Preparation for kidney urography with contrast. How is infusion urography performed? Excretory or excretory

Urography of the kidneys in children is one of the most common studies. It provides an objective picture of the condition of the organs. Based on this examination, the doctor can conclude whether there are damaged tissues, whether the functioning of the ureters and bladder is impaired. However, this type of diagnosis has its own characteristics. They should definitely be taken into account in order to properly prepare children for research.

Characteristics of the survey

What is urography? This diagnosis is an x-ray examination that shows the condition of the child’s urinary system.

The essence of the method is based on the injection of a contrast agent into the kidneys. That is why the study is called contrast urography. The injected substance is capable of blocking X-rays.

Initially it accumulates in the kidneys. At this time, the doctor can assess their condition using images. The substance then passes into the urinary system. Thus, this diagnosis gives an idea of ​​the functioning of the ureters and bladder.

When is the examination scheduled?

The main indications for this procedure are pathology:

• stones in the kidneys, ureters;
• abnormal kidney development;
• hematuria, tumors of unknown nature;
• illnesses - tuberculosis, acute pyelonephritis in children;
• kidney injuries;
• tumors.

There are several types of urography, each of which has its own indications, degree of information content and specificity of implementation.

Kinds

The following varieties are distinguished:

Doctors consider urography the most informative diagnostic method. However, there are situations when the use of research is prohibited. The list of restrictions for urography is much more extensive than for ultrasound.

X-ray examination with the use of a contrast agent is contraindicated for children diagnosed with:

• acute glomerulonephritis;
• thyrotoxicosis;
• renal failure (and chronic form, and acute);
• decreased blood clotting;
• some kidney ailments, genitourinary system;
• diabetes mellitus if the child is taking Glucophage;
• pheochromocytoma (active hormonal tumor).

Another obstacle to such diagnostics is the increased sensitivity in children to iodine-containing substances.

Objectives of the study

It is quite difficult to identify various kidney lesions or urinary tract disorders in children, since the symptoms of some kidney diseases are very similar to other pathologies. Such signs may indicate colds, acute respiratory viral infections, problems with the gastrointestinal tract, heart, and even diseases of the spine.

Therefore, in order for the doctor to make a correct diagnosis, it becomes necessary to check the functioning of the kidneys. It is urography that can solve such a problem.

This event allows you to determine kidney parameters that are directly related to their functioning:

• dimensions;
• contours and shapes;
• presence of increments (urolithiasis);
• location in relation to internal organs;
• functioning of the ureters, bladder;
• functional state.

In order for the diagnosis to be carried out correctly and show the most reliable results, children should be carefully prepared for urography.

Preparation.

Before urography you will have to take blood biochemistry. Such an analysis allows us to exclude pathologies such as renal failure, in which diagnosis is strictly contraindicated.

Preparation for the study consists of the following activities:

1. 3 days before the procedure, you should exclude foods rich in fiber and carbohydrates from your diet. Babies are transferred to dietary nutrition.
2. Older children are recommended to take Activated Charcoal. They give the kids this remedy only as prescribed by a doctor. This measure allows for excellent gas absorption.
3. 1 day before urography you need to take a laxative. The doctor will prescribe it. Before going to bed, the child is given an enema.
4. If the procedure is performed on teenagers, it is recommended to refrain from eating in the morning. Young children are allowed to eat a small piece of meat with white fried bread. After eating, you should give the enema again.

Mechanism

Now let's consider how to do the procedure itself. Before urography, an ultrasound is initially performed. It allows you to clarify the individual characteristics of the body.

Various substances are used for diagnosis:

• triombrine,
• urotrast,
• verografin,
• triiodotrust.

All of them are strong allergens. Therefore, initially the doctor calculates required amount contrast agent. It takes into account the child’s age, weight, liver and kidney condition.

To protect the patient from allergic reactions, it is recommended to take an antihistamine. Children can receive an injection half an hour before the examination. The most commonly used drug is Suprastin.

The doctor will definitely explain how the diagnosis is made. During urography, 5 images are recorded. It is very important that they turn out right the first time.

Therefore, the parents are with the child. Older children are asked to lie still. Parents should take care of the immobility of their children. After all, the slightest movement can affect the quality of the pictures. It is quite difficult to determine kidney disease in such a situation. One-year-old children may be given anesthesia.

Consequences of the procedure

The child may experience negative reactions on contrast agent:

• feeling of heat;
• nausea;
• slight dizziness;
• hives.

Such reactions most often go away on their own. Sometimes you may need to take an additional antihistamine.

More serious consequences of the procedure, which are observed extremely rarely, are:

• breathing problems;
• a sharp decrease in pressure.

Despite the fact that such symptoms occur only in isolated cases, the urography room is necessarily equipped with all the necessary tools to provide anti-shock emergency assistance.

The results of kidney urography allow an accurate diagnosis in children. X-ray examination with a contrast agent determines the degree of functioning of the kidneys, ureter, and bladder.

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Intravenous urography is a diagnostic research method that allows, using X-rays and a contrast agent, to examine the urinary system, the condition of the collecting structures, and the excretory capacity of the kidneys. Visually evaluate anatomical structure This is possible thanks to the passage of a special drug through the urinary tract - the process is recorded on photographs.

The diagnostic technique has been known since 1929, but since then has not lost its relevance, despite the development of medicine and the active introduction of high technologies in the field of health care. Of the several types of urography, the intravenous infusion type is recognized as one of the safest and most accurate.

Intravenous urography is used to determine a large number of pathologies of the urinary system.

The technique has the following capabilities:

1. Allows you to assess the functioning of organs in case of detected pathologies (tuberculosis, pyelonephritis, trauma). The action is possible with a certain accumulation of contrast agent.
2. Can visualize focal inflammation, foreign bodies and stones in tissues.
3. It makes it possible to obtain a complete morphological picture of the processes of change in the organ as a result of the development of the disease.

The diagnostic method is especially popular in pediatrics due to its ease of implementation. Unlike ascending urography, which is performed on children under anesthesia, the method does not require the use of serious anesthesia drugs.

Using the study, you can identify the following diseases:

• kidney hydronephrosis;
• traumatic lesions of renal tissue;
• malignant or benign formations;
• stone formation;
• foreign bodies, diverticula in the bladder cavity;
• dysfunction of bladder emptying;
• kidney development abnormalities;
• kidney tuberculosis.

Indications for intravenous urography:

1. violations of the excretory function of the kidneys;
2. abnormal development of one or two kidneys;
3. urolithiasis disease;
4. chronic organ pathologies;
5. suspicion of tumor formations of a malignant or benign nature;
6. changes in bladder functionality;
7. inflammation.

Contraindications are determined based on the irradiation process and possible individual intolerance to the contrast agent and saline solution. These include:

• individual iodine intolerance;
• pregnancy;
• excess iodine in the patient’s body;
• fever;
• hyperthyroidism;
• decompensated pathologies of the lungs, cardiovascular system, liver;
• collapse, shock;
• radiation sickness;
• severe kidney pathologies associated with impaired excretory function.

When prescribing intravenous urography for diabetic patients, the doctor needs to know about the medications they are taking: the drug Glucophage, which contains metformin, combines with an iodine-containing contrast agent to provoke a sudden increase in the level of lactic acid in the patient’s blood, which causes acidosis.

Also, if diabetes is diagnosed, it is necessary to control the release of contrast and speed up its removal from the body.

Patient preparation

The technique requires certain preparation, which should begin 3 days before the scheduled urography. Not only the information content of the procedure, but also the safety of the patient depends on compliance with the recommendations, so compliance with the instructions is mandatory.

Preparation for intravenous urography:

1. Anamnesis collection.
2. Colon cleansing feces, gases (washing, enema). The procedure must be done twice - in the evening, on the eve of the examination, and 3 hours before the appointed time.
3. In 3 days you need to switch to a diet that prevents increased gas formation. It is necessary to exclude baked goods, confectionery products, carbonated drinks, fresh vegetables and fruits, fermented milk products, and legumes.
4. The day before the test, limit the amount of liquid you drink - this will increase the concentration of urinary sediment.
5. 12 hours before the procedure, take activated charcoal, which will reduce the likelihood of gas accumulation in the intestines.
6. On the day of urography, a light snack is allowed, excluding foods that are too high in calories and dishes that increase gas formation.
7. If the patient is anxious or afraid of manipulation, he is prescribed sedatives in an individual dosage.

Preparation is necessary to obtain highly accurate data and minimize the risk of complications during contrast fluid administration. Measures before urography are aimed at preparing the patient and are complex not only because of the multi-stage nature, but also because individual characteristics each person.

Points to pay attention to:

1. Bedridden patients swallow large amounts of air, so they are advised to stay in bed more often. vertical position before the procedure.
2. Diet during the preparation phase is important for young people.
3. Elderly people and patients with intestinal atony require cleansing enemas for a quality diagnosis.

The use of iodine-based products impairs the liver's ability to neutralize gases - this must be taken into account in the period after the examination. After diagnostic procedure recommended drinking plenty of fluids, which will speed up the removal of contrast from the patient’s body.

The essence of the method and features of the drugs used

The contrast agent that is administered to the patient is reflected well on the urograms made, and allows one to evaluate the functioning of each of the kidneys, ureters, excretory tract, bladder, and urethra. It is important to record changes as the material is processed by the kidneys and fluid colored with a contrast agent passes through the body (to learn about deviations by comparing the data with established standards).

The choice of drug must be approached responsibly, because not only the informativeness of the method, but also the safety of the patient depends on it.

The selected drug should not:

• be toxic;
• accumulate in body tissues;
• take part in the general metabolic process.

IN modern medicine They use the following ready-made drugs: Urografin, Vizipak, Cardiotrast, Triyomblast. In addition to choosing the right medication, it is important to ensure its rapid removal from the body - after intravenous urography, drinking plenty of fluids is recommended.

How is the diagnosis done?

Before administering a drug containing iodine, it is necessary to ensure that the patient is individually tolerable and that the patient is not allergic to the components of the drug. The night before, you need to do an allergy test (skin test), or inject up to 3 ml of the drug subcutaneously.

The procedure is performed in the supine position. The patient lying on the couch is injected with up to 30 ml of contrast agent intravenously. It is important to administer the drug slowly, over 2–3 minutes, and at this time monitor the patient’s well-being. Patients with cardiac problems require special attention. vascular pathologies, atherosclerotic changes and people of the older age group.

The drug is administered slowly to prevent anaphylactic shock. The first pictures should be taken 5–6 minutes after the iodine-containing drug enters the bloodstream. The following images record the state of the organ at the 10th, 20th, 45th minutes and an hour later.

For the accuracy and information content of the method, data is recorded both lying down and standing. Changing the patient's body position during the examination will help identify abnormalities such as kidney prolapse.

The number of images and the frequency of recording changes depend on the preliminary diagnosis. If pathologies involving the urethra are suspected, data must be recorded during the urination process.

Side effects

Various reactions after the procedure are rare, but it is better to find out about them before the examination.

Side effects after urography:

• hypotension;
• fever during contrast administration;
• respiratory disorder;
• iron taste in the mouth;
• rash;
• swelling of the lips;
• renal failure.

To minimize the likelihood of side effects, experts recommend drinking more fluids after the procedure - this way the drug is eliminated from the body faster.

Pros and cons of the technique

Excretory urography is popular in diagnosing various pathologies of the urinary system. Compared to the retrograde technique, intravenous has the following advantages:

• does not require cystoscopy at the preparation stage;
• it is possible to obtain accurate information about the morphological and functional state kidneys, bladder;
• diagnosis is almost painless (no discomfort, except for the puncture for the administration of a contrast agent);
• makes it possible to examine patients with severe injuries
• does not require anesthesia.

1. reduced volume urinary tract;
2. inability to identify pathological disorders at an early stage of their development;
3. the picture of the ureters is presented in sections, and not as a whole;
4. there is insufficient contrast on urograms (including as a result of violation of the preparation rules);
5. non-simultaneous and uneven filling of the cups.

Intravenous urography has many advantages over innovative technologies and that is why it is still so actively used to determine pathologies in patients of various age groups.

Affordable and informative method diagnostics is used everywhere and has few contraindications. The use of urography makes it possible to differentiate pathologies with similar symptoms and begin treatment as quickly as possible.

The method is available everywhere and does not require large material costs, but at the same time it allows you to obtain no less data than expensive studies - CT, MRI. Intravenous urography is one of the main methods for diagnosing pathologies of the kidneys and urinary tract.

At various pathologies renal and urinary systems, in medical clinics Intravenous urography has been increasingly used.

The modern examination method allows you to obtain highly accurate results.

However, this procedure has its limitations for use, and it is also important to know a number of rules for proper preparation before intravenous urography.

Indications for the procedure

Intravenous urography of the kidneys is prescribed by the attending physician in the presence of the following diseases and disorders:

• various pathologies of the genitourinary system;
• inflammatory process of the urinary tract;
• disruption of the integrity of the bladder;
• abnormal change in bladder functionality;
• chronic kidney disease;
• urolithiasis disease;
• abnormal location (prolapse) of the kidneys;
• oncological neoplasms (both benign and malignant);
• failure and slowdown in the excretory functioning of the kidneys.

There is a fairly extensive list of pathologies for which intravenous survey urography will help as much as possible. in full determine the patient's condition.

If the patient is suspected of slowing the excretory functioning of the kidneys, he is prescribed intravenous excretory urography.

Also, intravenous urography is a mandatory procedure performed before any surgical intervention in the area of ​​the genitourinary system (for example, if surgery directly on the bladder itself or removal of kidney stones is indicated).

Undergoing an intravenous urography procedure is a serious intervention in the human body. The decision to perform the procedure must be made by the attending physician. It is strongly not recommended to carry out this examination technique on your own initiative!

Contraindications

Like anyone else medicinal method, this procedure has a number of contraindications for which it is strictly forbidden to perform this procedure examinations.

Contraindications to intravenous renal urography are presented in the following list:

• hyperfunction of the thyroid gland (hyperthyroidism);
• excess iodine in the body or intolerance to substances containing iodine;
• feverish condition.

However, if the patient’s health and life are at risk, the attending physician may decide (in exceptional cases!) to refer the patient for examination.

For representatives of the fair sex there is another conditional contraindication - the menstrual cycle.

Women during pregnancy and lactation (breastfeeding) require special, increased attention and caring attitude. In case of pathology of the renal and genitourinary systems, the attending physician must decide to refer the patient for intravenous urography with special precautions!

Preparation for the procedure

Preparation for intravenous urography requires special attention.

If the patient has received a referral from the attending physician for this examination, he needs to familiarize himself with a number of rules for proper preparation:

After following all the above recommendations, you can be sure that the examination will take place as efficiently as possible, and the result will be impeccably accurate. It is worth noting that in different medical clinics, patient preparation for intravenous urography may differ slightly.

Also, immediately before the procedure, the patient must be fully informed about how the examination will be carried out and how the patient will feel.

The fact is that intravenous urography can cause a person to have very unpleasant symptoms and sensations.

And human psychology is designed in such a way that all unusual and uncomfortable feelings can cause panic and fear. The patient may also experience obvious anxiety before an unknown procedure. Any nervous disorder and the patient’s emotional stress can have an extremely negative impact on the examination results.

Some medical institutions provide for the administration of sedative(intravenous or intramuscular route, or in tablet form). This will allow the patient to return to normal psycho-emotional state, get rid of fears and neuroses.

With the help of intravenous urography, the healthcare professional monitors the shadows of the urinary tract during x-rays. If the patient is nervous and under emotional stress, the shadows may not be displayed correctly, which will ultimately lead to inaccurate results.

Methodology of the procedure

Having familiarized yourself with all the indications and contraindications, as well as preliminary preparation, it’s time to understand how intravenous urography of the kidneys is done.

Equipment for urography

The procedure is carried out in several stages. The patient lies down on the X-ray table, after which several standard images are taken. After the first stage, the patient is administered a contrast agent intravenously.

It is usually inserted into a vein in the elbow. A contrast agent is a medicinal composition that, when conducting radiological studies, allows you to visualize the area being examined as accurately as possible and significantly increases the accuracy of the data.

The contrast is completely harmless and incapable of causing negative consequences(such as an allergic reaction).

However, in some cases, a person who receives intravenous contrast may experience some discomfort such as headache, dizziness, nausea, and vomiting. This is quite rare and is of an exclusively individual nature.

One of the most important points when performing intravenous urography of the kidneys is that medical worker very slowly injects the contrast agent into the patient (the duration of administration takes about two minutes). This technique allows you to minimize the occurrence of discomfort and discomfort at the patient.

Some time after the administration of the drug (within 5-10 minutes), the X-ray procedure begins. Several new images are taken at different time intervals, which are determined by an experienced urologist individually for each patient.

In some cases, another stage of examination may be required, for more later after administration of a contrast agent (on average an hour). The doctor can also refer the patient for an x-ray in a standing position.

This will allow you to observe the work of the kidneys in dynamics and track their mobility, and in addition, detect pathology or anomaly regarding the location of the kidneys.

The procedure is absolutely painless; you may only experience slight discomfort when inserting a needle with a contrast agent. However, since intravenous procedures are quite common in medical practice and are familiar to almost every person, then intravenous administration of the drug should not cause any concern.

Intravenous urography of the kidneys is sufficient safe procedure, especially if carried out by experienced medical specialists. Nevertheless, it is a prerequisite that the radiography room contains all the necessary means for providing first aid. medical care if the patient feels unwell when the drug is injected into a vein.

Side effects

Despite the fact that with proper preparation and under the close supervision of experienced physicians, the procedure is quite safe, side effects may occur after it is performed.

Side effects include the following:

1. after the procedure, the patient may feel a taste of iron in the mouth;
2. in some cases, a rash may be observed on the patient’s skin;
3. after the procedure, the patient may feel very thirsty and dry mouth;
4. slight swelling of the lips is a rather rare pathology after urography;
5. a contrast agent can lead to tachycardia (rapid heartbeat), which soon stops and the person notices the rhythm of the heart muscle that is familiar to him;
6. during urography, as well as after its completion, the patient’s blood pressure may drop significantly;
7. the hardest and dangerous consequence after the procedure - appearance liver failure(even if the patient has never previously complained of problems with the body’s main barrier – the liver).

Since the side effects are quite significant, it is worth noting once again that intravenous urography must be carried out under the close supervision of experienced doctors and all prescribed recommendations must be followed. If you feel unwell or have complications after urography, you must immediately notify your doctor.

Video on the topic

How does it feel during and after intravenous urography? Feedback from one of the patients before you:

Urography is performed to study the condition of the kidneys: the patient is injected with contrast and x-rays. For this reason, a similar method of studying the condition of the kidneys is called contrast urography. The method is based on the ability of the injected contrast to block X-rays: first, the dye accumulates in the kidneys, then it is released by the organs of the genitourinary system, and this makes it possible to assess their condition.

Urography is prescribed to patients with suspected kidney stones, genitourinary tract infection, in the presence of blood in the urine, which can signal acute inflammation or cancer, and in cases of damage to the urinary tract.

There are survey, intravenous, excretory urography.

Survey urography

Survey urography makes it possible to study the condition of the kidneys, starting from their upper poles and up to the beginning of the urethra.

Survey urography is prescribed in cases where it is necessary to additionally study the bones of the skeleton, the shadows of the kidneys, their shape and location, and assess the general condition and functionality of other genitourinary organs: the bladder, ureters.

Excretory urography

The technique is based on the excretory function of the kidneys and most photographs are taken at the moment when the kidneys begin to secrete contrast.

Excretory urography allows you to evaluate the intensity and time of filling of the pelvis and bladder with liquid, shape, size, homogeneity, location of stones and found neoplasms (cysts, tumors), structural features of the bladder and other organs of the urinary system.

Intravenous urography

This method of contrast urography is that the patient with an empty bladder contrast is injected and pictures are taken while the kidneys take it from the blood and accumulate it: in the first two minutes, after 4-5 minutes. and after another 7 minutes. after administration of contrast.

Radiographs obtained after intravenous urography show the kidneys, pelvis and ureters, bladder, prostate gland. Using intravenous urography, it is possible to identify tumors, cysts, stones, enlargements of the renal cavities (hydroureter, hydronephrosis), pathological wrinkling and stretching, hyperplasia of tissues of the genitourinary system.

Preparation for kidney urography

Usually, before kidney urography, the patient is prescribed to donate blood to study its biochemical composition - this rules out renal failure, in which the examination cannot be carried out.

Two days before urography, the patient is advised to exclude from his diet foods that cause excessive gas formation.

Three hours before the procedure, eating is not allowed. If the doctor deems it necessary, you can take a laxative the day before.

Before undergoing kidney urography, the patient must inform the doctor about the medications he is taking and whether he is allergic to iodine preparations.

Immediately before the examination, you must remove items containing metal from yourself: jewelry, glasses, dentures, etc.

The procedure is painless and lasts no more than an hour and a half. The patient can be in a supine position or in a standing position.

Contrast urography is contraindicated for pregnant and lactating women.

Side effects of contrast urography

Side effects rarely occur after the procedure, but the following patient reviews have been recorded:

• after the administration of contrast, a feeling of warmth is felt, after irradiation - a taste of iron in the mouth;
• the reaction to contrast manifests itself in the form of a transient mild rash and swelling of the lips. In some cases, the patient was prescribed antihistamines.
• blood pressure dropped, breathing problems arose;
• kidney failure suddenly appeared.

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The study of the kidneys using X-rays - urography, is aimed primarily at diagnosing nephrolithiasis (calculi, otherwise stones) and determining changes in the structure of organs. Depending on the suspected disease, the patient is prescribed excretory or survey urography.

The first type of examination is more focused on assessing the excretory functions of the kidneys, is carried out according to individual indications, and takes a fairly long period of time. The procedure is performed using a special contrast agent, the intravenous injection of which provides a more detailed image on the X-ray.

Possibilities of overview urography

Survey urography does not involve the use of contrast. Essentially, this is the same x-ray focused on the lower part of the body. The capabilities of the method make it possible to determine the presence of stones of different chemical composition:

• oxalates. The source of formation is oxalic acid;
• loss. The most common type of stones are formed from uric acid salts;
• struvites. The source is ammonium phosphate;
• phosphates. Composed of calcium phosphate;
• carbonates. They are formed from calcium salts of carbonic acid.

Survey urography allows you to clarify the location of kidney stones

Carrying out the procedure

Diagnosis of renal pathologies using urography is carried out as a regular x-ray examination. The patient may be in an upright or horizontal position, depending on the device model. The focus of the x-rays is projected onto the lumbar area L3–L4 (third and fourth vertebrae) at an angle of 90 degrees.

The procedure takes a short period of time (5 to 7 minutes) and is not burdensome for the patient. All that is required of the subject is to maintain a static position and for a few seconds, on command medical specialist, hold your breath. This is done to ensure that the image of the organs on the x-ray is clear, without blurred areas.

Excretory urography with the use of contrast involves the radiologist taking several sequential images with a time range of 15–20 minutes. The examination lasts about 50 minutes, and the patient may experience an uncomfortable burning sensation from the use of a contrast agent.

X-ray results

The department doctor decodes the results radiology diagnostics. The image is described sequentially according to a specific algorithm:

• condition of the spine and pelvic bones. For chronic renal pathology there is a high probability of developing a frontal curvature of the spinal column;
• shadows of the buds and their location. According to the standard, the left shadow should be located from the 12th thoracic vertebra up to the 2nd vertebra of the lumbar spine, the right one - slightly lower - from the 1st to 3rd lumbar vertebrae. When assessing shadows, the diagnostician describes their outlines, sizes and shapes;
• kidneys directly. Healthy organs should have clear outlines and a homogeneous structure. In the presence of a single cyst, a tubercle is visible; in polycystic disease, the kidney is enlarged, and the outline of the organ is wavy. The tumor is determined by the growth of the kidney and curved contours;
• lower back muscles. Blurry outlines indicate the presence tumor formations and internal hematomas;
• hollow tubes connecting the kidneys to the bladder or ureters. These organs are visualized on the image only if there are other concomitant diseases;
• bladder. Normally, the urinary reservoir is not visible; its visibility is due to the presence of urine with any impurities in the organ.

According to the doctor's description, the patient receives examination results, including information: about the condition of the kidneys (size, shape, shape, location, structure) and the presence (absence) of stones. And also, about the degree of deformation (if any) of the pelvic bones, the lower part of the spine, and possible injuries to the lower back muscles. For an experienced radiologist, the description process takes no more than a quarter of an hour.

Analysis of the urography results is carried out by a radiologist, but the final diagnosis is made by the attending physician

Preparatory activities

In the absence of contraindications to urography, two days before the examination, the patient is given an intravenous blood sample for laboratory analysis, and a diet is prescribed.

Nutrition

The need to prepare for survey urography of the kidneys is due to the fact that the study affects organs digestive tract. A full intestine will become an obstacle to clear visualization of the renal apparatus. The diet consists of simplifying the diet by excluding a number of foods from it. First of all, this concerns foods that can provoke increased gas formation in the intestines.

During the preparatory period, you should avoid the following dishes, drinks and food products:

• pickled, sauerkraut and raw cabbage;
• whole fresh milk;
• dishes made from beans, lentils, peas;
• products made from rich yeast dough and sweet desserts;
• multi-ingredient yoghurts;
• kvass and sweet carbonated water, alcoholic drinks.

Fruits and fresh vegetables are prohibited: radishes, radishes, cucumbers, apples, grapes, pears, as well as nuts, seeds and berries with small seeds. It is not recommended to eat heavy, fatty foods and foods processed by cooking by frying:

• mayonnaise-based fatty sauces;
• sausages;
• side dishes of pasta and potatoes;
• fatty fish and meats;
• hot seasonings and spices.

You should not eat salty or pickled foods, since the drinking regime is subject to a limit the day before kidney urography. The amount of liquid you drink should be minimal and without added sugar. The restriction is introduced to achieve the required level of urine concentration. This condition of the patient contributes to the appearance of the maximum contrast pattern on the radiograph.

The examination is usually scheduled for morning hours. In order for the gastrointestinal tract to completely process food, you need to have dinner no later than 10-12 hours before the procedure.

Medical training

In addition to the diet, preparatory measures before survey urography include bowel cleansing with the help of special medications and an enema procedure. To carry out lavage (cleansing), laxatives are used that do not have an aggressive effect on the gastrointestinal tract. The basis of such medicines constitutes a linear polymer macrogol.

The most commonly used are Fortrans, Lavacol, Endofalk, etc. Medicines are available in powder form for the preparation of a solution. The drug is diluted with water at the rate of one packet per liter. The dosage of liquid medicine is liter for every 20 kg of the patient's weight. You should drink it in two doses: half at night, the rest in the morning. It is necessary to do an enema twice. The volume of liquid for rectal administration is two liters, the temperature of the water should correspond to body temperature. If desired, you can add a decoction of medicinal herbs to the water.

The use of sena-based medications is not recommended

Purpose of urographic examination and contraindications

Indications for the examination are the symptoms that the patient complains about, kidney disease previously diagnosed, confirmation of the doctor’s diagnosis. Diagnosed diseases include:

• dilation of the renal pelvis and calyces due to impaired urine outflow (hydronephrosis);
• renal anomaly of anatomical nature (displacement, doubling, mobility of the kidney);
• the presence of stones of various origins in the kidneys, ureter and bladder;
• various formations (tumor, cyst, abscess);
• presence of blood in the urine (hematuria);
• inflammatory damage to the renal tubular system (pyelonephritis);
• mechanical injuries of organs;
• syndrome of acute pain in the lumbar region.

Urography is not done if the patient suffers from radiation sickness, has a history of surgery to remove one kidney, or for women in the perinatal period. The procedure is not recommended for children without clear indications. The examination should not be performed more than twice a year, since X-rays tend to accumulate in the body. If diagnostics are needed more often, you should resort to a more modern and safe method– magnetic resonance imaging.

Indirectly, according to excretory urography, one can judge the function of other organs of the genitourinary system.

Genitourinary system

The main function of the kidneys is to excrete ( excretion) urine, which, in turn, is realized through filtration and secretion. It is these basic functions that are examined during urography. Normally, with good excretory capacity of the kidneys, the contrast introduced into the body is excreted by the kidneys in a 5% concentration. The contrast present in the urine colors the contours of those urinary organs, in which it is located. Therefore, the main criterion for urogram ( urography image) is a display of the outlines of the kidneys, ureters and bladder.

The method involves intravenous injection of a contrast agent into the blood, after which it spreads throughout the body. The substance is then transported to the kidneys and excreted through the urinary tract. X-ray images are taken 10 to 15 minutes after the substance is administered. They visualize excretion ( excretion) substances, and by how this happens, kidney function is judged. Thus, urography is nothing more than a radiography method using contrast.

As a rule, before performing excretory urography, a plain radiography is performed.

Intravenous contrast urography of the kidneys

Survey urography

Survey urography covers almost the entire urinary system - from the kidneys to the beginning of the urethra, including the spine. During survey urography, a so-called overview image is taken, from which any X-ray examination of a urological patient begins.

When interpreting a survey radiograph, the condition of the bone skeleton and soft tissues is taken into account ( if any are displayed), contours of the kidneys, shadow of the lumbar muscles.

The stages of description of survey urography include:

• determining the position of the spine– significant curvature of the spine ( lumbarization, scoliosis) affect the functioning of the genitourinary system;
• localization of the kidneys on both sides of the spine– normally the right kidney is located slightly lower than the left;
• kidney outlines- normally homogeneous ( homogeneous);
• shadow of the lumbar muscles– homogeneous, on the radiograph it takes the form of a truncated pyramid;
• disappearance of the shadow of the lumbar muscles- indicates availability pathological changes- about injuries, hemorrhages;
• ureters– normally not visible on a survey image, the appearance of their contours indicates the presence of an inflammatory process;
• bladder- is visualized only in the form of a shadow, which has the shape of an ellipse.

CT urography

Computed tomography is a modern diagnostic method for identifying various structural and functional anomalies, including the genitourinary system. The study is based on the same X-ray radiation. However, the advantage is that the method allows one to obtain layer-by-layer images of the organ. Thus, CT urography is more informative than simple urography.

Indications for CT urography are:

• suspicion of stones in the kidneys, ureters, bladder;
• chronic, periodically exacerbating urinary tract infections;
• congenital anomalies of the kidneys, ureters, bladder;
• suspected urinary tract blockage;
• kidney and urinary tract injuries;
• neoplasms ( tumors, kidney cysts) in the genitourinary system;
• hematomas ( collections of blood) or abscesses ( accumulations of pus) in the kidneys.

The contrast agent is administered intravenously, most often using a catheter, less often using a dropper. The volume of the required substance is calculated using the formula - 0.5 milliliters per kilogram of body weight. Thus, the volume of contrast ranges from 30 to 50 milliliters. Regardless of the volume, the contrast is injected very slowly, at least over 2 to 3 minutes. At the same time, during the infusion of a contrast agent, the specialist conducting the procedure carefully monitors the patient’s condition. He monitors his blood pressure, pulse, skin. At the same time, the patient should be informed that during the procedure such sensations as a feeling of heat, dizziness, and mild nausea are possible.

After the contrast is administered, the patient is placed on a table that moves through the tomograph. During scanning, it must remain motionless, since the slightest movement leads to blurred images. The doctor is in a special room nearby and monitors the progress of the scan through the window and on the monitor. At the same time, he communicates with the patient, asks him about his health and gives recommendations. On average, a scan lasts from 15 to 25 minutes. Classically, three series of images are taken - at 5, 15 and 25 minutes.

MRI urography

MRI urography allows you to see on the display screen, and then on film, the thinnest ( up to 0.1 millimeter) sections of the genitourinary system. The information makes it possible to differentiate the renal cortex and medulla and analyze their excretory function. Also, MRI urography can detect many forms of pathology, in particular volumetric processes ( benign and malignant tumors) in the genitourinary system, foci of inflammation and edema, hematomas, abscesses and even traumatic lesions.

Preparation and the first stage are similar to simple urography and CT urography. Bowel preparation and desensitization ( decreased sensitivity to the injected substance) organism.

The magnetic resonance imaging method is based on the principle magnetic field. So, the human body is placed in a chamber, which is nothing more than a magnet. Considering this fact, there are a number of, albeit narrow, contraindications to MRI urography.

Contraindications for MRI urography include:

• the patient has a pacemaker ( pacemaker);
• metal implants in the body - prostheses, electronic middle ear implants, hemostatic clips;
• acute renal failure;
• claustrophobia ( fear of closed spaces).

Retrograde urography

The injected contrast agent, as with conventional excretory urography, is impenetrable to X-rays and is clearly visible on photographs. It “outlines” the contours of the organs in which it is located, namely the bladder, ureters, and the collecting apparatus of the kidneys. The purpose of the method is to diagnose disorders of the patency, form and function of the urinary system. Indications for retrograde urography are not much different from those for conventional urography.

Indications for retrograde urography include:

• pain in the lumbar region at rest and, most importantly, during movement;
• blood in urine;
• decreased daily urination ( diuresis);
• suspicion of a cyst, hematoma and neoplasms in the kidneys;
• injuries of the genitourinary system;
• frequent recurrent ( escalating) kidney and bladder infections.

To diagnose reflux, a variant of retrograde urography is used, which is called voiding cystourethrography. It consists in filling only the bladder with a contrast agent. This is done using a special catheter. After filling, the patient empties the bladder, that is, urinates. Next, photographs are taken. With vesicoureteral reflux, contrast is thrown into the ureters, which should not normally occur.

How is intravenous excretory urography done?

As a rule, the following contrast agents are used when performing urography:

• urografin;

• iodamide;
• isopak;
• ultravist;
• hexabrix;
• omnipack.

Indications and contraindications for intravenous urography

Indications for excretory urography are:

• blood in urine ( hematuria);
• frequent urinary tract infections;
• suspicion of a tumor process in the kidneys;
• obstruction ( blockage) urinary tract;
• lower back pain.

Contraindications for excretory urography include:

• pathologies of the cardiovascular system in the stage of decompensation;
• renal failure;
• severe thyrotoxicosis;
• allergy to iodine-containing substances.

Algorithm for urography

So, the first stage consists of intravenous administration of a contrast agent. It is injected into one of the peripheral veins, usually into the vein of the elbow. With retrograde urography, the substance is injected using a catheter directly into the urethra. The volume of the administered substance is calculated based on 0.5 milliliters per kilogram of body weight. On average, no more than 50 milliliters of the substance is administered. The injection rate is 0.2 milliliters per second. Thus, the drug administration time should be at least 3 to 5 minutes. During this time, the doctor monitors the patient and his vital signs.

The parameters that the doctor monitors during urography include:

• arterial pressure– it is not allowed for the patient’s blood pressure to drop by more than 10 - 15 millimeters of mercury from the original figures;
• heart rate, that is, pulse– should not be less than 60 and no more than 90 beats per minute;
• breathing rate– should not exceed 20 breathing movements in a minute;
• skin condition– color and moisture, because sharp pallor of the skin indicates sharp drop blood pressure.

Mandatory photographs during urography include:

• first photo– done 5 minutes after contrast administration;
• second photo– performed between 12 and 15 minutes of the study;
• third picture– carried out at 25 minutes of the study.

Allergic reactions during urography

Allergic reactions to contrast media

These side effects, by contrast, refer to general allergic reactions affecting the entire body. However, side effects can also be local or directly toxic. The first include those reactions that develop at the site of administration of the substance, namely phlebitis or necrosis of soft tissues. Phlebitis refers to inflammation of the wall of the vein into which a contrast agent was injected. Soft tissue necrosis is the death of the skin and underlying tissue in the area of ​​the injection.

Direct toxic side effects include nephrotoxicity, cardiotoxicity and neurotoxicity. This means that some contrast agents can selectively affect certain organs, affecting them. For example, cardiotoxicity is a selective damage to heart cells, and nephrotoxicity refers to damage to kidney tissue. However, it is worth noting that modern contrast agents used in excretory urography extremely rarely have such side effects.

First aid measures for an allergic reaction include:

• injection of 10 milliliters of sodium thiosulfate;
• subcutaneous injection of 1 milliliter of adrenaline;
• antihistamines, like diphenhydramine, are also administered intramuscularly ( diphenhydramine) or chloropyramine.

Preparation for urography

The stages of preparation for urography include:

• taking a biochemical blood test - carried out a few days before the test in order to assess kidney function;
• testing for intolerance to iodine-containing drugs is also carried out in advance;
• a hypoallergenic diet excluding citrus fruits, chocolate, seafood is recommended for everyone ( both patients with risk factors and patients without them) – carried out over 5 days;
• a diet that reduces gas formation and excludes fresh fruits and vegetables, legumes, sweet foods and brown bread from consumption - carried out 2 days before the procedure;
• the day before the study it is recommended to exclude dinner;
• cleansing enema on the eve of the study;
• On the day of the study, repeat the enema and exclude breakfast.

An integral part of preparation for urography is the prevention of possible complications and, first of all, the prevention of allergic reactions. It is based on careful collection of anamnestic data in order to identify risk factors. If at least one of the risk factors is identified, the doctor must weigh the balance of possible benefits and dangers of the planned study.

Risk factors for complications during urography include:

• history of allergies to iodine-containing substances;
• previous allergic reactions to any medications;
• chronic renal failure;
• patient age over 65 years;
• dehydration of the body;
• chronic diseases in the acute stage.

Cardiovascular drugs are used to provide emergency care for anaphylactic reactions ( dopamine), means that stimulate respiration, oxygen.

Urography pictures

Provisions in the description ( assessment) urography is as follows:

• description of the cups and pelvis - their shape, structure, accumulation of contrast in them;
• description of the ureters ( in this case the left and right ureter are compared) – their diameter, position, the presence of twisting or ornateness, the structure of the walls, the movement of contrast along them;
• characteristics of the bladder - size, shape, position, contours of the walls.

Excretory urography of the kidneys in children

Indications for excretory urography ( and its types) in children are:

• kidney and urinary tract injuries ( bladder and urethra);
• tumors in the pelvis;
• inguinal hernias accompanied by urination disorders;
• control after surgery on the urinary system and rectum;
• chronic urinary tract infection;
• suspicion of vesicoureteral reflux;
• congenital nephropathies;
• microhematuria ( the presence of blood in the urine, which is not detectable with the naked eye);
• difficult and rare urination.

Contraindications for excretory urography in children include:

• acute and chronic renal failure;
• allergy to iodine and non-iodine contrast agents;
• tuberculosis in the active phase;
• liver failure;
• thyrotoxicosis.

Features of preparation for urography in children are as follows:

• On the day of the study, the child is allowed breakfast. So, an hour before the test, children are given porridge or a small bun with tea. This is done in order to avoid the formation of “hungry” gases.
• Newborn children ( up to a year) It is recommended to skip breakfast on the day of the study. However, once the examination begins, they begin to feed him using a pacifier.
• 2-3 days before the test, foods rich in carbohydrates are excluded from the diet. The list of products includes raw vegetables, cow's milk, and black bread. This is done to prevent the accumulation of gases in the colon ( aerocolia).
• Sorbents are prescribed ( Activated carbon), carminatives ( espumisan), chamomile infusion. For easily excitable children, a decoction based on valerian root is recommended.
• The day before, two cleansing enemas are done, using Vaseline oil. So, oil in a volume of 30 milliliters is given to the child orally, and two hours later two enemas are given. The procedure with oil is repeated on the day of the study.
• For older children age category Instead of an enema, ordinary laxatives are recommended - Duphalac, Microlax.

The urinary system includes several organs. One part of them forms, and the other secretes urine. The system includes the kidneys ( paired organ). Next, we will briefly consider the functions of the system, its pathologies, as well as the diagnostic method used to identify them.

Objectives of the structure

The main functions of the urinary system include:

• Maintaining water-salt balance.
• Product highlighting metabolic processes.
• Maintaining hormonal balance due to biologically active compounds synthesized in the adrenal glands.

Maintaining homeostasis and excretory function are considered vital tasks. The products of metabolic processes are excreted through the ureters. Urine accumulates in the bladder. The kidneys are parenchymal organs bean-shaped. They consist of medulla and cortical layers. The kidneys perform an important task in detoxifying the body.

System pathologies

Diseases may be congenital or genetic infectious nature. In the latter case, inflammation of specific components of the structure occurs. The pathological process predominantly affects the kidneys. Inflammation of other elements of the system, as a rule, poses less danger. However, in any case, pathological processes are accompanied by discomfort, pain, and pain. Genetic diseases are caused by anomalies in the structure of one or another organ. Due to these violations, it is difficult or impossible to possible education and urine output. Among genetic pathologies there are also anomalies in the formation of the body. These include, for example, the absence of one or two kidneys at once. In this case, death usually occurs immediately after birth. The ureter may also be missing or not enter the bladder. Developmental anomalies can also affect the urethra (excretory canal). Women are more at risk of contracting infections. This is due to the structural features of their urethra - they have it shorter than men. Due to this, the infectious agent quickly penetrates the system, rises to higher organs and provokes inflammation.

Diagnostics

To assess the condition of the urinary system, excretory intravenous urography is used. This method is an X-ray examination using a contrast agent. During routine imaging urinary tract are not viewed well enough. Survey intravenous urography allows you to get a more complete picture of the state of the system and its individual components. The contrast agent enters the bloodstream. From there it enters the kidneys and concentrates there. The contrast then exits through the urethra along with urine. Due to the presence of the substance, X-rays are blocked in accordance with the kidney structure. In the photographs it looks like white spots. The images obtained during diagnosis are called intravenous urograms or pyelograms.

Purpose of the study

Intravenous urography of the kidneys is prescribed in the following cases:

Intravenous urography: patient preparation

Before the procedure, a biochemical blood test may be required. It is necessary to confirm the absence renal failure. If it is present, the study is not carried out. This is due to the fact that the kidneys must normally secrete the contrast agent. The patient should also inform the doctor about the presence of an allergy to compounds containing iodine. Preparation for intravenous urography is quite simple. It is not recommended to eat a few hours before the procedure. When the bowel is free, the X-ray image becomes clearer. Preparation for intravenous urography sometimes includes taking a laxative. This is needed for better cleansing intestines. A prerequisite in some clinics is that the patient signs consent to the procedure. Patients with diabetes mellitus and those taking metamorphine should stop taking it two days before the expected date of the study. Otherwise, the combination of this substance with contrast may cause tissue damage to the organs of the system.

Intravenous urography: how is the study done?

The patient should undress before the procedure. Intravenous urography is performed on the patient in the supine position. A radiopaque contrast agent is injected into the blood. The injection is carried out intravenously. In this case, the patient may feel a slight burning sensation. The substance penetrates the kidney tissue and ureter. During the procedure, the doctor takes several pictures, usually at intervals of 5-10 minutes. All this time the patient lies on the couch. Before taking the last image, the specialist may ask you to empty the bladder. In some cases, delayed (several hours later) images are taken. Typically, intravenous urography is performed within 30-60 minutes. You can go home immediately after completing the study. You are also allowed to eat after the procedure.

Possible side effects

When intravenous urography is performed, when contrast is administered, the patient may feel a metallic taste and warmth in the mouth. Usually such sensations pass quickly. In rare cases, intravenous urography may cause an allergic reaction. Its severity may vary. In particular, allergies can manifest themselves in the form of swollen lips or a small rash. Rarely, more serious reactions such as low blood pressure or difficulty breathing occur. To normalize the condition, the doctor’s office has all the necessary tools. Another fairly rare negative manifestation is renal failure.

Additional Information

Despite the diagnostic importance of the procedure, not everyone can undergo intravenous urography. Contraindications to the study include pregnancy, individual intolerance to contrast and compounds containing iodine. The procedure is also not recommended for people suffering from functional impairment.