Intravenous Pyelography (IVP, Excretory Urography)
Norm of Intravenous Pyelography (IVP, Excretory Urography)
Normal renal pelvis, ureters, and bladder. No obstruction or masses.
Usage of Intravenous Pyelography (IVP, Excretory Urography)
Berger's disease, glomerulonephritis, hydronephrosis, renal cell cancer, renal failure, renal hypertension, tubular necrosis, and Wilms' tumor. Examination of the superior ureters during pregnancy as compared with ultrasonography (see Contraindications ).
Description of Intravenous Pyelography (IVP, Excretory Urography)
An invasive test that uses contrast radiopaque dye to assess the ability of the kidneys to excrete dye in the urine. Radiographs are taken after dye injection to visualize the kidneys, ureters, and bladder to assess for obstruction, hematuria, stones, bladder injury, and renal artery occlusion of the renal pelvis. IVP is the first choice for evaluation for kidney stones, if noncontrast computed tomography is not available. IVP is primarily used to examine the upper urinary tract.
Professional Considerations of Intravenous Pyelography (IVP, Excretory Urography)
Consent form IS required.
Risks
Dysuria, nephrotoxicity, urinary tract infection, vasovagal response, allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), renal toxicity from contrast medium, weakness.
Contraindications
Dehydration, pregnancy (because of radioactive iodine crossing the blood-placental barrier), previous allergy to iodinated radiographic dye, renal insufficiency.
Preparation
- Bowel preparation of orally administered evacuation preparation 24 hours before the test and evacuation enema 8 hours before test.
- Assess for high-risk clients: dehydration, elderly, severe diabetes mellitus, renal insufficiency, or multiple myeloma.
- Have emergency equipment readily available.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
Procedure
- The client is placed in slight Trendelenburg position or supine.
- A venipuncture is performed, and dye is injected into a vein.
- Serial radiographs are taken periodically for the next 30 minutes.
Postprocedure Care
- The client should drink at least three 8-ounce glasses of liquid to flush the kidneys of the dye (when not contraindicated).
- Assess for signs of allergic reaction to the dye (listed under Risks) for 24 hours.
Client and Family Teaching
- It is normal to feel flushed and warm and to notice a salty taste soon after the dye is injected. This will last only a few moments.
- Stress the importance of drinking water after the test to flush dye from the body, prevent osmotic diuresis from the dye, and protect the kidneys.
- In women who are breast-feeding, formula should be substituted for breast milk for 1 or more days after the procedure.
Factors That Affect Results
- Poor bowel evacuation or poor renal perfusion will decrease the uptake of dye, leading to poor radiograph quality.
Other Data
- Dosages of radiation range from 1047 to 1465 mR (milliroentgens).
- The test Magnetic resonance urography, although much more costly, is superior to renal ultrasonography in identifying pathology for clients with kidneys that do not opacify (such as those with renal transplants) during excretory urography.
