Intravenous Urography (IVU)

Presented by:
Kemika Bastola
Intravenous Urography
(IVU)
Introduction
Intravenous urography (IVU) is the imaging

investigation of the urinary tract following the
introduction of water- soluble intravenous contrast
media.
Definition
Intravenous urography is a radiological procedure
that is done to visualize abnormalities of the urinary
system including the kidney, ureters, and bladder.
The contrast material is administered intravenously

which is excreted by kidneys, making the urine
opaque to x-ray and allow the visualization of the
renal parenchyma together with calyces, renal
pelvis, ureters and bladders.
In recent years, there has been a decline in the
intravenous urography because of:
Development of newer imaging modalities like

CT Scan, USG, MRI.
Adverse effects of contrast media.
Indications
In adults:
 Suspected urinary tract pathology.
 Investigation of persistent hematuria.
 Renal/ureteric calculi
 Recurrent urinary tract infection including
renal TB.
 Ureteric fistulas and strictures.
 Suspected transitional cell carcinoma.
In childrens:
 Evaluation of VATER anomalies- 90% has
Renal anomalies.
 Malformation of urinary tract: e.g. polycystic
disease, PUJ obstruction.
 Malformation of genitalia:- hypospadiasis
(Hypospadias is a birth defect congenitial
condition in which the opening of the
urethera is on the underside of the penis
instead of at the tip.)
Contraindication
There is no any absolute contraindication.
Relative contraindications are:
 Severe history of anaphylaxis previously
carries 30% risk.
 Renal failure (raised serum creatinine level
>1.5mg/dl).
 Previous allergy to the contrast agent/ iodine.
 Pregnancy.
 Diabetes.
Patient preparation
 Ask the patient for any history of diabetes
mellitus, renal disease or allergy to any drugs
and any specific food especially iodine
containing food.
 Keep the patient NPO for at least 6 hours.
 Instruct the patient to take laxatives to make
sure the digestive system is cleaned out.
Cont..
 If the patient is diabetic and is under
medication called metformin. Hold the
medicine for two days prior to the procedure.
This is because the combination of metformin
and contrast media may affect the kidney
resulting lactic acidosis.
 Take a informed consent.
procedure
 Explain the detailed procedure to the patient.
 Keep the patient on supine position and
provide comfort.
 Open the intravenous line into a prominent
vein in the hand.
 Administer the contrast media. Test the 1ml of
contrast and observe the patient for 1 minutes
to look for any contrast reactions.
 If any reaction does not occur administer the
rest of contrast rapidly within 30-60 seconds.
Filming techniques
1) Plain x-ray KUB/scout film
2) Immediate film (Nephrogram)
3) 5minutes film
4) 15minutes compression film
5) 15 minutes release film
6) Post micturition film
Plain x-ray KUB/scout film
It provides valuable information and it is useful
in assessing :
• Calculus
•Intestinal abnormalities
•Calcification
•Abdominal mass
•Foreign body
Immediate film (Nephrogram)
 This film is exposed 10-14 seconds after contrast

injection (arm to kidney time).
 Renal parenchyma is opacified by contrast media
in the renal tubules.
 It is aim to see Renal outlines.
 The average thickness of renal parenchyma is
3.5cm in polar region and 2.5cm in interpolar
region.
Cont...
 Decrease in parenchymal thickness is seen on
post inflammatory or stone related scarring.
 Increase in renal parenchymal thickness is
seen on renal mass.
5minutes film
This 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.
To see pelvicalyceal system.
Compression band is now applied around the
patients abdomen and balloon is positioned midway
between the anterior superior iliac spine that
precisely over the ureters as they crosses pelvic brim.
Cont..
Compression is done as it inhibits ureteric
drainage and promote distension of
pelvicalyceal system, optimising their
visualization.
Contraindication of compression
1) Recent abdominal surgery
2) Abdominal tenderness
3) Large abdominal mass
4) Acute painful abdomen
5) When 5 minutes film shows already distended
calyces.
6) Renal trauma
15 min compression film
 There is usually adequate distension of

pelvicalyceal system with opaque urine.
 Compression is removed when satisfactory
demonstration of pelvicalyceal system has been
achieved.
15 min release film
This film is taken to over view the
visualization of whole urinary tract: kidneys,
ureters, bladder. Bladder distension can also be
evaluated.
Post micturition film
 This view is taken immediately after voiding. It is

used to assess :
a) Residual urine
b) Bladder mucosal lesions
c) Demonstrate uretheral diverticulum
d) Diagnosis of bladder tumor
Contrast media
• Low osmolar contrast

media:
• Adult dose: 50 -100ml
• Paediatric dose: 1ml/kg
Complication due to contrast
Minor reactions(5%):
 Nausea
 Vomiting
 Mild rashes
 Light head ache
 Mild dyspnea
Intermediate reactions(1%):
 Extensive urticaria
 Facial edema
 Bronchospasm
 Laryngeal edema
 Dyspnea
 Hypotension
Severe reactions(0.05%):
 Circulatory collapse
 Convulsion
 Coma
 Cardiac or respiratory arrest

 Anaphylatic shock
Nursing responsibilities
pre procedure :
 Explain the purpose of procedure to the
patient, benefits and risks, possible
complication and asked to sign an informed
consent form.
 Keep the patient NPO for at least 4-6 hours
before procedure.
 Before the procedure starts, nurse should
review the medical history of patient including
allergies and medications.
 Check the patients chart to determine the
creatinine and BUN levels. patient with
elevated blood levels have a greater chance of
experiencing an adverse contrast media
reaction.
 Patient is asked to empty the bladder and
change into a hospital gown.
 Patient is asked to remove contact lenses,
eyeglasses, jewelry and hairpins.
 An IV line should also be inserted in the
patients hand before the procedure begins in
case of medication or in case of complication
arise.
 Arrange or make ready of intubation set in
case of emergency.
Post procedure:
 Monitor the patients vital sign.
 Observe the patient for at least 4 hours.
 Watch for the late contrast reactions.
 Monitor the patients urine output and instruct the
patient to measure urine for several days.
 Encourage the patients to take fluids inorder to
prevent from dehydration.
 In high risk patient RFT should be done to watch
for deterioration.

Intravenous Urography (IVU)

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Presented by:

Intravenous urography (IVU) is the imaging

The contrast material is administered intravenously

Development of newer imaging modalities like

 This film is exposed 10-14 seconds after contrast

 There is usually adequate distension of

 This view is taken immediately after voiding. It is

• Low osmolar contrast

 Light head ache

 Cardiac or respiratory arrest

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