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D Reyes

Publications and source records attributed to D Reyes.

8 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2024

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.

C McNerlin↗
NASA NTRS2024

A Specialized Ultrasound Protocol for NASA's Renal Stone Surveillance and Clinical Practice

INTRODUCTION Ample evidence exists on the effectiveness of ultrasound in the diagnosis of kidney stones. However, terrestrial practice is mostly concerned with diagnosis of clinically significant urolithiasis. Adapting this non-irradiating, low-cost imaging modality for the asymptomatic astronaut population offers high-sensitivity screening and limits their career radiation dose. METHODS NASA developed a novel ultrasound-based detection and surveillance protocol to identify, categorize, and monitor mineralized renal material (MRM) in astronauts. The term MRM was developed to denote abnormal, presumably calcified, focal material of unknown clinical significance in the kidneys. Sonographic criteria for MRMs include measurable echogenic foci, their detectability in multiple, designated imaging plains, posterior shadowing, and “twinkle” pattern visualized in Color Doppler and/or demonstrated in Spectral Doppler modes. The mere discovery of an MRM does not trigger further imaging or intervention, unless the affected crewmember is mission-assigned, or the MRM meets actionable criteria based on size, location, and sonographic characteristics. If the threshold is met, the crew surgeon is notified, and additional diagnostic imaging and urology consultation are considered. RESULTS In total, 73 individuals have been scanned using our specialized methods, 60 have had more than one study done. As of April 2023, 282 total studies have been performed. So far, over 30 pairs of pre-and postflight studies have been obtained, and the findings are presented elsewhere in this panel. DISCUSSION A surveillance program was initiated nine years ago to screen asymptomatic members of the astronaut corps for renal calcifications, from their initial hiring, through their mission timeframes, and throughout their career. The goal is to reduce the probability that an astronaut will fly with a renal stone that may become symptomatic. This also gives NASA the information it needs to improve screening criteria for future long-duration crewed missions.

H Lyons↗
NASA NTRS2024

Findings From 9 Years of Renal Stone Surveillance of U.S. Astronauts

INTRODUCTION: Renal stones are thought to be a risk for spaceflight due to urine chemistry changes, induced by microgravity. Asymptomatic stone can have significant medical and mission impact.For9 years astronauts travelling to the International Space Station (ISS) have received pre-and post-flight renal ultrasound, according to a specialized renal ultrasound protocol, to look for renal calcifications or mineralized renal material (MRM).A new ultrasound machine was put in service halfway through the screening program. METHODS: MRM screening data from pre-and post-flight were compared, to look for changes in MRM burden. Pre-and post-flight scans from 42 subjects were compared. Studies were further stratified by old versus new machine. Measures were modeled using the analysis of variance (ANOVA) as defined by the interaction between pre-to postflight, and machine-to-machine. RESULTS: There was no observed statistical change seen in MRM burden pre-to postflight using the new higher-resolution ultrasound machine. DISCUSSION: The new machine gives more precise measurements and allows us to differentiate MRMs from other bright objects seen on ultrasound, such as small blood vessels. These data imply that spaceflight does not increase the risk of renal stone formation, at least out to the length of ISS missions. This data will be used to update NASA’s Human System Risk Board’s risk tracking documents, in-flight Concept of Operations, and our Clinical Practice Guideline.

K Cortez↗
NASA NTRS2024

Evolution of Spaceflight Renal Stone Risks and Update to the NASA Human Research Program (HRP) Renal Stone Evidence Report and Integrated Concept of Operations

BACKGROUND: The NASA HRP Evidence Report on the Risk of Renal Stone Formation is being updated based on new information obtained from 9 years of data from NASA’s astronaut renal stone surveillance program. In addition, the Concept of Operations for missions beyond Low Earth Orbit (LEO) was created to supplement the Evidence Report, and the NASA clinical practice guideline(CPG)for renal stone surveillance was updated. OVERVIEW: A literature review was performed to evaluate the state of literature regarding renal stone prevention, mitigation, and management both in terrestrial and spaceflight environments. Current renal stone treatment guidelines for the ISS, which were created by the Inflight Clinical Medicine Working Group and approved by the Multilateral Medical Operations Panel (MMOP)were reviewed, as well as recent ultrasound technology demonstrations onboard the ISS. This information was used in conjunction with emerging evidence from the surveillance program to update the Evidence Report and in-flight Concept of Operations. DISCUSSION: There are known and emerging renal stone prevention strategies including astronaut selection, the use of medications and resistive exercise, early diagnosis with regular urine studies and ultrasound imaging. In-flight treatment options include pharmaceuticals, use of lithotripsy and propulsive ultrasound, placement of percutaneous drains and other modalities. This information is useful to gauge future risks and update our strategies for prevention and management of renal stones in astronauts to reduce the risk of in-flight renal stone colic that could cause morbidity and mission impact.

E Stratton↗
NASA NTRS2024

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.

D Reyes↗
NASA NTRSDate not supplied

Medical Lessons Learned from the Exploration Atmospheres Study

Background: The National Aeronautics and Space Administration’s (NASA) Exploration Atmospheres study (EA) was done to evaluate alternative cabin atmospheres for future spacecraft designs and planetary surface exploration of the Moon, Mars and beyond. Deep space exploration involves creating habitats and environments safe for human occupancy and means to explore the outside environment (extravehicular activities, EVA). In order to validate alternative atmospheres and pre-spacewalk procedures, the EA study was conducted to evaluate factors such as hypoxia risks, denitrogenation protocols, food limitations, medications, and the impact of other factors on human performance. Overview: Space travel is constrained by mass, volume, power and the cost of vehicle development, which creates tradeoffs in various capabilities, including breathing gasses. Higher atmospheric pressure in a vehicle means more gas, and a stronger containment vessel/habitat; while lower pressure requires higher oxygen partial pressure, which may increase fire risk. NASA’s EA study evaluated a proposed alternative cabin environment (8.2 psia, 34% Oxygen), for future spacecraft habitat, and planetary EVAs. EA included both a 3-day and a 11-day trial. These trials included a depressurization and saturation to 8.2psi at 34% O2 with additional depresses to 4.3 psia at 85% O2 for simulated EVAs, (1 EVA during the 3-day and 5 during the 11-day trials). Discussion: Planning for and executing the medical monitoring and response plan for a trial of this scope was a huge undertaking with no prior practice to fall back on. Food obstacles, sleeping issues, medications, joint injury, equipment limitations, medical privacy, multiple cases of decompression sickness, and even a COVID outbreak among the support team proved challenging. Conclusion: Testing of this nature is an essential part NASA’s preparation for the upcoming Lunar Artemis missions. As spaceflight transitions beyond low earth orbit, to planetary, even more trials of this nature will be required to learn what are the optimal atmospheric and associated operational constraints to maintain the optimal health of the crew and achieve mission objectives.

R Sanders↗