Intravenous Pyelogram RENAL TESTS ADULTS.pptx

RENAL SYSTEM

1. Intravenous Pyelogram

2. Intravenous pyelography (IVP), or intravenous urography, is a diagnostic test that involves the administration of intravenous contrast and X-ray imaging of the urinary tract.  The iodinated contrast flows through the renal vasculature and filtered into the collecting system highlighting the anatomic structures on the X-ray image.

3. It is often useful for the evaluation of hematuria , and renal stone disease, and as a follow-up after the intervention . The urographic imaging sequence is designed to depict specific parts of the urinary tract optimally. Portions of the urinary system appear opaque when filled with contrast material.

4. In modern times, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used for the evaluation of urinary tract diseases owing to the limitations of intravenous pyelography.

5. Procedures Contrast material, radiologic table, X-ray tubes, monitor, fluoroscope, and detector are required to perform the test . A set of preliminary images (Kidney-ureter-bladder [KUB] radiograph) is necessary before contrast administration. Next , a bolus of contrast should be administered. After 1 to 3 minutes of contrast administration, nephrographic images should be obtained. (Oblique images are also an option.) A KUB radiograph should follow five minutes after contrast administration. Apply abdominal compression immediately after getting a KUB radiograph.

6. Five minutes after compression, obtain pyelographic images during early bladder filling. Immediately after the release of compression, obtain a KUB radiograph and fluoroscopic spot images of ureters.  Obtain the radiographic image of the bladder.

7. Indications IVP is a tool in the assessment of flank and lower back pain and hematuria . It is useful in diagnosing congenital anomalies of the urinary tract, urinary calculi, enlarged prostate, neoplasms of kidney, ureter, bladder, and scars and strictures of the urinary tract.

8. Potential Diagnosis Assessment of both kidneys Size  Position  Vertical axis  Renal contour and symmetry Renal parenchyma and parenchymal thickening Scarring of the parenchyma Calyceal distortion  Cyst  Assessment of the urinary bladder Physiologic distention   Position of the bladder Bladder wall thickening Irregularity of the lumen  Contour abnormalities Diverticula  Neoplasms   Assessment of the ureters Symmetry of both the ureter(s) Diverticulum/diverticula of ureter(s) Ureteral obstruction Medial and lateral deviation of the ureter(s) Obstructive and non-obstructive dilatation of ureter(s) Asymmetry of the ureteral caliber

9. Normal and Critical Findings The average length of the kidney ranges from 9 to 13 cms . The average renal parenchymal thickness in the polar regions is 3 to 3.5 cms , and in the interpolar regions is 2 to 2.5 cms .  The upper pole of the right kidney is usually at the level of the 12th rib, and the left kidney is slightly higher than the right one. 

10. Complications Adverse reaction to the contrast material can present as hives, skin rash, and sometimes may even produce anaphylactic shock

11. Patient Safety and Education Preparing the patient  Fasting is recommended for the patient before the procedure. The patient must empty their bladder before the procedure. Mild laxatives may be prescribed. Explain the procedure to the patient. Carefully note the history of patient’s allergies, comorbidities, previous illnesses, and drug history. Ask the patient to remove all jewelry and other metal objects before the procedure. If the patient is a female, ensure that she is not pregnant at the time of the procedure. If she is pregnant, take precautionary measures to shelter the fetus from radiation exposure.

12. This examination is usually performed on an outpatient basis. The patient must lie still on the table while the procedure is taking place. The procedure usually takes 1 hour, but it might take longer if the kidneys are functioning at a slower rate. Compression bands may be applied to properly visualize the lower segments of the urinary tract