Synonyms Infusion Pyelogram; Intravenous Pyelogram; IVP

Procedure Commonly Includes Intravenous administration of a contrast material. The contrast material is concentrated and excreted by the kidneys. Appropriate radiographs are exposed during the concentration and excretion of the contrast material for evaluation of the morphology and function of the urinary tract.

Indications This examination accurately demonstrates normal anatomy and a wide range of abnormalities involving the urinary tract.

Contraindications Allergy to iodine or a previous serious adverse reaction, advanced renal failure. A known diagnosis of multiple myeloma constitutes a relative contraindication. Every attempt should be made to hydrate patients with this diagnosis or with the diagnosis of diabetes mellitus prior to performance of a urogram as these patients run an increased risk of acute renal failure.

Patient Preparation Patients are encouraged to take nothing by mouth after midnight the night before the examination. This degree of fluid restriction will not produce significant dehydration but will improve the overall quality of the examination. If the urography examination is to be performed in the afternoon, a light liquid breakfast may be consumed. Views on the necessity and the usefulness of cathartics in the preparation of patients for urography vary. Some physicians advocate the routine use of 10 oz of magnesium citrate the evening before the examination. Alternatives would include a mild laxative such as 1 1/4 oz of a standard extract of senna fruit the evening before the examination.

Aftercare Encourage hydration by fluid ingestion.

Special Instructions All patients undergoing this examination should be questioned specifically with regard to drug allergies, particularly iodine. A recent serum creatinine is requested on patients 60 years of age or older, those with significant atherosclerotic disease, those with a known diagnosis of diabetes mellitus or with known pre-existing renal disease.

Complications Reactions to contrast material and specific treatment for such reactions are beyond the scope of this handbook. An appropriately equipped emergency cart should be immediately available should resuscitation be necessary.

Equipment Overhead radiography tube with float top table. Tomographic capabilities are desirable.

Limitations Urography should be performed prior to barium studies of the gastrointestinal tract. The presence of barium within the abdomen will compromise the urographic examination.

References