INTRAVENOUS UROGRAM I.V.

Radiographic examination of urinary tract including renal parenchyma, calyces & pelvis after IV injection of contrast media.  IVP - misnomer


NORMAL I.V.U

INDICATIONS
IN ADULTS:  Screening of urinary tract haematuria/pyuria  Diseases of renal collecting system & pelvis  Differentiation of function of both kidneys  Abnormalities of ureter  Obstructive uropathy (gold std)

    

TB of urinary tract Calculi Potential renal donors Prior to endo-urological procedures & surgery of urinary tract Suspected renal injury

IN CHILDREN
VATER anomalies  Malformation of urinary tract  Girls with constant/intermittent dampness s/o ectopically inserted ureter (mandatory)  Anorectal anomalies


CONTRAINDICATIONS (relative)
Iodine sensitivity  Pregnancy  H/O Anaphylaxis RISK FACTORS  Cardiac failure  Dehydration  Diabetes with azotemia  Previous allergic reaction  H/O Phaeochromocytoma


CONTRAST MEDIA
In adults  Non ionic media Iohexol Omnipaque 300 mg I/ml 40-80ml  Ionic media 300 to 600 mg iodine equivalent/kg bw. Max of 40 mg of iodine In children 240 mg I/ml 300mg I/ml <7 kg: 4ml/kg 3ml/kg >7 kg: 3ml/kg 2ml/kg


Meglumine iothalamate or diatrizoate Dose : 1-2 ml/kg bw

MODE OF ADMINISTRAION
 

I.V bolus inj within 3060 secs Density of nephrogram directly proportional to plasma conc of contrast

PREPARATION
FOR ADULTS  Past history  Fasting for 4 hrs  Do not dehydrate the pt  Bowel preparation FOR CHILDREN  NPO for 3-4 hrs  Do not dehydrate  Colon should be empty

PROCEDURE


 

Pt in supine position with pelvis at the cathode side of the tube Support placed under pts knees to reduce lordotic curvature of LS spine Scout film is taken Contrast injected IV into prominent vein in the arm.Test inj of 1 ml given & pt observed for reactions Contrast injected rapidly within 30-60 secs

CORTICAL NEPHROGRAM : within 20 secs of inj.Renal parenchyma opacified by contrast. cortical phase vascular filling tubular phase contrast within lumen of renal tubules PYELOGRAM: (contrast in calyces) 2 mins after inj  If a kidney fails to excrete detectable amount of contrast into collecting system termed Non-visualising kidney.

FILMING TECHNIQUE: low KV(65-75) high mA(600-1000) & short exposure to get optimum image contrast STD FILMS TAKEN  Plain X-ray KUB/Scout film- 14 * 17  1 min film 10 * 12  5 min film 10 * 12  10 min film 15 * 12  15 min film -15 * 12  35 min film -14 * 17  Post void film 10 * 8

1 min film shows nephrogram.  5 min film shows nephrogram,renal pelvis, upper part of ureter  Compression band : produces better pelvicalyceal distension. Contraindicated in renal trauma large abdominal mass abd. Aneurysm after abdominal surgery if 5 min film shows dilated calyces obstruction exists  If compression is applied, film is taken 5 mins after compression to demonstrate distended calyceal system & prox ureters.


15 min film :better visualisation of ureter in prone position / modified trendelenberg position  35 min film : complete overview of urinary tract kidney, ureter, bladder.  Post void film : assess residual urine, bladder mucosal lesions, diverticula, bladder tumor, outlet obstruction, VUR.

Mast Gagan 7 yrs

Mr Dharnappa, 31 yrs

SPECIAL FILMS IN I.V.U

OBLIQUE VIEW :  project ureter away from spine & separate radio opaque shadows mimicking calculi.  Visualisation of posterolateral aspects of bladder  Differentiation of extrinsic or intrinsic renal, ureteral or bladder masses & doubtful urethral masses.

ERECT FILM
Provoke emptying of urinary tract  Demonstrate layering of calculi in cysts & abscesses  Detect urinary tract gas not seen in other films  Demonstration of renal ptosis,bladder hernia, cystocele & obstruction in ureter


PRONE FILM
 

View ureteral areas not seen in supine films Demonstration of renal ptosis & bladder hernia. Cases of obstruction where early nephrogram is seen but collecting system is not seen Long standing hydronephrosis renal parenchyma is seen but collecting system is not visualised until many hrs later. Congenital lesions : non-visualised upper calyceal system with ectopic or obstructed ureter.

DELAYED FILMS
 

MODIFICATIONS OF UROGRAM
1. 2. 3. 4. 5. 6. 7.

Diuretic Urogram Hypertensive Urogram Tailored Urogam Drip Infusion Urography Limited Urography Emergency Urography High Dose Urography

COMPLICATIONS
DUE TO CONTRAST  Minor reactions ( 5%) nausea, vomiting, mild rash, headache, mild dyspnoea  Intermediate reactions (1%) extensive urticaria,facial edema, bronchospasm,laryngeal edema, hypotension  Severe reaction (0.05%) circulatory collapse, pul edema, severe angina, MI,convulsions , coma, cardiac/respiratory arrest

DUE TO TECHNIQUE  Upper arm or shoulder pain.  Extravasation of contrast into injection site. AFTER CARE  Watch for late contrast reactions.  Prevention of dehydration.  In high risk patients, RFT should be done to watch for deterioration.

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