Kidney urogram. Excretory urography. Intravenous contrast urography. Algorithm for urography. CT urography. MRI urography. Urography in children

Every day doctors are increasingly diagnosing various diseases kidney

To make a final diagnosis, patients undergo a number of laboratory and instrumental studies.

Doctors prescribe ultrasonography, magnetic resonance imaging and urography. These methods allow specialists not only to determine external kidney damage, but also their internal changes.

Urography (cystography) - X-ray examination, studying structural changes kidneys and determining urolithiasis pathologies. Urography is performed by specialized specialists. Thanks to the results of urography, the doctor will be able to definitively make a diagnosis and prescribe appropriate treatment.

During diagnosis, doctors inject into the kidney contrast agent and it is highlighted on the x-ray. Thus, when a substance enters the urinary canals, it is easy to notice, which allows you to fully study the structure genitourinary system.

Previously, this technique was used quite often, but since the procedure is not pleasant, urography is now being replaced with alternative diagnostics.

What does a survey type of urography show?

Survey urography of the kidneys is performed to determine:

• size and weight;
• border contours;
• position and mobility;
• forms;
• general condition of organs abdominal cavity.

Thanks to this information, the doctor can accurately diagnose and prescribe the correct treatment.

The main advantage this study The fact that all abdominal organs can be seen is considered. Thus, the doctor determines or excludes other pathological processes.

In what cases is urography prescribed?

Urography was developed so that the functionality of the kidneys could be assessed. Therefore, in almost all cases when there is a suspicion of a pathological process, doctors prescribe this diagnostic method.

By using survey urography Doctors can determine:

• presence of benign or malignant neoplasm or tumor lesion;
• structural changes in kidney tissue;
• stones and small concretions in the kidneys;
• abnormal structure of the kidneys and urine excretory system;
• possible complications of kidney injury;
• nephrogenic hypertension (persistent blood pressure caused by disease of the renal parenchyma), pyelonephritis ( inflammatory disease renal pelvis), glomerulonephritis (damage to the renal glomeruli), hydronephrosis (enlargement of the renal pelvis caused by impaired outflow of urine) and tuberculosis;
• reasons for the appearance of blood in urine.

Doctors may prescribe a survey urography if they suspect the development of genitourinary infectious processes caused by renal colic. It is also possible to obtain an accurate picture of kidney function after surgery.

Urography can 100% determine the type and severity of the lesion, the stage of the pathological process. This allows doctors to select effective treatment.

In what cases is it prohibited to conduct survey urography?

Like other x-ray examinations, urography is not performed on women during pregnancy. Experts do not recommend performing such diagnostics on patients who have recently undergone contrast gastroscopy.

In such cases, the contrast agent makes visual examination of the kidneys difficult. If there are still indications for survey urography, then it is performed a few days after the previous study.

During this time, the intestines are cleared of barium residues. It is strictly forbidden to perform survey urography:

• women during pregnancy;
• patients with one kidney;
• patients with chronic radiation sickness.

Preparation for survey urography

Before starting a diagnostic study, the patient must donate blood from a vein. Thus, doctors confirm or rule out kidney failure. Also, the patient undergoes a test in advance to determine an allergic reaction to the injecting substance.

The main condition for survey urography is special diet, which includes several basic rules:

• It is forbidden to eat two days before the diagnostic test fresh vegetables and fruits that have not been pre-heat-treated;
• It is strictly forbidden to consume grains and beans, sweets and fresh baked goods within two days;
• per day it is necessary to reduce the amount of fluid consumed to a minimum.

By observing these simple rules You can achieve an increased concentration of urine, which in turn increases the contrast in the image.

You should not eat too much before the diagnosis. It is better to eat 10 hours before urography, and preferably if it is a light meal.

If a diagnostic test is scheduled for the morning, then it is advisable to do an enema before bedtime and in the morning. This way the gastrointestinal tract is cleansed intestinal tract. It's better not to have breakfast.

Preparation for urography depends on the type of diagnosis (survey, excretory or intravenous urography). Each urography has its own specific purpose, therefore, the preparation rules are different.

When performing a survey urography, it is very important that the intestines are not filled with gases. Therefore, it is necessary to eat for several days before the study dietary products. Also, doctors prescribe activated carbon or polyphelan.

You shouldn’t overeat before the procedure, but you shouldn’t be hungry either, because empty stomach Gases may form. Be sure to do two enemas - in the morning and before the study.

Using excretory urography, doctors determine the morphology of the kidneys. In this case, the presence of gases in the intestines may misinform the specialist.

The day before, doctors recommend drinking 30 grams castor oil(about three teaspoons). This allows you to reduce gas formation in the intestines. Get rid of increased gas formation possible using activated carbon. To do this, you need to take six tablets in the morning and six in the evening.

Before intravenous urography, it is enough to stick to it for several days. proper nutrition. Avoid fatty, spicy and sweet foods. This cleanses the gastrointestinal tract and makes the images clearer and more accurate.

How is kidney urography performed?

Observational urography does not take much time and is easy to perform. The patient assumes a supine position, and a pillow is placed under the head. This is the most comfortable position for the patient in which the main muscle groups are not strained. Before the diagnosis itself, the doctor talks with the patient, finding out the expressed discomfort and unpleasant feeling that the patient has been experiencing recently.

If the doctor does not ask, the patient must tell him about all the medications he has taken over the past month. The doctor directs the X-ray beam so that it is slightly lower than the xiphoid process.

The beam should pass strictly perpendicular to the body. at the moment when the device takes the picture, the patient must not breathe. If you breathe during this period, then in the picture you can see how the doubling occurs collecting system or stones.

Is survey urography harmful?

The human body may react negatively to the fact that a urographic examination was performed, namely:

• burning sensation in the veins into which the contrast agent was injected;
• nausea;
• hot flash;
• dizziness;
• iron taste in the mouth.

These conditions are considered normal and do not require special treatment. They will go away on their own in a few hours. To quickly remove the contrast agent from the body, doctors recommend drinking more, preferably freshly squeezed juices, green tea or milk.

If the patient has no contraindications to this research technique, then adverse reactions respectively. It is possible that short-term x-ray exposure will occur.

Also, doctors can perform survey urography on young children, since this type research - absolutely safe. Only the dosage of the contrast agent is determined by the child’s weight and the functionality of the liver and kidneys. Since it is very difficult to force a child to lie in one position for a long time, the diagnosis is carried out at an accelerated pace. To prevent an allergic reaction, children additionally take an antihistamine.

It is strictly forbidden to use this diagnostic method for children under one month. Before the procedure, parents should mentally prepare the baby so that it is not a surprise for him. Then diagnostics will pass quickly and painlessly.

How are plain urography analyzes interpreted?

The results of survey urography are deciphered by a specialist. Experts use two types of interpretation of results. When performing a survey urography, healthy kidneys look like clear clouds. Wherein left kidney slightly below the right.

The abdominal organs are turned towards the spine. Ureters and bladder not found in the image. If the patient has urolithiasis, then the stones are clearly identified. A “humpbacked” kidney is considered normal. In 42% of patients, one kidney is not visible.

Otherwise, the contrast agent should clearly visualize the kidneys. The bladder and ducts should be in a visible place. A healthy kidney has a homogeneous structure.

Doctors need to determine whether the contrast agent is leaving the kidneys. If it comes out, then this indicates a rupture of the ureters.

If the patient has diseased kidneys, the doctor will immediately determine this.

Kidney urography is a diagnostic study that helps determine the structural integrity of this organ. The retrograde procedure is carried out using a contrast agent, due to which the resulting image shows pathologies in the patient’s urinary system.

Thanks to this methodology, the method was called “survey urography”. It is based on the specific ability of the contrast agent: to delay the X-ray beam. After being introduced into the patient’s body, the dye accumulates in the kidneys, then it begins to be released by the organs of the genitourinary system, which gives the doctor the opportunity to find out their condition.

The use of contrast is due to the deep location of the kidneys. The kidneys are poorly visualized with non-contrast examination methods, and the diagnosis may be inaccurate.

Urography can be prescribed to any person, regardless of gender and age. The study may be considered necessary if there are the following indications: suspicion of stones, bladder infection, presence of blood and mucus in the urine, diagnosis acute inflammation And cancerous tumors. An excretory urogram is prescribed for established injuries of the urinary tract.

Excretory urography can be performed with the following symptoms:

• Complaint about chronic pain in the lumbar region, which sometimes radiates to the groin and bladder area;
• Constantly high blood pressure;
• Swelling of the face, especially noticeable on the lower eyelids;
• Difficulty urinating, blood or mucus;
• Alleged kidney diseases, signs of urolithiasis, glomerulonephritis, pyelonephritis, tuberculosis or kidney amyloidosis, tumors, nephroptosis, hydronephrosis.

Contraindications

Excretory urography of the kidneys is not performed:

• After strokes and heart attacks;
• With multiple organ failure;
• During pregnancy and lactation;
• All forms of diabetes;
• Due to individual intolerance to iodine-containing substances;
• If the patient is in in serious condition, which does not allow him to lie down or stand in the desired position.

Preparation for the procedure

Before urography, the patient will definitely be sent for a blood test according to biochemical composition, this will help differentiate the signs renal failure. This pathology has direct contraindications to the procedure using contrast. Preparation for urography should begin at least two days before the appointed time. The patient is prescribed a diet, all foods that can cause increased gas formation are excluded from the diet.

A retrograde urogram is performed on an empty stomach; you can no longer eat three hours before it. If the doctor deems it necessary, the study includes forced bowel movement. It is extremely important that before you begin retrograde procedure, the attending physician knew about all the medications the person was taking. And also about possible allergies to iodide substance.

A retrograde urogram assumes that immediately before the session the patient will remove all metal objects from the body, for example, jewelry, glasses, prostheses.

The procedure itself is completely safe and does not cause pain or discomfort. Its duration is from 60 to 90 minutes. The patient is either placed on a couch or scanned in a standing position.

There are also categorical contraindications, these include pregnancy and lactation. Urography in children is carried out using a gentle principle and takes less time. The dosage of the contrast agent is calculated based on the individual parameters of the child. A starch-free diet is recommended. To prevent flatulence from complicating diagnosis, you need to do a cleansing enema the night before.

Side effects

Negative consequences of the retrograde technique occur very rarely after the procedure, but daily practice indicates the following patient complaints:

• Feeling of discomfort in the bladder area due to heat spreading throughout the body after intravenous or catheter administration of contrast;
• After the scan is completed, a characteristic metallic taste appears in the mouth;
• A localized allergic reaction to an iodine-containing substance appears, in the form of a rash or swelling of the lymph nodes.

To prevent a retrograde urogram from causing such consequences, it is enough for the patient to be prescribed antihistamines before it is performed. If there is a sharp decrease in blood pressure, respiratory dysfunction occurs, or renal failure is detected, the procedure is urgently stopped.

Alternative methods

If the patient is at risk, then survey urography can be replaced with nuclear magnetic resonance diagnostics, computed tomography, and ultrasound scanning. They make it possible to study the condition of the retroperitoneal region, identify the condition of the kidneys, bladder and other pelvic organs.

Survey urography of the kidneys is used in urology to identify stones and formations of the renal collecting system.

On the urogram, urate stones are clearly visible, oxalate stones are less visible. Phosphate stones are rarely detected by plain urography.

The image obtained during the study is recorded on a 30x40 cm radiograph.
This film size allows you to visualize the following anatomical formations:

• Ilia;
• Spine;
• Small pelvis;
• Kidneys;
• Bladder;
• Dense foreign bodies.

The urogram shows intestinal loops. If they are filled with gas or feces, the visibility of the kidneys is impaired. Qualitative interpretation of the results depends on the preliminary preparation of the patient, the degree of cleansing gastrointestinal tract.

The overview image shows the shadow of enlarged kidneys with an expansion of the pyelocaliceal system. An attentive radiologist will detect an enlargement of the renal hilum. The shadow of the kidneys on the radiograph may be shifted to the side, and its Bottom part facing outwards.

Coral stone right kidney on urogram

Dilation (expansion) of the kidneys is characterized by spherical protrusions on the surface. The display of formations is not clear. Gentle renal darkening in pathology looks more massive than normal. Can move beyond midline belly.

All of the above changes are not clearly visible on x-ray. The definition of pathology during urography depends on the qualifications of the radiologist.

The essence of the method

The essence of the survey urography method is to perform a panoramic photograph of the abdominal cavity on the patient in a standing position after cleansing the intestines. feces.

The urogram shows skeletal system, soft fabrics, spine, which should also be assessed by a doctor.

The study has many other subtleties, but it is always performed before intravenous urography.

Most often, after undergoing a survey urography, the doctor prescribes deeper X-ray examinations. and possible allergic reactions to a contrast agent - read here.

About treatment renal colic at home, as well as in a hospital setting, read.

And here is everything about how hydronephrosis is diagnosed in children and what treatment methods are used. How dangerous is the operation and is it possible? full recovery renal function.

Indications

Indications for survey and excretory urography:

Hydronephrosis of the right kidney on x-ray

• Tumor stones;
• Foreign bodies;
• Kidney and ureteral stones;
• Injuries of the lower back and abdomen;
• Renal colic.

There is an emergency surgical indications for conducting survey urography.

If there is severe pain in the lower back that lasts several hours, an examination is performed to establish the location of the stone and assess its size.

Contraindications

The examination is contraindicated for pregnant women (as are all types of x-ray examinations).

A relative contraindication is performing the study on patients who have recently undergone a contrast gastroscopy procedure, passage of barium through the intestines.

Contrast material in the gastrointestinal tract will make it difficult to visualize the kidneys. Such patients need several days to clear the intestines of excess barium.

Absolute contraindications to survey urography:

1. Conceiving and bearing a child;
2. Absence of one kidney;
3. Chronic radiation sickness.

Regarding urography it works general rule for all x-ray examinations: the benefit of the procedure must be greater than the harm.

Preparation

The basis of preparation for survey urography of the kidneys is diet therapy to cleanse the gastrointestinal tract. Basic principles of diet before an x-ray of the kidneys:

1. Exclusion of products causing flatulence(sugar, bread, milk, legumes, potatoes);
2. Colon cleansing with sorbents (activated carbon, polyphepane, carbolene);
3. Refusal to eat in the evening and morning before the procedure;
4. Breakfast with tea without sugar.

An example of an overview urogram of a patient with kidney stones

Classic urography requires checking the condition of the patient's intestines using fluoroscopy. In practice, in order to reduce the patient's exposure to radiation, a survey X-ray is taken immediately after the person visits the X-ray room.

To prevent flatulence, you should not drink a lot of water.

According to European requirements, any x-ray examination must be carried out with the consent of the patient or his relatives.

For suspicious and impressionable patients it is recommended sedatives, painkillers, analgesics.

There are 2 ways to prepare the intestines for a urogram:

• Dissolve a packet of fortrans in 2 liters of water. Drink the solution a day;
• Take 4 tablets of activated carbon 4 times daily. Before the procedure, you need to do cleansing enemas with water;
• In children, espumizan is used to eliminate intestinal gasification.

In infants, urography is performed according to emergency indications. In a small child, due to the constant contraction of the smooth muscles of the gastrointestinal tract, the risk of accumulation of feces and gases in the intestine increases.

How is survey urography performed?

The procedure involves recording images of the kidneys and pelvis on X-ray film (30x40 cm).

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.
• Maintenance 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 bean-shaped parenchymal organs. They consist of medulla and cortical layers. The kidneys perform important task to detoxify 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 abnormalities 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, you may need biochemical research blood. It is necessary to confirm the absence of 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 in rare cases intravenous urography may cause allergic reaction. Its severity may vary. In particular, allergies can manifest themselves in the form of swelling of the lips or 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 quite rare negative manifestation considered to be 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.