Intravenous pyelagraphy (IVP) technique, value, complications,alternatives

This is a discussion of Intravenous pyelagraphy (I.V.P) regarding its method, value, complications, people-at-risk to its complications and alternative methods .

How IVP is done ? and how it works

Dye ==>  I.V uptake ==> concentration ==> excretion.
 The contrast medium concentrates in the renal tubules and produces a nephrogram image, As the medium passes into the collecting system, the calyces, renal pelvis, ureters and bladder are visualized.

- Few minutes after the injection of the contrast ==> visualization of the soft tissue shadow of the kidney (nephrogram).
- After 5-10 minutes, the films obtained are used for evaluation of the collecting structures, ureter and bladder which are best demonstrated within the first 20 minutes.
- Abdominal compression is used to produce greater visualization of the calyceal system and to allow better visualization of the entire ureter after compression is released .

Value:

1- It is considered to be an anatomical description of the urinary system.
2- Stones, tumors (filling defect).
3- Details of ureters.
4- Rapid sequence I.V.P. may be helpful to diagnose renal Artery stenosis .

Comglications of Intravenous pyelagraphy (IVP) :

1- Anaphylactic shock.
2- Acute renal failure as the dye is nephrotoxic ==> ATN  = contrast nephropathy.

  ** Patients liable to contrast nephropathy :

- D.M. - Old age. - Multiple myeloma.
- Patient under ACE inhibitors. - Renal impairment. - Volume depletion .

* Alternatives of Direct I.V.P

I.V.P infusion method

- Its advantage is to decrease incidence of contrast nephropathy as we give the dye with saline by infusion.
- You can give mannitol after the procedure ===> diuresis & rapid excretion of the dye .

Ascending pyelagraphy  (Retrograde pyelagraphy) :

- Cystoscopy  ===> ureteric catheter  ===> flushing of dye  ===> visualization of ureter, bladder, pelvis.
- It is mainly used to investigate lesions of the ureters.
- It is invasive and may introduce infection.
- It can be used if there is contraindication of IVP as previous allergy to contrast media or impaired kidney function.

Ante-grade pyelagraphy

- It involves percutaneous puncture of a renal calyx with insertion of a fine catheter and injection of the contrast.
- It is used in patients with upper urinary tract obstruction.
- The catheter can be left in situ to allow urine drainage in oliguric patients.

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