Intravenous Urography (IVU)., radiological procedure

ivu, intravenous urography, radiological procedure

1. Intravenous Urography (IVU)

2. It is the radiographic examination of urinary tract including renal parenchyma, calyces and renal pelvis after intravenous injection of contrast media. renal parenchyma is the functional part of the kidney that includes the renal cortex (the outermost part of the kidney) and the renal medulla

3. Indication Hematuria Nephrolithiasis Diseases of renal collecting system and renal pelvis. Differentiation of function of both kidney. Abnormalities of the ureter . TB of the urinary tract Potential renal donors. Suspected renal injury Renal colic or flank pain Obstructive U ropathy .

4. contraindication Pregnancy Contrast media sensitivity

5. Contrast media HOCM or LOCM 300 – 370 mgI / ml Adult dose : 50 – 100 ml Pediatric : 1 ml / kg

6. Patient preparation Bowel preparation is important as abdomen should ideally be free of radio-opaque fecal matter and gas No food for 5hr prior to examination laxatives should be given prior to the day of examination Urea And Creatinine should be in normal range.

7. Normal range for urea- 7-20mg/dl Normal range for creatinine - 0.7-1.2mg/dl

8. technique Preliminary film (Control Film) Contrast administration Immediate film ( Nephrogram ) 5 min film 15 min film Full length release film full bladder After micturition film / post void film

9. Preliminary film (control film) Plain film is to demonstrate the urinary tract prior to administration of contrast medium Supine full length AP of the abdomen. Done to check exposure factors, centering, bowel preparation and obvious pathology, particularly urinary tract calcification or calculus.

10. Contrast administration Cannula is inserted in median ante- cubital vein and contrast media is administrated.

11. Immediate film ( Nephrogram ) AP of renal areas. This film is exposed 14 seconds after contrast injection (arm to kidney time) Aim is to show nephrogram i.e renal parenchyma opacified by contrast medium .

12. 5 min film AP of renal areas is taken. Film is taken to determine if excretion is symmetrical and for assessing if need to modify technique e.g - a further injection of contrast medium if poor opacification . Compression band is now applied around the patients abdomen if necessary and is positioned midway between the anterior superior iliac spine. Aim: is to produce better pelvicalyceal distension

13. 15 min film AP view of renal areas Compression removed when satisfactory demonstration of pelvicalyceal system has been achieved. There is usually adequate distension of pelvicalyceal system and ureter is visualized as well.

14. Release film Supine AP film This film is taken to show whole urinary tract

15. full bladder Coned view of bladder area is taken b To demonstrate shape and size of bladder, identify the mass within bladder dder area is taken

16. After Micturition film / post void film Full length abdominal film or coned view of bladder can be taken on the basis of clinical finding. Main aim of film are: Demonstrate urethral diverticulum residual urine VUR Bladder tumour

17. Complication Due to contrast media : mild, moderate or severe reaction Due to technique : arm or shoulder pain and contrast extravasation at injection site

18. Aftercare observation for 6 hrs watch for late contrast reaction preventation of dehydration