Intravenus Urography/Pyelography (IVU/IVP)

HAMZEH ALMASRI

This exam is used to visualize urinary system anatomy and excretory function.

Take patient history before giving the contrast media injection:

1- are you allergic to anything? 2- are you allergic to fish, iodine, eggs or any type of medication? 3- do you have asthma, allergic rhinitis? 4- have you done a previous intravenous CM injection and had a reaction?

Take patient history before giving the contrast media injection:

5- are you a diabetic patient taking Glucophage (metformin)? 6- check patient chart (kidney function test); Createnine level 0.5-1.5 mg/dl BUN(Blood-Urine-Nitrogen) 5-25 mg/100ml

Indications for imaging:

1-Suspected urinary tract pathology. 2-Repeated infections. 3-Heamaturia. 4-Investigation of hypertension. 5-Renal colic (stone). 6-Trauma.

Contraindication of this exam:

1- Allergy to iodine. 2- Kidney failure. 3- High createnine and urea level in blood. 4- DM patient that is taking Glucophage (must be withheld 48 hours prior to the contrast media study). 5- Anuria, or absence of urine excretion.

What to do in case of an allergic patient?

We give the patient prophylactic (hydrocortisone) Prednizelone (1 tablet 5 mg) Day 4 Day3 Day2 Day1 4*2=40 mg 3*2=30 mg 2*2=20 mg 1*2=10 mg

Patient preparation before the day of the exam and on the day of the exam:
1-Light evening meal. 2-Drink laxative (castor) oil on the day prior to the exam. 3-Fasting for 6-8 hours 4-Don't smoke on the day of the exam. 5-Void prior to the exam to avoid diluting of the CM in the bladder.

General IVU procedure

Scout Image (control or Preliminary),KUB

is taken to: 1-verify patient preparation (bowel clear from gases and feces) 2-Determine whether exposure factors are acceptable. 3-Verify positioning. 4-Detect any abnormal calcification.

(CR is at the level of iliac crest, Exposure is made on suspended expiration).

Contrast Media Injection:

The median cubital vein is punctured and the warmed contrast agent is injected rapidly.

Basic imaging routine:

1) Immediate film (nephrogram):

AP of renal area is taken immediately after complete of injection to see the renal parenchyma.

(CR is centered at level of lower costal margin , Exposure is made on suspended expiration).

2) 5-minute (Excretory film):

Full KUB to see if the excretion is symmetrical, or if uptake is poor and a further dose of contrast agent is required.

(CR is centered at level of iliac crest ,Exposure is made on suspended expiration).

Compression may be applied in some centers at this point to distend the pelvicalyceal systems to demonstrate any filling defects and a film taken at 10 minutes of the renal areas.

Compression is contraindicated in:

1- Possible ureteric stones (difficult to distinguish between the effects of compression versus the appearance due to a stone). 2- Large abdominal mass (acts as compression). 3- Abdominal aortic aneurysm. 4- Recent abdominal surgery. 5- Severe abdominal pain. 6- Renal trauma.

3) Full bladder:
to demonstrate the distended bladder(size and any filling defects). (CR :15 caudal angulation centered 5 cm above the upper border of the symphysis pubis).

4) Post Micturition (void) film:

to demonstrate the bladder emptying success(if there is any residual urine). (CR :15 caudal angulation centered 5 cm above the upper border of the symphysis pubis).

Possible reactions to CM:

Mild reactions ( reassurance, no treatment ): Nausea, hives, urticaria, itching. Moderate: ( hydrocortisone, antihistamine,iv fluid ) Tachycardia, vomiting, excessive urticaria, Severe( emergency treatment -epinephrine ) Low blood pressure, respiratory arrest, loss of consciousness, cyanosis,convusions.

NOTE: Common side effects occurr after CM injection are temporary hot flash and metallic taste in the mouth.

The patient should NEVER be left alone.