The document discusses an intravenous urogram (IVU), also known as an intravenous pyelogram (IVP). An IVU uses intravenous contrast dye and x-ray imaging to evaluate the kidneys, ureters, and bladder. It provides an anatomical roadmap and can detect abnormalities like obstructions. Patient preparation includes fasting, laxatives, and a scout film is done prior to injecting contrast dye intravenously and obtaining serial x-ray images as the dye moves through the urinary system. Potential risks are minimal but include reactions to the contrast dye and exposure to radiation.

1. Indications
 check for normal function of kidneys
 check for anatomical variants or congenital anomalies (e.g. horse-shoe kidney)
 check the courseof the ureters
 detect and localize a ureteric obstruction (urolithiasis)
 assess for synchronous upper tract disease in those with bladder transitional cell
carcinoma (TCC)
Patient preparation
 overnight fasting prior to the date of examination; a laxative would help to achieve a
good preparation
 on the day of the procedure take a scout/pilot film to check patient preparation and
also for radiopaque calculi
 check serum creatinine level to be within the normal range (as per hospital guidelines)
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 (7) INTRAVENOUS UROGRAM (IVU), aka INTRAVENOUS
PYELOGRAM (IVP)
Indications
Indications are diminishing due the introduction of CT urography (CTU), but the standard list
includes:
1. Anatomic roadmap for kidneys, ureter and bladder
2. Evaluation of flank pain or renal colic
3. Evaluation of hematuria
4. Evaluation of urinary tract status post trauma
Patient Preparation
1. 1 day before exam- eat a light lunch and dinner.
2. Clear liquids after 8 PM the night prior to exam.
3. Magnesium citrate or other mild laxative, e.g. dulcolax, the night prior to exam.
4. NPO for 3 hours prior to exam.
Description

2. Intravenous contrast is excreted by the kidneys via glomerular filtration. Following injection,
there are 3 phases:
1. Total body opacification phase (TBO) when contrast is in the capillaries.
2. Nephrogram phase when contrast is in the renal parenchyma
3. Pyelogram phase when contrast is in the pelvicalyceal system, ureters, and bladder.
The size and shape of the kidneys are evaluated, and an assessment is made for renal masses.
Opacification of both kidneys at the same time is a rough indicator of normal blood supply and
function. The calyces, renal pelves, ureters and bladder are evaluated. These structures are
examined sequentially by serial x-rays and should show symmetric filling without dilatations,
narrowing, or filling defects.
Procedure: The bowel is prepped prior to the study to minimize the presence of gas and fecal
material, which may obscure the urinary collecting system. A preliminary “scout” x-ray of the
abdomen is obtained prior to contrast administration to identify calcified renal stones. An IV
catheter is then inserted into an arm vein and contrast is administered. Serial x-ray images of the
abdomen are obtained as the contrast moves through the urinary system. At the end of the exam,
the patient goes to the bathroom to urinate and images of the post-void bladder are obtained. The
exam usually takes about 1 hour.
Patient Comfort Level
1. Needle stick for the IV catheter.
2. Intravenous contrast may cause a feeling of warmth and a metallic taste in the mouth. Some
patients get nauseated and may even vomit.
3. Adverse reactions may occur to IV contrast agents, ionic> nonionic.
Contraindications
An IVU involves radiation and intravenous contrast, and the contraindications are largely due to
the necessity of limiting these.
1. IVU should be avoided in pregnant women unless absolutely necessary.
2. Nursing mothers should pump and discard breast milk for 24 hours after receiving intravenous
contrast.
3. Patients with documented allergy to iodinated materials and intravenous contrast should not
receive contrast. There are many accurate imaging modalities for the kidney that do not require
contrast, e.g. non-contrast renal CT, US, MRI, or nuclear imaging.
4. Patients with renal insufficiency, especially if diabetic, or in renal failure should not receive
IV contrast.
5. Contrast can lead to precipitation of Bence Jones protein and acute tubular necrosis in patients
with multiple myeloma, especially when dehydrated.
6. Contrast is hyperosmolar and may worsen CHF.
7. Contrast is uricosuric and can worsen gout.
Limitations
1. IVU is only a rough indicator of function. If both kidneys function simultaneously, they both
may have decreased function or blood supply.
2. Small lesions in the kidney may be missed.

3. 3. A normal IVU does not rule out significant abnormalities, especially in the bladder. IVU
misses up to 33% of bladder tumors.
Risks
An intravenous pyelogram is generally safe, and complications are rare. As with any medical
procedure, intravenous pyelogram does carry a risk of complications, including allergic
reactions.
In some people, the injection of X-ray dye can cause side effects such as:
 A feeling of warmth or flushing
 A metallic taste in the mouth
 Nausea
 Itching
 Hives
Rarely, severe reactions to the dye occur, including:
 Extremely low blood pressure
 A sudden, full-body allergic reaction that can cause breathing difficulties and other life-
threatening symptoms (anaphylactic shock)
 Cardiac arrest
During the X-rays, you'll be exposed to low levels of radiation. The amount of radiation you're
exposed to during an intravenous pyelogram is small, so the risk of any damage to cells in your
body is extremely low.
However, if you're pregnant or think that you may be pregnant, tell your doctor before having an
intravenous pyelogram. Though the risk to an unborn baby is small, your doctor may consider
whether it's better to wait or to use another imaging test.