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Intravenous Urography

  1. The main current indications:
    1. For assessment of function of the kidney (although scintigraphy is the best)
    2. Persistent or frank hematuria
    3. Renal and ureteric calculi (particularly prior to endourological procedures)
    4. Ureteric fistula
    5. Ureteric strictures
    6. Complex urinary tract infection (especially tuberculosis) Q
    7. Some urogenital congenital anomalies
  2. QThe sequence of taking film is:
    1. Plain KUB film  Nephrographic phase and a 5 minutes after injection of contrast full-length 15 minutes film 30/45 minutes prone full length film and lastly the post-void film.
    2. As required, oblique views, compression views, erect view and other modifications like rapid sequence IVU or diuretic urography or infusion study can be done.
  3. QThe main contraindications:
    1. Liver failure with renal failure
    2. QMyelomatosis
    3. Pregnancy
    4. Previous history of reaction to contrast
    5. Severally dehydrated patient

Patients with limited renal function (creatinine 1.5 and greater) generally should not receive iodinated intravenous contrast for IVU/CT. Gadolinium chelate contrast agents used for MRI are generally safe for these patients.

  1. Modifications in IVU/IVP/ Excretory urography
    1. QRapid sequence IVU: Done in patients with suspected renovascular hypertension. Films taken at 1, 2 and 4 minutes after injection of contrast medium in addition to the routine filming sequence.
    2. Infusion urography: Done in patients with compromised renal function. 40–50 grams of iodine (as against 16 grams in usual procedure) is injected into 200–500 cc of glucose and given as infusion.
    3. Diuretic urography: Done in patients with PUJ obstruction. A patient is not dehydrated prior to procedure. IV frusemide is injected immediately following contrast, which causes copious contrast secretion, thus dilating the renal pelvis to greater extent and demonstrating the pathology nicely.​

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