Intravenous Pyelogram

An intravenous pyelogram (IVP) is a type of x-ray that allows visualization of the kidneys and ureters after the injection of a contrast dye. The dye helps enhance the image on an x-ray film.

As the contrast dye moves into and through the kidneys, ureters, and bladder, x-rays taken at short intervals can capture its movement. A delay in the contrast dye moving through the urinary system may indicate an obstruction in the kidney’s blood flow or poor kidney function.

A radiologist can then assess the function and detect abnormalities of the urinary system. This test is usually ordered as one of the first tests in cases of suspected kidney disease or urinary tract disorders.

Reasons for the Procedure

An IVP can demonstrate the size, shape, and structure of the kidneys, ureters, and bladder. It can also be used to evaluate kidney function, the presence of kidney disease, ureteral or bladder stones, enlarged prostate, trauma or injury, and tumors. IVP may be performed in the presence of flank pain or spasmodic pain in the kidney area.

A CT scan of the kidneys, sometimes performed at the same time as an IVP, aids in more accurately diagnosing and locating kidney tumors and lacerations of the kidneys resulting from trauma.

There may be other reasons for your physician to recommend an IVP.

The amount of radiation used during an IVP procedure is considered minimal. Therefore, the risk for radiation exposure is very low.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

If contrast dye is used, there is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications, contrast dye, iodine, or shellfish should notify their physician.

Patients with kidney failure or other kidney problems should notify their physician. In some cases, the contrast dye can cause kidney failure, especially if the person is taking Glucophage® (a diabetic medication).

Possible complications of IVP include, but are not limited to, problems with urination, urinary tract infections, allergic reaction, and/or renal toxicity resulting from the contrast dye.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician before the procedure.

Certain factors or conditions may interfere with IVP. These factors include, but are not limited to, the following:

• Feces or gas in the colon
• Poor blood flow to the kidneys
• Barium in the intestines from a previous barium procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form, which gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• You will need to fast for a certain period of time before the procedure. Your physician will notify you how long to fast, whether for a few hours or overnight.
• If you are pregnant or suspect that you may be pregnant, you should notify your physician.
• Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or seafood.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, or anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking. If you are diabetic and taking a medication called Glucophage, you may be asked to stop taking that medication 24 hours before the test.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications before the procedure.
• A laxative may be prescribed the night before the test and a cleansing enema or suppository may be given a few hours before the procedure.
• Your physician may request a blood test to assess your kidneys’ ability to tolerate the contrast dye.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

An IVP may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, an IVP follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
2. If you are asked to remove clothing, you will be given a gown to wear.
3. An intravenous (IV) line will be inserted in your hand or arm.
4. You will be asked to lie face up on an x-ray table.
5. A preliminary KUB x-ray will be taken.
6. Contrast dye will be injected into the IV line. You may feel some effects when the dye is injected into the IV line. These effects include a flushing sensation, a salty or metallic taste in the mouth, a brief headache, itching, or nausea and/or vomiting. These effects usually last for a few moments.
7. To help visualize the internal structures, a band may be placed around your waist to help compress the organs.
8. A series of x-rays will be taken at timed intervals, generally over a 30-minute period, as the dye travels through the kidneys and urinary tract. You may be asked to assume various positions while the x-rays are being taken.
9. You will be asked to empty your bladder. You may be given a bedpan or urinal, or you may be allowed to go to the restroom.
10. After you have emptied your bladder, a final x-ray will be taken to examine the amount of contrast dye remaining in the bladder.

After the Procedure

You may resume your usual diet and activities, unless your physician advises you differently.

You should monitor your fluid intake and amount of urine voided over the next 24 hours. You may be instructed to increase your fluid intake to help flush the contrast dye from your body.

Notify your physician to report any of the following:

• Fever and/or chills
• Redness, swelling, or bleeding or other drainage from the IV site
• Blood in your urine
• Nausea, itching, and/or sneezing

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.