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Intravenous Pyelography

Intravenous pyelogram (IVP) is an X-ray test that provides pictures of the urinary tract, which consists of the kidneys, the bladder, the ureters, and the urethra. IVP can show the size, shape, and position of the urinary tract, and it can evaluate the collecting system inside the kidneys.

During IVP, a dye called contrast material is injected into a vein (intravenous, IV) in your arm. A series of X-ray pictures is then taken at timed intervals.

IVP is commonly done to diagnose certain diseases of the urinary tract (such as kidney stones, tumors, or infection) and detect abnormalities of the urinary tract that were present from birth (congenital). See an illustration of an IVP showing a kidney stone.

An ultrasound or a computed tomography (CT) scan may be done instead of an IVP to provide more details about the urinary system.

Why It Is Done

Intravenous pyelogram (IVP) is done to:

Evaluate the structure of the urinary tract.
Determine the cause of blood in the urine.
Evaluate ongoing back and flank pain.
Determine the size and location of a tumor of the urinary tract.
Determine the size and location of a kidney stone.
Determine the cause of recurring urinary tract infections.
Detect damage to the urinary tract after an injury.

How To Prepare

Before having intravenous pyelogram (IVP), tell your doctor if:

You are or might be pregnant.
You have an intrauterine device (IUD) in place.
You are allergic to the iodine dye used as the contrast material for X-ray tests or to any other substance that contains iodine.
You have ever had a serious allergic reaction (anaphylaxis) from any substance (such as the venom from a bee sting or from eating shellfish).
Within the past 4 days, you have had an X-ray test using barium contrast material (such as a barium enema) or have taken a medication (such as Pepto-Bismol) that contains bismuth.
You have a history of kidney problems or diabetes, especially if you take metformin (Glucophage) to control your diabetes. The contrast material used during an IVP can cause kidney damage in people who have poor kidney function. If you have a history of kidney problems, blood tests (creatinine, blood urea nitrogen) may be done before the test to confirm that your kidneys are functioning properly.
You will need to sign a consent form that says you understand the risks of intravenous pyelogram and agree to have the test done. Talk to your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will indicate. Complete the medical test information form to help you understand the importance of the test.

Do not eat or drink for 8 to 12 hours before the IVP. You may need to take a laxative the evening before the test (and possibly have an enema the morning of the test) to make sure that your bowels are empty.

How It Is Done

Intravenous pyelogram (IVP) is usually done by a radiology technologist. The IVP pictures are interpreted by a doctor who specializes in interpreting imaging tests (radiologist).

You will need to remove any jewelry that might interfere with the X-ray picture. You will need to take off all or most of your clothes, and you will be given a cloth or paper covering to use during the test. You will be asked to urinate just before the test begins.

You will lie on your back on an X-ray table. A preliminary X-ray picture of your abdomen will be taken. This picture is reviewed by the radiologist before the next part of the test begins.

The injection site on your arm will be cleaned and the contrast material will be injected into a vein on the inside of your elbow. The dye travels through the bloodstream, is filtered out by the kidneys, and passes into the urine. The urine then flows into the tubes (ureters) that lead to the bladder.

X-ray pictures are taken several minutes apart as the dye goes through the urinary tract. Each picture is developed immediately. Sometimes additional pictures are taken based on earlier ones. You may be asked to turn from side to side or to hold several different positions so the radiologist can take a complete series of X-rays.

During IVP, a compression device may be applied to your abdomen to keep the dye in the kidneys. The most common compression device is a wide belt containing two inflated balloons that push in on either side of your abdomen to block the passage of dye through the ureters. If you have recently had abdominal surgery or have an abdominal disorder, the band will not be used.

A special type of X-ray technique called fluoroscopy may also be used during IVP. During fluoroscopy, a continuous X-ray beam is used to display a moving image on a video monitor.

IVP usually takes about an hour. After the test is completed, you will be encouraged to drink plenty of liquids to help flush the contrast material out of your body.

If you are breast-feeding, give your baby formula for 1 to 2 days after the procedure until the contrast material has passed from your urinary system.

How It Feels

You will feel no discomfort from the X-rays. However the X-ray table may feel hard and the room may be chilly because air-conditioning is used to keep the X-ray equipment at a constant temperature.

You will feel a brief sting when the needle is inserted into the vein in your arm. When the contrast material is injected, you may feel slight burning in your arm and flushing throughout your body. You may also notice a salty or metallic taste in your mouth.

The compression belt may produce a sensation of pressure. If it becomes painful, tell the technologist and ask that it be readjusted.

You may feel slightly weak, nauseated, or lightheaded for a short time after the test.

Risks

There is always a slight risk of damage to cells or tissue from being exposed to any radiation, including the low levels of radiation used for this test. However, the risk of damage from the X-rays is usually very low compared with the potential benefits of the test. There are precautions you can take to reduce your risk of radiation exposure from X-rays.

There is slight risk of developing an allergic reaction to the iodine contrast material. The reaction can be mild (itching, rash) or severe (difficulty breathing or sudden shock). Death resulting from an allergic reaction is very rare. Most reactions can be controlled with medication. Be sure to tell your doctor if you have allergies of any kind (such as hay fever, iodine allergy, asthma, bee stings, or food allergies).

People with certain conditions (such as diabetes, multiple myeloma, chronic kidney disease, sickle cell disease, or pheochromocytoma) have an increased risk of developing sudden kidney failure from IVP. Older adults and people taking medications that affect the kidney may also have an increased risk for complications from IVP.

Results

Intravenous pyelogram (IVP) is an X-ray test that provides pictures of the urinary tract. Preliminary results are sometimes available immediately after the test. Full results are usually ready in a day.

Normal:The kidneys, ureters, and bladder are normal in position, size, and shape. The contrast material reaches the kidneys in a normal amount of time.
No blockage can be seen in the kidneys, ureters, or bladder.
In men, the prostate gland appear normal in position, size, and shape.

Abnormal:The kidneys, ureters, or bladder may be abnormal in position, size, or shape. A kidney may be absent, or an extra kidney or ureter may be present.

The contrast material may take longer than normal to reach a kidney, which may indicate kidney problems.

An abnormal growth (such as a tumor) or condition (such as a cyst, an abscess, or a kidney stone) may be present. A kidney swollen with urine from a blockage (such as a tumor or kidney stone) may be present. Multiple cysts on the kidney may suggest polycystic kidney disease.

If trauma occurred, the degree of injury to the kidney or ureter may be seen.

Scarring on the kidney may indicate a chronic kidney infection.

A small kidney may indicate chronic kidney problems.

In men, the prostate gland may be enlarged.

What Affects the Test

Factors that can interfere with your test and the accuracy of the results include:

Inability to remain still during the test.
Having a large amount of stool (feces) or gas in the large intestine (colon).
A recent test with barium (such as a barium enema) or bismuth.

Intravenous pyelogram (IVP) is not usually done for a pregnant woman because the X-rays could damage the developing fetus. If a view of a pregnant woman's kidneys is needed, an ultrasound test may be done instead.

2012-01-12