home Audience 12 Preparation for intravenous urography in children. Excretory urography - indications, patient preparation, description of the procedure and possible complications

Preparation for intravenous urography in children. Excretory urography - indications, patient preparation, description of the procedure and possible complications

Excretory urography is a method radiology diagnostics, based on the ability of the kidneys to secrete a contrast agent that has previously been administered intravenously. Excretory urography is also called intravenous or contrast urography. Thus, the name reflects the essence of the method - a contrast agent is used, which is administered intravenously. The term “excretory” characterizes the main function of the kidneys, which is being studied. Urography is the gold standard and, in fact, the main method in the diagnosis of urological patients. The images obtained are called urograms.

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

Genitourinary system

The genitourinary system includes the kidneys, ureters, bladder and urethra. Urography is used for abnormalities of each of these organs.

Kidneys are a vital pair important organ, located in lumbar region, on the sides of the spine. In the structure of the kidneys, parenchyma is distinguished ( the fabric itself) and the collecting apparatus, which performs the function of storing urine. At the exit pelvic system the kidneys pass into the ureters. Each kidney has its own ureter. Through them, urine formed in the kidneys is collected in the bladder, since then the right and left ureters flow into it. The bladder stores urine until it is released through the urethra ( urethra ) out. Thus, the course of urine in the body can be represented as follows - kidneys - ureters - bladder - urethra.

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 contours 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

Excretory urography of the kidneys is intravenous urography or urography using contrast. The purpose of this method is to assess the condition of the kidneys and urinary tract. The method consists of obtaining an image of the organs being examined on a monitor screen and on film. X-rays can be used to obtain a picture ( classical urography), CT scan ( CT urography) or magnetic resonance imaging ( MRI urography).

Survey urography

Survey urography is an x-ray method for examining the genitourinary system, which is recommended to be done before intravenous urography. This is explained by the fact that often after a general photograph there is a need to intravenous urography disappears. Despite the seemingly low information content, this method is able to detect kidney stones, the presence of hematomas, and various abnormalities of organ development urinary system.

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 urological patient.

When interpreting a survey radiograph, the condition of the bone skeleton and soft tissues is taken into account ( if any are displayed), kidney contours, shadow 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 the presence of pathological changes - 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

CT urography is an excretory urography, during which a computed tomograph is used instead of an X-ray. Thus, CT urography is combined method computed tomography and contrast of the kidneys.

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.

During preparation for the study, the patient is recommended to have a hypoallergenic diet, as well as to exclude foods that cause bloating from the diet ( legumes, cabbage, sparkling water). A light lunch is recommended the day before, dinner is excluded and a cleansing enema is performed. An enema is also given on the day of the procedure. If the patient is characterized by excessive gas formation, then drugs that eliminate gas formation are recommended in parallel ( for example, espumizan).

The contrast agent is administered intravenously, most often using a catheter, less often using a dropper. Volume required substance 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 is an excretory intravenous urography, during which X-rays are used instead magnetic tomograph. Thus, by analogy with CT urography, MRI urography is a combined method of magnetic resonance imaging and renal contrast. The advantage of the method is its high resolution, as a result of which the picture of the organ under study is as accurate as possible.

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

Retrograde urography is a variant of urography when a contrast agent is injected using a catheter through the urethra. Thus, with retrograde urography, filling the urinary tract with contrast occurs in an ascending manner - urethra - bladder - ureters - kidneys ( with excretory urography, the movement is reversed). The movement of contrast occurs in the opposite direction, hence the name of the study.

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 patency, form and function urinary systems s. 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.

The advantage of retrograde urography is minimal risk development of allergic reactions. This is explained by the fact that during this procedure the contrast agent does not enter the blood, but only into the organs of the genitourinary system. Also, retrograde urography is the most informative in the diagnosis of certain diseases. For example, the maximum information content of the method is noted for vesicoureteral reflux ( PMR). VUR is a pathology in which there is reflux of urine from the bladder into the ureter. Thus, there is a movement of urine in the opposite direction. The consequence of this is an increase in pressure inside the ureter. This, in turn, can lead to urine reflux from the ureters into the kidneys. The end result of this phenomenon is frequent infections, the development of hydronephrosis and atrophy of renal tissue.

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 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?

So, the method takes place in two stages - intravenous administration contrast agent into the blood and taking pictures directly. To carry out the first stage of the study, iodine-containing substances are used, which subsequently filter from the blood into the urine and color the latter. Urine stained with a contrast agent subsequently “reveals” the organs in which it is located. For contrast, substances such as urografin and urotrast are used.

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

urografin;

iodamide;
isopak;
ultravist;
hexabrix;
omnipack.

The second stage is to take images that directly visualize the distribution of the substance. This stage can be carried out in several ways. Classic version is the use of x-rays. However, it is also possible to use computed tomography ( CT urography) or magnetic resonance imaging ( MRI urography). One way or another, the essence of the second stage is to visualize the process of secretion of the substance by the kidneys. How quickly the substance is distributed and where it gets stuck tells the specialist about kidney function.

Indications and contraindications for intravenous urography

Despite the simplicity of the method, urography should be performed strictly according to medical indications. It is resorted to only if the method cannot be replaced by other, less invasive studies. The main condition is that the expected benefit of the study must exceed possible risk. The greatest risk group in this case are women during pregnancy. Research in this category of patients is carried out only for exceptional indications.

Indications for excretory urography are:

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

At the same time, there are contraindications for intravenous urography. These are mainly decompensated conditions - renal failure, severe defects of the cardiovascular system. Absolute contraindication to conduct research is an allergy to iodine. A relative contraindication is, in principle, a history of allergies.

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

The algorithm for performing excretory urography is standard. However, based on individual characteristics For each patient, the doctor determines the order of the study. In this case, the medical history must be taken into account, clinical picture diseases at the time of the study, as well as data from laboratory and instrumental studies. The patient’s allergy history is very important, that is, clarification of previous allergic reactions, the presence of allergies among close relatives.

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.

The second stage begins with taking x-rays. If we're talking about about CT urography or MRI urography, then images corresponding to these studies are taken. As a rule, three pictures are taken at intervals of 5 to 10 minutes. However, depending on the individual characteristics of each patient ( his age, medical history), the doctor can take as many pictures as he deems necessary.

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.

Additionally, most often, the radiologist resorts to so-called delayed images, which are taken half an hour after the contrast is administered. The patient is in a prone position or in a vertical position. Next, the doctor directly begins to evaluate the images.

Allergic reactions during urography

Allergic reactions to contrast media can be classified as mild, moderate, or severe. One of the most dangerous unpredictable reactions to a contrast agent is anaphylactic shock. Anaphylactic shock is characterized by a lightning-fast reaction with a drop in blood pressure, obstruction ( obstruction) respiratory tract and a high mortality rate ( mortality).

Allergic reactions to contrast media

These side effects in contrast, they 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 allergic reaction relate:

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

Next comes the preparation of the patient for the study. It includes restricting food and fluid intake for at least 18 hours before the test. The main goal of preparation is maximum emptying of not only the bladder, but also the intestines. This is done in order to avoid gas contamination of the intestines, which significantly complicates the visualization of the genitourinary system. If the patient does not follow a diet that prevents the formation of gases in the intestines, then on the eve of the study the intestines will be swollen, and this will create “interference” with a clear picture.

Preparation for urography

The main principle of preparation is diet and bowel cleansing on the eve of the study. On the day of the procedure, the patient’s fluid intake is increased so that the contrast is eliminated from the body faster. The patient must be informed about the upcoming procedure, namely the nature of the study and possible side effects. The patient should also be explained that during the procedure itself he will also experience various sensations - heat, slight dizziness. This is especially important for patients with labile ( unstable) nervous system. If a person simultaneously suffers from panic attacks or anxiety disorder, then it is first recommended to administer an anxiolytic ( more often - diazepam).

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;
hypoallergenic diet, excluding citrus fruits, chocolate, seafood, recommended for everyone ( both patients with risk factors and patients without them) – carried out over 5 days;
a diet that reduces gas formation and eliminates consumption fresh fruits and vegetables, legumes, sweet dishes and black bread - 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.

The greatest difficulty in preparing for intravenous excretory urography is presented by young patients, namely children under four months of age. This is explained by the fact that due to anatomical features their intestines are very swollen and gassy. Therefore, even with the use of carminatives ( espumisan), it is not always possible to achieve good bowel preparation. This, in turn, significantly limits the possibilities of urography.

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 ratio possible benefits and the dangers of the planned research.

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.

One way or another, the X-ray room must be equipped with the necessary set of medications, among which, first of all, sodium thiosulfate and prednisolone. It is worth noting that some clinics use the tactic of premedicating patients with prednisolone. This means that patients at risk are given 50 milligrams of prednisolone before the study. This is done twice - 10 and 5 hours before the diagnostic procedure.

To provide emergency assistance at anaphylactic reactions are used cardiovascular drugs (dopamine), means that stimulate respiration, oxygen.

Urography pictures

During urography, images are taken ( urograms or nephrograms), by which kidney function is assessed. The main criterion for kidney functionality is contrast time ( staining) pyelocaliceal apparatus and also the intensity of this contrast. Slow and low-intensity staining indicates reduced excretory function of the kidneys. In addition, urograms also describe other organs of the urinary system - ureters, bladder. In dark photographs, due to the accumulation of the drug in them, they appear as light structures.

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.

Description of urography images is normal

Organ	Description OK
*Ureters*	They look light ( shadow) stripes with a width of 2 to 5 millimeters, which are displayed in fragments. The ureter itself, due to its structural features and the presence of certain structures ( cystoids) along its entire length is represented by areas of expansion and contraction. The widened areas are filled with contrast and therefore appear light in the image, while the narrow areas are represented by darkening.
*Bladder*	It plays the role of a reservoir, and therefore a large amount of contrast accumulates in it in delayed images. Within normal limits, the shape of the bladder can vary from round to pear-shaped and even pyramidal. Upper limit the organ is located at the level of the 3rd and 4th sacral vertebrae, while the lower one reaches the pubic joint. The contours are normally clear, even and slightly convex.
*Pyelocalyceal system*	Each healthy kidney has 4 calyces that open into the pelvis. The pelvis is a funnel-shaped cavity in which urine accumulates, and then passes into the ureter. Small cups ( normally from 6 to 12), from which larger ones subsequently form, are not always visible in the image. This kidney structure is the first to be filled with contrast material in the images. Also in delayed shots ( at 30 minutes) Normally, tight filling of the pelvis system is recorded.

Each pathology has its own types of urograms. For example, with tubular necrosis, a so-called dense nephrogram is observed. It is characterized by the fact that maximum staining is observed at the end of contrast administration. However, unlike the norm, this picture persists for many hours. When taking delayed images, the doctor also records the maximum dense staining of the kidneys. In acute pyelonephritis ( inflammation of the collecting apparatus) a dense nephrogram is also noted, but the pelvis and calyces are practically not stained. When the urinary tract is blocked, the site of occlusion ( blockages) corresponds to the place where staining stops. So, the kidney secretes colored urine, as can be seen in the picture, to the point of blockage. This can be seen in the image by the fact that the colored stripe of the ureters stops, and after it the contours of the organ are not visualized. A variant of the pathological urogram includes a silent kidney. This term is used to describe the phenomenon when there is no shadow of the contrast agent in the image.

Excretory urography of the kidneys in children

Excretory urography is the most commonly used diagnostic method in pediatric nephrology practice. As in adults, several of its variants are used - retrograde urography and voiding cystography.

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 include acute infections (acute pyelonephritis and urethritis) and the serious general condition of the child. A relative contraindication to urography is macrohematuria - the presence of blood in the urine, which is accompanied by noticeable redness.

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.

The main difficulty in conducting excretory urography in children is preparation for this study. So, preparation plays a role in the quality of the radiograph. gastrointestinal tract child, namely his cleansing from feces and gas. Considering the features digestive tract In children, preparation for the study is somewhat different from in adults.

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, instead of an enema, ordinary laxatives are recommended - Duphalac, Microlax.

Intravenous urography in children also takes place in two stages. The first is the introduction of a contrast agent. The second is taking pictures. The volume of substance required is calculated based on age, body weight or surface area ( in square meters) child's body. The average amount of the drug for a child under 5 years old is 15 milliliters, for a child 10 years old – 20 milliliters. The method of administering contrast is somewhat different. So, it is recommended to initially introduce one milliliter of solution, then take a three-minute pause. During this pause, the doctor monitors the child’s condition – his blood pressure, skin, breathing. If there are signs of an allergic reaction ( redness,

In medical practice, there are a large number of tests, laboratory research and various methods for determining the condition of internal organs and our body in general. One of these research methods is kidney urography.

What is urography?

Let's start with the fact that the word “urography” itself consists of two concepts that answer the question posed. The first word is “uro”, “urina” is urine, the second is “graphy” - to depict, to write. This is an X-ray method for examining the urinary system, which evaluates its condition. There are many diseases, so excretory urography of the kidneys shows what deviations from the norm are present in each specific case.

Indications for the study

In order to make sure that the kidneys or urinary tract are damaged, doctors prescribe an examination. Most often it is done if the following diseases are suspected:

developmental anomalies of the ureters and kidneys;
hematuria of unknown etiology;
and kidneys;
such particular ones as pyelonephritis, hydronephrosis, tuberculosis, glomerulonephritis, nephrogenic hypertension and others;
kidney injuries.

Also, using a study such as kidney urography, you can see the condition abdominal cavity to study the state of the digestive system.

Contraindications to the procedure

As happens in other cases, this examination has negative impact on some people. Excretory urography of the kidneys is not recommended for patients with pathologies such as renal and liver failure. The study is contraindicated for patients who have suffered a stroke or myocardial infarction. Separate group Pregnant women are not allowed to undergo the procedure. Urography of the kidneys during pregnancy is contraindicated for women, since passing rays can cause the development of abnormalities in the child.

Very rarely there are complications after the study, such as urticaria, anaphylactic shock and laryngospasm, this must be taken into account when prescribing urography for allergy sufferers.

How does the research take place?

During this study, a person is administered intravenously. In this case, the patient must be in a horizontal position. For urography, a special substance is used - sergazin, in a dosage of 40 ml per 40% solution; cardiotrast (20 ml in 35% solution) or some other contrast agent is also often used. The drug is slowly injected into a vein, then 3-5 photographs are taken in the area of the urinary tract and kidneys. To do this, it should be located strictly in the middle between the navel and pubis. You can start taking the first photo within 10 minutes after intravenous injection. Then the specialist looks at the dynamics of the picture on the screen. If the picture is good, pictures can be taken after 20 minutes, 40, 60, and also after 2 hours.

What does a survey urography of the kidneys show?

The study is very informative for the doctor. When conducting such studies, X-rays pass through the structural elements of the body. Using electromagnetic radiation, a negative image appears on a special plate. Here the specialist looks at the density of the tissue or organ - the lighter the picture on the film, the higher it is. Urography of the kidneys allows you to study their excretory capacity. In addition, the dimensions are clearly visible here morphological elements: calyces, pelvis. The film shows whether there are stones, where they are located, and whether they have caused changes in the ureters and kidneys. Also, using this study, you can determine hydronephrosis, various types of tumors, and kidney tuberculosis. Urography meaningfully displays the processes and functions of a healthy kidney if the second one is damaged. After the examination, the specialist compares the results of urography and other clinical data. If the kidneys are functioning normally and there are good urodynamics, then the study can be completed within 30 minutes. However, there are cases when it drags on for up to 24 hours after the administration of a special substance.

For additional research reserve capacity of the kidneys based on the administered radiopaque agent, furosemide (40 mg) is administered after 20 minutes. This special technique, called pharmacourography, allows you to determine dilatation of the upper urinary tract, that is, hidden disorders caused by complex diseases. To do this, furosemide must be dissolved in an isotonic sterile sodium chloride solution.

Kidney urography: preparation for it

Before the study, it is important to carefully consider the doctor’s recommendations. Most often, the preparation procedure is the same for everyone; there are, of course, exceptions. Early in the morning, before the event, the patient eats fried White bread, as well as meat. After this, the person must be given a cleansing enema. Any other special ones preparatory actions not required.

Before the procedure, you should discuss all your concerns with your doctor. For example, how do rays affect the human body, or how many x-ray studies are there in certain period safe for the body over time. Some even keep records of such studies in order to provide the specialist with accurate information about themselves. It is imperative to report that you are pregnant or suspect that you may be pregnant.

Urography of the kidneys in children is carried out without any special differences from the usual study for adults. But there are some nuances here. It is very important to correctly determine the dose of contrast agent. It depends on the child’s age, body weight, functional state of the liver and kidneys. There are differences by age for children: from several months to one year, 3 or 4 ml of the substance are prescribed, and from one to three years - 2-3 ml. Since small children cannot withstand the examination for a long time, urography is performed for them with minimal time ranges: from 1 minute to 40 - this is for children under three years of age. For older people, this range extends to 60 minutes.

Urography is a radiopaque study of kidney and urinary tract function, which is used to diagnose most urological diseases.

The resulting urogram perfectly visualizes the anatomical position of the kidneys, their shape and size, allows you to assess the degree of functionality of the urinary organs, and detect various pathologies (neoplasms, stones, foci of inflammation).

Urography happens:

overview - without introducing contrast, in essence it is X-ray kidneys and urinary tract;
excretory (intravenous) - a contrast agent is used, which is administered intravenously. This is done for better visualization.

Iodine-containing preparations are used as a contrast in excretory urography. Iodine is a substance that can cause an allergic reaction varying degrees gravity. Therefore, 1-2 days before the examination, a test for individual sensitivity to iodine must be carried out. Testing is performed in an outpatient setting under the supervision of medical staff. If an allergy develops (hives, runny nose, swelling), the patient is immediately provided with qualified assistance. In this case, the administration of a contrast agent is strictly contraindicated.

Preparation for urography

For 3 days before urography, you must follow a diet that excludes foods that cause fermentation and gas formation in the intestines (vegetables, fruits, dairy products, carbonated drinks, black bread, etc.).

If necessary, a cleansing enema and activated charcoal may be prescribed on the eve of the procedure.

8 hours before the examination, you should not eat or drink much liquid.

Immediately before urography, the bladder and stomach should be empty.

Indications

Urography is used to diagnose diseases of the urinary system and is prescribed by a urologist if there are certain indications:

chronic infections of the urinary system;
hematuria (blood in the urine);
urolithiasis disease;
obstruction (blockage) of the ureter;
congenital kidney anomalies;
pathological kidney mobility;
traumatic injuries;
control after surgical treatment.

Contraindications

Conditions in which urography is not advisable or is completely contraindicated include:

allergy to iodine-containing drugs;
pregnancy at any stage;
various bleedings;
decreased blood clotting;
renal failure (acute or chronic form);
glomerulonephritis (acute course);
thyrotoxicosis;
therapy diabetes mellitus the drug "Glucophage";
pheochromocytoma (hormonal active tumor adrenal medulla).

If it is not possible to perform urography (if there are contraindications), this method can be replaced with other, less informative, but safer for a particular person studies: ultrasound kidneys and bladder, CT or MRI.

The decision on the advisability of replacing or adding one diagnostic method others are taken by the attending physician, based on the individual characteristics of the patient. In any case, all examinations are aimed at obtaining as much reliable information as possible about the condition of the kidneys and urinary tract.

The accuracy of the diagnosis and the effectiveness of the prescribed treatment depend on the completeness and quality of the information.

Urography technique

It is better to undergo urography in those clinics that specialize in the diagnosis and treatment of urological pathologies.

Before the examination, you must sign an official consent to perform urography. This can be done by the patient himself or his relatives. Then you need to remove all metal objects and change into disposable medical clothing. If the patient is worried severe pain or feeling of fear, sedatives and painkillers may be offered.

Before administering a contrast agent, a survey urography is performed - an x-ray of the kidneys and urinary tract.

Carrying out excretory (intravenous) urography

Filming begins in the first minutes after the contrast has entered the blood and lasts from 45 to 60 minutes. During this time, several pictures are taken at regular intervals, for example, 5-7 minutes, then 12-15, 20-25, etc.

When the contrast is released slowly, it is possible to perform delayed shooting (at 45, 60 minutes). How many images need to be taken is determined by the radiologist, taking into account the characteristics of the disease.

Side effects

Often, during the administration of a contrast agent, patients feel a burning sensation along the vein, nausea, dizziness, or a feeling of heat throughout the body. These reactions are considered normal unpleasant symptoms pass on their own.

On a note: to speed up the process of removing contrast and neutralizing the received radiation dose, it is recommended to drink more fluids on the first day after the examination, milk is better And fruit juices.

Since a sensitivity test was performed before the full dose of radiopaque contrast agent was administered, an allergy to it is extremely rare.

If the preliminary examination of the patient is carried out correctly and does not reveal any contraindications to urography, then these and other side effects are usually not observed.

Kidney diseases remain very common today. For their diagnosis they are used various methods- moreover, more modern ones, for example, ultrasound and magnetic resonance imaging - are gradually replacing outdated and less informative ones. However, X-ray examination of the kidneys, also known as urography, is still in demand due to the fact that it allows one to learn about changes in the structure of the organ and make the correct diagnosis.

Types of urography

There are several types x-ray examination kidney It is up to you to decide which method to use in each specific case. The doctor must choose the optimal way to study kidney tissue and their functionality, depending on the nature of the disorders.

This procedure is prescribed to the patient if the doctor sees some evidence of kidney disease. As a rule, it precedes all other, more complex studies. Survey urography is a regular x-ray of the area of the body where the kidneys are located.

Particularly informative this diagnostic cannot be named, but with its help you can check the location of the organ, as well as identify large stones and some other problems. The undeniable advantage of this method is the fact that this study does not require any additional equipment, and it is carried out in any clinic. This method requires certain preparation of the patient, which will be discussed below.

Survey urography allows the specialist to examine the structural condition of the kidneys, starting with their upper section to the beginning of the bladder outlet. In addition, the doctor sees the bones of the pelvic area, and can also “at a first approximation” assess the condition and performance of the ureters and bladder.

Intravenous diagnostics

Intravenous urography is an x-ray examination that involves the use of a contrast agent. As a rule, it contains iodine and. This solution is injected into a vein to the patient, provided that his bladder is empty. After this, several photographs are taken.

Preparation for intravenous urography is that the patient must empty the bladder. There are three methods of intravenous urography: excretory, compression and infusion.

Excretory urography

In many ways it resembles a review. The only difference between these diagnostic methods is that excretory examination uses a contrast agent. The first picture is taken one to two minutes after its introduction, the second after five minutes, and the third after seven minutes. The study allows you to assess the intensity with which the bladder is filled with fluid and renal pelvis, and also allows you to evaluate the shape and structure of the kidneys, the location of stones and cystic tumor neoplasms.

Compared to survey urography, the method is more informative, and the image itself is clearer. Among the disadvantages of this technique is the possibility of an allergic reaction to contrast agents. The doctor must find out whether the patient suffers from individual intolerance to any drugs. Even if the answer is negative, a test is carried out before administering the substance: 0.1 ml of a contrast agent solution is injected intradermally into one forearm, and saline solution into the other forearm. Then the doctor compares the reaction.

Compression urography

This type is a more complex procedure. During this procedure, the patient's ureters are artificially clamped. The image is very clear, but it is impossible to assess the condition of the ureters because they are compressed. Therefore, experts recommend combining the compression method with the excretory method so that the result is as informative as possible. A significant disadvantage of the procedure is the fact that this research method is very painful.

Infusion urography

Usually prescribed to people with disabilities, as well as those who cannot move. The contrast agent is administered through a catheter, and the examination is carried out with the patient lying down.

Depending on where exactly the contrast agent is injected, urography can be retrograde or antegrade. In a retrograde study, a contrast agent is injected directly into the ureters under general anesthesia. After this, a survey urography is performed. This method makes it possible to study the ducts as clearly as possible.

In antegrade percutaneous urography, a contrast agent is injected through the skin into the top part ureters. Going down them, the drug allows the doctor to study them properly. This method allows you to identify ureteral ruptures, inflammation, and neoplasms.

Each of the above methods has its own advantages and disadvantages. Thus, survey urography is fast and does not require the introduction of contrast, but it cannot boast of high information content. During excretory examination, the image is not very accurate, but this method is simple and reliable. Compression urography also does not take much time, but the procedure is very painful. Infusion therapy is suitable for people with disabilities, but is time-consuming due to the need to be on a drip. Retrograde and antegrade methods provide a comprehensive amount of information, but require general anesthesia.

Possibilities of survey urography

The main purpose of a survey x-ray examination of the kidneys is to identify stones in different levels urinary system. These can be stones in the kidneys, bladder and ureters. However, it should be taken into account that this method does not allow visualizing all types of stones, but only stones of urate and oxalate origin. Phosphate neoplasms are most often invisible on photographs. In addition, the image shows tuberculosis lesions and echinococcal cysts.

Also using this method the doctor may identify others pathological processes based on the data received. Thus, visualization of the renal shadow will allow us to draw a conclusion about the size of the organ and its location. Based on the outlines of the psoas muscle, one can judge the condition surrounding the kidneys. The doctor may also look at the lumbosacral spine, hip joints, lower edges of the ribs, as well as the pelvic bones.

Indications and contraindications

As noted above, survey urography is the first procedure to which a patient is referred if pathological processes in the kidneys are suspected.

Indications for the study are:

Congenital or acquired hydronephrosis of one or both kidneys.
Stones in the urinary tract: in the tissues of the kidneys, bladder and ureters.
The presence of foreign bodies in the urethra or in the lumen of the bladder.
Lower back injuries, including back muscle tears.
Tumors and other pathological foci (cysts, abscesses, etc.).
Abnormalities in the development or location of the kidneys

At the same time, like any x-ray examination, the procedure also has its contraindications. Thus, the study is not carried out on pregnant women, patients suffering from radiation sickness, as well as those who have had one kidney removed and the functionality of the second is impaired.

In addition, they try not to refer patients for urography who have recently undergone a study of the gastrointestinal tract with a barium suspension. This is because barium remaining in the body significantly impairs visualization of the kidneys and urinary tract. Therefore, the interval between studies should be at least a week so that the barium suspension is completely removed from the body.

What can a survey urography show?

This diagnostic method, as noted above, is the initial stage of studying the condition of the kidneys. The doctor prescribes this procedure if he has suspicions about organ dysfunction or the presence of certain pathological processes in it.

Thus, survey urography helps to identify:

Benign or malignant neoplasms
Changes in the structure of organ tissue.
Stones.
Anomalies in the structure of the kidneys.
Pyelonephritis, glomerulonephritis, hydronephrosis, renal tuberculosis.
Causes of blood in urine.
Possible complications after surgery.

How to take a photo correctly

There are several principles that must be followed in order for the X-ray image to be as informative as possible and for the specialist to be able to diagnose the pathological process.

First of all, you should not do an x-ray of just one kidney. Doctors are aware of situations where changes in the site pain syndrome cannot be detected, but disorders are detected in the opposite organ.

A high-quality image is considered to be one that maximally covers all the structures that are components of the urinary system: the kidneys and ureters and the bladder. The image should also show the contours of the eleventh and twelfth ribs and the upper edge of the pubic symphysis. You should use a film measuring thirty by forty centimeters.

How is the procedure performed?

Survey urography is a simple and not time-consuming procedure. Immediately after the patient enters the office, he is asked to remove Jewelry and metal objects. After this, the patient is asked to lie on his back, with a pillow placed under his head. The X-ray beam is directed strictly perpendicular to the surface of the body, several centimeters below the xiphoid process. Immediately at the time of the photo, the patient must hold his breath. This will help avoid “double” images.

Special training

In order for the results to be as reliable as possible, the patient must prepare for it in advance.

Thus, it is often normal to visualize the processes that occur in the organs of the urinary system, but sometimes swollen intestinal loops interfere. Therefore, it is extremely necessary to clean it of feces in advance.

For this purpose, patients are asked to exclude foods that can cause flatulence from their diet at least three days before the test. These are bread made from white flour, cereals and legumes, dishes from, fruits and dairy products.

Dinner the night before should be light. You should sit down at the table no later than six o’clock in the evening. On the day of urography, it is better to refrain from breakfast.

You should refrain from using large quantity liquids. On the day of the test, you can drink a glass of unsweetened tea.

Features of the procedure for children

The method of conducting survey urography for children is no different from how the study is carried out on adult patients. It is not recommended to conduct the study on babies under one month of age.

Note that when performing urography with a contrast agent, the amount of the drug should be carefully calculated for small patients.

However, even when conducting survey urography, which is absolutely painless, parents should prepare the child in advance and explain to him that he will not experience discomfort, and therefore you should not be afraid.

Algorithm for describing the resulting image

The first stage of describing the image is to study the state of the skeletal system. The thing is that pathological processes in the organs of the urinary system also affect the bones. So, for example, when chronic diseases kidneys, there is a so-called “compensatory scoliosis” of the spine towards the healthy organ.

If the patient has carefully prepared for the procedure, the shadows of the kidneys are clearly visible in the image. The norm is the location of the left kidney at the level of the twelfth thoracic and to the second lumbar vertebral bodies, and the right kidney - from the first to the third lumbar vertebral bodies. The fact that the right kidney is located lower than the left is explained by the fact that the liver puts pressure on it.

When describing the shadows of the kidneys, the specialist must indicate their shape, size and condition of the contour, and also comment on the density of the organ tissue.

The doctor is also interested in the condition of the lumbar muscles, their contours and symmetry. Any changes may indicate that an inflammatory process is occurring in the retroperitoneal space or that there are tumor foci.

As a rule, the ureters are normally not visualized because they are hollow. If there is inflammation in their lumen or there are stones, then shadows are noticeable in the images, which correspond to the location of the ureters.

The bladder is visible in the image if concentrated urine is present in its lumen.

After the specialist has compiled a description of all the “natural” shadows and structures, he begins to study pathological and additional shadows that may indicate dysfunction in the body.

Alternative to survey urography

Despite its popularity, urography is considered an outdated research method. Almost the same functions are performed today by ultrasound and MRI. They allow you to explore everything internal organs, identify inflammatory processes, tumors and kidney stones.

At various pathologies renal and, 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.

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;
abnormal location (prolapse) of the kidneys;
(both benign and malignant);
failure and slowdown in the excretory functioning of the kidneys.

A fairly extensive list of pathologies in which intravenous injection will help to determine the patient’s condition as fully as possible.

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

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 elimination 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 in which it is strictly forbidden to carry out this examination procedure.

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 the fair sex, there is another conditional contraindication - the menstrual cycle.

Women during pregnancy and lactation (breastfeeding) require special, increased attention and careful treatment. 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:

the patient needs to undergo a complete bowel cleanse. This is done with the help of an enema or by using special medications aimed at soft bowel movements. One of the most famous and effective drugs, intended for this purpose, is Fortrans. The enema must be performed in the evening, on the eve of the examination, and also early in the morning, three hours before urography. Any of these options is suitable for older people age group For children, it is preferable to cleanse the intestines with the help of special preparations;
the day before the procedure, you must refrain from consuming foods and drinks that increase gas formation in the intestines. Such products include all kinds of sweets, baked goods, fruits (especially with high content sugar), peas, cabbage, bread, fruit juices, carbonated drinks;
On the day of the procedure, the patient is allowed to eat a small portion of morning breakfast. In addition, you need to significantly increase the amount of water consumed. Moreover, the water must be purified, non-carbonated. You should refrain from sweet drinks and give preference to spring water;
Three hours before the start of the procedure, you must completely abstain from any food intake.

After following all the above recommendations, you can be sure that the examination will be as effective 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 very unpleasant symptoms and sensations in a person.

A 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.

In some medical institutions administration to the patient is provided sedative(intravenous or intramuscular route, or in tablet form). This will allow the patient to return to a normal psycho-emotional state and 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. The contrast agent is medicinal composition, which, 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 to minimize the occurrence of discomfort and unpleasant sensations in 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.

The injected contrast agent helps doctors monitor how long it will take for it to be excreted by the kidneys, and also makes it possible to most accurately determine the state of the renal and urinary systems, detect early stage oncological tumors and kidney stones.

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, intravenous administration of the drug should not cause any concern.

Intravenous urography of the kidneys is a fairly safe procedure, especially if performed by experienced medical specialists. However, it is a prerequisite that the radiography room contains all the necessary equipment to provide first aid if the patient feels unwell when the drug is injected into a vein.

Side effects

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

Side effects include the following:

after the procedure, the patient may feel a taste of iron in the mouth;
in some cases, a rash may be observed on the patient’s skin;
after the procedure, the patient may feel very thirsty and dry mouth;
slight swelling of the lips - quite rare pathology after urography;
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;
during urography, as well as after its completion, the patient’s blood pressure may drop significantly;
the most severe and dangerous consequence after the procedure is the appearance of 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 performed under close supervision experienced doctors and follow all prescribed recommendations. If you feel unwell or have complications after urography, you must immediately notify your doctor.