember these tests are snapshots. Context is EVERYTHING.
 
Michael Uleski said:
...He checked my record and the test was submitted as a 1+. He told me to come back in tomorrow to retest...
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Abstain tonight, take it easy, and drink a bunch glasses of water for a few hours before you go in for the retest.
 
Went back today and tested negative. AME called the FAA in Oklahoma and of course no one was available, but he told them he did not see a reason to move forward on any other testing requirements. Now I just wait to see what they decide.

Related to this, and anyone else that can use the information. I did a bit of a science project yesterday. All morning dip stick tests were negative for proteinuria, ate and drank normally for the day. At 4 I went for my daily walk/run, 6.38 miles. Came home, drank 24oz, got a shower, drank some more. Tested again approximately 2 hours after my run and sure enough, 1+ positive. Continued testing that evening and it took 4 more hours for the result to return to trace, and another 2 hours to return to a negative reading. So, lesson learned, don't work out before your physical. Hopefully the FAA sees the logic in this as well and no further action is required.

Thank you all for the advice.
 
Michael Uleski said:
Went back today and tested negative. AME called the FAA in Oklahoma and of course no one was available, but he told them he did not see a reason to move forward on any other testing requirements. Now I just wait to see what they decide.

Related to this, and anyone else that can use the information. I did a bit of a science project yesterday. All morning dip stick tests were negative for proteinuria, ate and drank normally for the day. At 4 I went for my daily walk/run, 6.38 miles. Came home, drank 24oz, got a shower, drank some more. Tested again approximately 2 hours after my run and sure enough, 1+ positive. Continued testing that evening and it took 4 more hours for the result to return to trace, and another 2 hours to return to a negative reading. So, lesson learned, don't work out before your physical. Hopefully the FAA sees the logic in this as well and no further action is required.

Thank you all for the advice.
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Yep, exertion and physical “jostling” of the kidneys can transiently turn urinalysis positive - both for protein and also occasionally for microscopic hematuria.
 
Just a quick update:

After a few hours on hold my AME got through to Oklahoma City and advised them of the retest results, the probable reason for the previous 1+ result, and his opinion that any further testing would be unnecessary.

Finally got a letter today from the FAA to disregard the previous request regarding the workup and restore my full eligibility.

So...lesson learned, don't workout directly before the FAA medical.

Thanks all for the advice.
 
Michael Uleski said:
...
So...lesson learned, don't workout directly before the FAA medical.
..
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Or, to extrapolate further... exercise is just not good for you. Work out, you get protein in your urine. Run, you blow out your knees. Lift weights improperly, you hurt your back or end up with pinched nerves. Swim... ear infections, and maybe eye problems. Exercise sucks. ;)
 
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