The document discusses the indications, technique, and findings of intravenous urography (IVU). It provides details on: 1) The traditional preparation of IVU including bowel preparation and fluid restriction to optimize contrast opacification of the urinary tract; however, recent recommendations state bowel preparation is unnecessary and fluid restriction should be avoided in high-risk patients. 2) The standard technique involves a series of films before and after intravenous contrast administration, including compression of the abdomen to distend the collecting system, with modifications for different clinical situations. 3) The expected timing of nephrogram, pyelogram, and other findings seen on IVU and their significance in evaluating the urinary tract anatomy and function.

3.  Indications
1) Persistent or frank hematuria.
2) Renal & ureteric calculi. (Especially prior to
endourological procedures)
3) Ureteric fistulas & strictures.
4) Complex urinary tract infections.

4. o Consists of series of film after IV
administration of contrast.
 Traditional preperation
 4 hours starvation & liquid deprivation along
with bowel purgation with laxatives.

5.  Recent Recommendations
o Bowel preparation: unhelpful & is
unpleasant for patient.
Food should be avoided 2-4 hrs before
procedure.
o Fluid restriction: better opacification of
collecting system.

6.  Fluid restriction increase risk of
nephrotoxicity
 High risk conditions
› DM
› Multiple Myeloma
› Hyper urecemia
› Sickle cell disease
› Pre existing renal disease.

7.  Risk of contrast induced injury to previously
healthy kidney is very low.
 Fluid restriction should be avoided in high
risk patients
 If dehydration is present it should be
corrected.

10. 1) Pre contrast film “scout” film. (full length)
2) Immediately post contrast film. (Cross
kidney)
3) 5 mins after contrast film (Cross
kidney).(apply abdominal compression)
4) 15 mins after contrast. (Cross kidney)
5) Immediately after release of
compression full length film. (full length)
6) Post Micturation film. (full length)

16.  Compression is omitted in :
 Children.
 Aortic aneurysm.
 Tender abdomen.
 Recent abdominal surgery.
 Acute abdomen including renal colic.
 If patient can not tolerate.

17.  Modifications to deal with
different circumstances.
o To increase the sensitivity of the
procedure.
o To reduce the radiation dose.

18.  Acute Obstruction:
 There is delay in opacification of the
collecting system.
 Delay may be considerable up to 24 hrs
or more.
 It is then necessary to perform additional
films

19.  Time interval b/w films is doubled
0.5 hrs/ 1 hr/ 2 hrs/ 4 hrs/ 16 hrs/ 24 hrs
as necessary.
 To minimize the radiation exposure If there is
no opacification at 30 mins it is usually
unhelpful to perform next film before 4 hrs

20.  In patient with strong suspicion of
ureteric calculi omit all films after
contrast until a full length film is
performed at 15 mins.
 Patients with proven ureteric calculus for
follow up IVU there should be a full
length plain film & 15 mins post contrast
film

21.  Pregnant female
 Very rarely necessary to perform IVU.
 If required minimize radiation exposure.
 Single full length film pre contrast.
 Solitary full length film at 30-45 mins.

22.  Rapid sequencing IVU
 Taken in cases of suspected renal
vascular hypertension to evaluate
differential rates of contrast uptake.
 Several time-spaced films of kidneys
within 1st several minutes after contrast.

23.  IV Frusemide
 20 mg after 15 mins with a further film 15
mins later.
 In suspected obstruction if no evidence
on 15 min film , it provokes
hydronephrosis & pain.

25.  Contrast takes 12-20 sec to reach the renal
arteries after iv injection.
 Nephrogram : diffuse enhancement which
healthy kidneys show In the 1st min of IVU.
 Renal size 3-4 vertebrae in length no > 4
vertebrae
 Out lines best seen in 1st 30 sec.

26.  Medullary or pyramidal blush:
 Contrast may be visible as fine linear
opacities running along the medullary
pyramids
 Pyelogram:
 Excretion of contrast into the pelvis &
ureter
 Compression impedes ureteric drainage
& distends PCS at12-15 mins

27.  On releasing compression increase flow in
ureters making them prominent in post
release film.
 Normal ureters have contractions & are not
seen entire length.
 There are smoothly narrowed areas esp at
PUJ and as the ureters cross ilial vessels in
pelvis.

28. History
taking

29. Weight
of
patient
for dose
of
Urografin

30. IV
Urografin
1mg/Kg
Body Wt

31. X ray films
1) Pre contrast
2) 5 mins
3) 25 mins
4) Post void

32. Editing &
printing of
films

63.  The plain film demonstrates
calcification within distended
upper pole calyces