IVU

IVP
What is an Intravenous Pyelogram (IVP)?
What are some common uses of the procedure?
How should I prepare for the procedure?
What does the equipment look like?
How does the procedure work?
procedure?
Who interprets the results and how do I get
How is the procedure performed?
What will I experience during the them?
What are the benefits vs. risks?

What are the limitations of IVP studies?

 What is an Intravenous Pyelogram (IVP)?
An Intravenous Pyelogram (IVP) is an x-ray examination of
the kidneys, ureters, and urinary bladder. Most people are
familiar with x-ray images, which produce a still picture of the
body's interior by passing small, highly controlled amounts of
radiation through the body, and capturing the resulting
shadows and reflections on film. An IVP study uses a
contrast material to enhance the x-ray images. The
contrast material is injected into the patient's system, and its
progress through the urinary tract is then recorded on a
series of quickly captured images. The exam enables the
radiologist to review the anatomy and the function of the
kidneys and urinary tract.

What are the benefits vs. risks?
Benefits
IVP images provide valuable, detailed information to
assist physicians in diagnosing and treating urinary tract
conditions from stones to cancer.
Imaging of the urinary tract with IVP is a minimally
invasive procedure with rare complications.
An IVP can often provide enough information about stones
and obstructions to direct treatment with medication and
avoid more invasive surgical procedures.
The imaging process is fast, painless, and less expensive
than alternatives such as computed tomography (CT) and
magentic resonance imaging (MRI).
 indications
Intravenous urography may be indicated for:
ureteric colic - to confirm the presence of stones in the
urinary tract and any proximal dilatation.
Macroscopic or microscopic haematuria.
First urinary tract infections in men
recurrent urinary tract infections in women
acute pyelonephritis
fever not settling within 48 hours of treatment
unexplained renal failure
isolation of an unusual organism from the urinary tract which increases
the probability that there is a structural abnormality
 preparation
Preparation is unnecessary in the emergency situation.
Bowel preparation may be desirable to remove overlying faeces.
Fluid restriction for 4-6 hours before the examination ensures maximum
concentration of contrast in the urine but is contraindicated in:
neonates
diabetics
multiple myeloma
poor renal function
A doctor and adequate resuscitation equipment must always be at hand
because of the risk of allergic reaction to the contrast which varies from a
mild urticarial rash to anaphylactic shock.
 interpretation
The most important question under examination conditions is
"Has contrast been given ?". Examiners have drawers full of
plain abdominal radiographs with huge radioopaque staghorn
calculi, calcified bladder stones or tumours which they delight
in showing examinees, who then tell them in detail how the
intravenous urogram shows...
The intravenous urogram has three phases which overlap:
nephrogram phase
the collecting phase
the cystogram phase
 nephrogram phase
The nephrogram is that part of the IVU during which contrast is in the glomeruli
and proximal tubules. It occurs 1-3 minutes after injection.
It enables the assessment of:
1. presence - are there bilateral functioning kidneys
2. size - normal range is approximately the height of three vertebral bodies.
Bilateral, enlarged kidneys suggest polycystic disease, acute pyelonephritis or
glomerulonephritis. Bilateral, shrunken kidneys imply chronic disease.
3.. shape - cysts and tumours may cause distortion. The two are often
indistinguishable, however, tumours opacify to a variable extent, and may
show a characteristic "vascular blush."
4.orientation - disorientation may be intrinsic, for example, a horseshoe
kidney, or extrinsic i.e. the effects of pressure from other organs.
 collecting phase
During the collecting phase, contrast medium is passed into the renal
pelvis. Particular examination is made of the calyceal tips.
Hydronephrosis, of increasing severity, is revealed by:
blunting of the calyces
clubbing
the "crescent" sign - contrast collects in the lower parts of
grossly dilated calyces
Polycystic kidneys may demonstrate the "cookie cutter sign";
the cysts press into the renal pelvis to give the appearance of
semi-circles having been cut out of the contrast in the renal
pelvis.
Excretion of contrast down the ureters reveal any filling
defects in them.
 cystogram phase
The cystogram phase is the part of an intravenous urogram
where the contrast fills the bladder.
Intravesical filling defects may arise due to:
tumour
stone
clot
the prostate - bilobed, from below
ureterocele, especially in the presence of a duplex system
renal papillary necrosis
catheter - the balloon inflated in the bladder

Contrast materials used in IVP studies can cause adverse
reactions in some people.
Special care is taken during x-ray examinations to ensure
maximum safety for the patient by shielding the abdomen and
pelvis with a lead apron, with the exception of those
examinations in which the abdomen and pelvis are being imaged.
Women should always inform their doctor or x-ray technologist if
there is any possibility that they are pregnant.
The effective radiation dose from this procedure is about 1.6
What are the limitations of IVP studies?
An IVP shows details of the inside of the urinary tract
including the kidneys, ureters and bladder. CT or MRI
may add valuable information about the functioning
tissue of the kidneys and the surface and surrounding
structures nearby the kidneys, ureters and bladder.
IVP studies are not usually indicated for pregnant
women.
 the diagnostic role of renal size
The determination of renal size may help in the diagnosis of the renal
disease.
The main correlations are:
normal sized kidneys:
acute tubular necrosis ,acute obstruction
myeloma ,amyloidosis,
polyarteritis
bilateral small kidneys:
chronic renal failure
bilateral large kidneys:
amyloidosis
renal vein thrombosis
bilateral hydronephrosis
polycystic disease of the kidney
acute glomerulonephritis
acute interstitial nephritis
kidneys of unequal size (>1.5 cm difference):
proximal urinary obstruction
reflux nephropathy
papillary necrosis (rare)
renal vascular disease (rare)
acute tubular necrosis
renal damage associated with multiple myeloma
amyloidosis
polyarteritis
chronic renal failure
renal vein thrombosis
hydronephrosis
polycystic disease
glomerulonephritis
acute interstitial nephritis
reflux nephropathy
papillary necrosis
Normal Development of the Kidney
Abnormal kidney development
Multiple Renal Arteries
Normal Development of the Bladder
Normal Intravenous Pyelogram (IVP)
 Horseshoe kidney, a congenital anomaly in which the
kidneys are connected by an isthmus, usually in the lower poles.
The band of parenchymal tissue has its own blood supply. In some
cases, the connecting band consists purely of fibrous tissue. It is
thought to occur due to an abnormal position of the umbilical
artery which disturbs the normal cephalad migration of the kidneys
so that it stops at the inferior mesenteric artery
 Intravenous Pyelogram (IVP) Showing
Hydronephrosis
This film shows the abdomen 20 minutes after contrast was
injected intravenously. Concentration of the contrast is seen in both
kidneys. The right kidney and ureter are seen to be normal. The
left kidney has hydronephrosis. They are dilated because there
is an obstruction at the ureteropelvic junction. The ureter is
never seen.
contrast radiograph showing a
bladder tumour
[]
Urolithiasis
Isotop Renogram
 Sponge Kidney

Medullary Sponge Kidney, or cystic

dilatation of the renal collecting tubules
Medullary nephrocalcinosis is believed
to occur due to urinary stasis within the
collecting tubules.
The abnormalities are restricted to the
medulla, and do not involve the calyces
 Renal trauma
Plain IVU

Renal Trauma

Avulsionattheureteropelvicjunctionisamajorrenalinjuryoften
associatedwithalargeurinoma.ThisisconsideredagradeVinjury.


Theshatteredkidneycontainsmultipledeeplacerationsoftenextending
intothecollectingstructuresandessentiallyseparatingthekidneyinto
multiplefragments.ThisisagradeVinjury.


ThisisagradeIVinjuryinwhichthelacerationextendsintothe
collectingsystem.Thisresultsinurineextravasationaswellas
hematoma.


Alacerationgreaterthan1cminlength,butnotextending
intothecollectingstructuresisagradeIIIlesion.Hematoma
isoftenpresent,butnoextravasationofurine.


Aparenchymallacerationlessthan1cminlengthisconsideredagrade
IIlesion.Varyingdegreesofperinephrichematomamaybepresent.


Aperirenalhematomawithoutobviouslacerationisconsideredagrade
IIlesion.


Asubcapsularhematomawithoutapparentlacerationisconsidereda
gradeIlesion.


Majorinjurytotherenalhilarvesselswithdevascularizationofthe
kidneyisagradeVinjury.
 Voiding Cystourethrogram (VCUG)

performed:
insertacatheterintotheurethra
Instilledcontrastmaterialintothebladder
throughthecatheter
thecatheterisremovedafterthebladderfull.
X-raysaretakenbefore,duringandafterfilling
ofthebladder.Whilethepatientvoids,
additionalx-raysaretaken.
 Usefulness

helpfulindetectingabnormalitiesofthebladder
andurethra.
Refluxisdetectedifcontrastisseentoflowin
retrogradefashionuptheuretersfromthebladder.
Ifthebladderisruptured,extravasationof
contrastwillbeseenoutsidethebladderinthe
pelvisorabdomen.
Obstructions or strictures of the urethra(such
asposteriorurethralvalves)canbeseenonthex-
raystakenduringvoiding.
Normal Voiding C U
 Reflux
a- 10 year old girl had UTI
Posterior Urethral Valves Seen on Voiding
Cystourethrogram (VCUG)