This is a discussion of Intravenous pyelagraphy (I.V.P) regarding its method, value, complications, people-at-risk to its complications and alternative methods .
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 .
2- Acute renal failure as the dye is nephrotoxic ==> ATN = contrast nephropathy.
- Patient under ACE inhibitors. - Renal impairment. - Volume depletion .
- You can give mannitol after the procedure ===> diuresis & rapid excretion of the dye .
- 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.
- It is used in patients with upper urinary tract obstruction.
- The catheter can be left in situ to allow urine drainage in oliguric patients.
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.