Intravenous Pyelography

Intravenous pyelography refers to a series of x-rays taken of the kidneys, the urethras and the
bladder.
IVP may be performed to detect a problem of the kidneys, urethras, and bladder.
IVP is done to locate a suspected obstruction to the flow of urine through the collecting system.
The most common cause of blockage is a kidney stone.
The IVP test also gives information about the functioning of the kidneys.

Indications for IVP

An IVP is done to:

Look for problems with the structure of the urinary tract.

Find the cause of blood in the urine.
Identify the cause of ongoing back or flank pain.
Locate and measure a tumor of the urinary tract.
Locate and measure a kidney stone.
Find the cause of recurring urinary tract infections.
Look for damage to the urinary tract after an injury.

Contraindications for IVP

Pregnant women should not have an IVP because of the high radiation exposure.
People with known kidney disease or failure should not have an IVP because the dye can
worsen kidney function.
Elderly people, diabetics, and those with high blood pressure, heart disease, or evidence of
dehydration are at risk of developing kidney failure following administration of the dye.
Diabetics or certain others (for example, women with polycystic ovarian syndrome) who are
taking metformin (Glucophage), will have to discontinue this medication for 2 days after the
IVP.

To avoid this complication, the kidney function should be tested with a blood test of the BUN
and creatinine, and the results should be known before the IVP is performed.
Procedure

Preparation

The intravenous pyelogram may be performed as an emergency procedure or on an outpatient basis.

The Emergency department the doctor will draw blood and start an IV line.
The IV will be used to give medication to alleviate pain, nausea, and vomiting and to administer
fluids as well as the dye used in the test.
Urine will be tested for abnormalities.
While waiting for the IVP to be done, you should be lying down and resting, without any pain
or discomfort.

In nonemergency cases, the patient will need to prepare for the test.
Preparation will involve the use of laxatives and, in some cases, enemas to cleanse the bowel of
stool.
Patient is usually asked not to eat for 8-12 hours before the test is done.

Method

Patient will need to remove any jewelry that might interfere with the X-ray picture.

Patient will need to take off all or most of your clothes, and you will be given a cloth or paper
covering to use during the test.

Patient will be asked to urinate just before the test begins.

Patient will lie on his back on an X-ray table.

An X-ray picture of your abdomen will be taken and reviewed by the radiologist before the next
part of the test begins.
 The injection site on patients arm will be cleaned and the contrast material will be injected into
a vein on the inside of patients elbow.

The dye travels through the bloodstream, is filtered out by the kidneys, and passes into the
urine. The urine then flows into the ureters that lead to the bladder.

X-ray pictures are taken several minutes apart as the dye goes through the urinary tract.

Each picture is developed right away.

Patient may be asked to turn from side to side or to hold several different positions so the
radiologist can take a complete series of X-rays.

During IVP, a compression device may wrap around patient belly to keep the dye in the
kidneys.

The most common compression device is a wide belt containing two inflated balloons that push
in on either side of your belly to block the passage of dye through the ureters..

A special type of X-ray technique called fluoroscopy may also be used during IVP. During
fluoroscopy, a continuous X-ray beam is used to display a moving image on a video monitor.

IVP usually takes about an hour. After the test is over, you will need to drink plenty of liquids to
help flush the contrast material out of your body.

The dyes also called radio contrast media are of 2 types: ionic and nonionic. Both types of dye contain
iodine but differ in 2 key ways: the rate of adverse reactions and the cost. Although the overall rate of
adverse reactions is relatively low with both, there is a greater incidence of adverse reactions with the
less expensive ionic dye than with the nonionic.

Minor reactions, which happens less frequent and do not last long, include flushing, nausea, vomiting,
and itching. A small percentage of people experience a severe reaction to the dye, such as difficulty
breathing, speaking, or swallowing; swelling of the lips and tongue; low blood pressure; or loss of
consciousness.

The x-rays are taken at several intervals, such as at 0, 5, 10, and 20 minutes. Zero time is the time of
injection of the dye. Although the dye is colorless, it makes the kidneys and ureters appear white on the
x-ray so that they contrast with the background of the rest of the abdomen.
If, for example, the kidneys, urethras, and bladder can be seen after the 5-minute film is taken, then one
last film will be taken immediately after you have urinated. If only one kidney and its ureter are seen
after the 5-, 10-, and 20-minute pictures are taken, then the doctor will decide when further films
should be taken. As a general rule, the interval for further films is determined by doubling the time
from the last film. The time will be doubled until both kidneys and urethras can be seen.

Follow up

If, while waiting for the "stone" to pass, patients symptoms worsen over the next 5-7 days, the
doctor might order a repeat intravenous pyelogram to determine if the stone has changed
location.

If patient are waiting to pass a stone, drink a lot of water to generate urine that will flush the
stone through the urethras and into the bladder then out. The stone that passes out of the body
through the urine can be easily captured if you urinate into a special cup that has a sieve at the
bottom. The urine passes through the cup and into the toilet, and the stone is trapped in the cup.
Save the stone and take it to doctor for analysis.
Results
.
Intravenous pyelogram (IVP)
unable to
The kidneys, ureters, and bladder are normal in position, size, and shape. during th
Having
The contrast material reaches the kidneys in a normal amount of time.
amount
Normal:
No blockage can be seen in the kidneys, ureters, or bladder. (feces) o
large
In men, the prostate gland looks normal in position, size, and shape.
(colon).
Having
The kidneys, ureters, or bladder may be abnormal in position, size, or shape. A
with bar
kidney may be absent, or an extra kidney or ureter may be present.
a barium
The kidneys are too large or too small.
bismuth.

The contrast material takes longer than normal to reach a kidney.

An abnormal growth (such as a tumor), one or more cysts, an abscess, or a

kidney stone is seen.
Abnormal:
A kidney is swollen with urine from a blockage such as a tumor or kidney
stone.

Injury to the kidney, ureter, or bladder is seen.

The kidney contains scarring.

In men, the prostate gland is too large.