Intravenous pyelogram

Intravenous pyelogram or IVP is a diagnostic test that refers to an X ray exam of kidneys, bladder and ureters. This test is also known as excretory urogram and is essentially performed to assess disorders related to the urinary tract.

IVP test is performed by injecting iodinated contrast dye into the patient's veins. It enters the blood stream and pools in the kidneys and the urinary tract thus producing brighter images of the organs. As the dye travels through the urinary system, the IVP test provides useful information regarding the functioning of the kidneys, bladder and ureters. Any delay in the fluid flow indicates blockage in the urinary system. Intravenous pyelogram is performed to diagnose the following disorders:

• Blockage or obstruction in the normal flow of urine.
  
• Kidney stone or bladder stone
  
• Enlarged prostate gland
  
• Injuries and congenital disorders of the urinary tract
  
• Kidney tumor
  

As the dye travels through the urinary system, a series of x-ray images are taken at frequent intervals. The visualization of the fluid flow will help understand the efficiency of the kidney functioning and as well as to diagnose the obstruction, if any.

Before the procedure

1.Patient should not consume any food 5 to 6 hours prior to the procedure. The day before the procedure, patient may be given a laxative to clear the bowels.

2. Pregnant women must not take this test.

3. Diabetic patients should inform the doctor about their medical condition and adjust their insulin dosage as per the instructions given by the doctor.

4. If the patient is allergic to coloring agents, the same should be informed to the doctor so that an anti-allergic medication is prescribed to be taken before the procedure.

Risks of Intravenous pyelogram

IVP is a safe procedure and there are rarely any complications associated with the intravenous pyelogram. Yet on few occasions, a patient may experience hot flushes, itching, nausea and vomiting. Very rarely patient develops allergic reaction to the dye and may experience breathing difficulty, choking sensation and swelling of the lips and tongue. Blood pressure may drop to alarming levels and patient may also lose consciousness.

Hydronephrosis

Hydronephrosis refers to the swelling of one or both of the kidneys that occurs due to accumulation of urine in it. The urine goes through the ureter and is excreted by the urethra. If the outward flow of urine is blocked for some reason, it passes back to the kidneys, causing pressure and swelling. This condition is called as Hydronephrosis. It is not a disease in itself but occurs due to other underlying conditions. Reasons such as obstruction in urinary flow, kidney stones, reflux of urine from bladder to kidney lead to Hydronephrosis.

Symptoms of Hydronephrosis

• Sudden or intense pain in the back or sides
  
  
• Dull pain in the groin area
  
  
• Nausea and Vomiting
  
  
• Reduced urine output
  
  
• Frequent or painful urination
  
  
• Blood in the urine
  
  
• Weakness or malaise
  
  
• Fever due to urinary tract infection
  

Causes of Hydronephrosis

• Urinary stone
  
  
• Blood clots in the kidney or ureter
  
  
• Kidney tumor or Tumors in the bladder, prostate gland
  
  
• Urinary scarring
  
  
• Renal enlargement
  
  
• Renal failure
  
  
• Uterine prolapse
  

Congenital Hydronephrosis

• Hydronephrosis can also occur in infants. Such congenital cases are noticed either at prenatal or antenatal stage.
  
  
• Hydronephrotic in infants is normally due to Vesico-ureteral reflux in which urine, instead of flowing from the kidneys to the bladder, abnormally flows back in the ureter.
  
  
• Another common cause is congenital Hydronephrosis obstruction either at uretero-pelvic junction or at ureter-bladder junction.
  
  
• The condition is also caused due to Ureterocele wherein the ureter does not develop properly and causes a small pouch into the bladder.
  
  
• Pregnant women also experience gestational Hydronephrosis due to mechanical compression of the ureter blocking the urine flow.
  

Diagnosis of Hydronephrosis

• Early diagnosis is very important; the longer hydronephrosis remains untreated, the more kidney function is lost.
  
  
• Diagnosis may begin by a thorough physical examination of the patient where the enlarged kidneys would be palpable due to swelling.
  
  
• After noting down the symptoms and the medical history of the patient, doctor may order few blood and urine tests to check the level of infection.
  
  
• Ultrasound scan is normally taken to confirm the diagnosis.
  
  
• Imaging tests like CT scan and MRI of abdomen and kidneys may be required to understand the underlying condition and the exact location of the blockage which helps in deciding the course of the treatment.
  

Hydronephrosis Treatment

• The first step in treating the condition would be to drain the accumulated urine through catheterization.
  
  
• Once the fluid is drained off, the underlying condition that resulted in Hydronephrosis needs to be addressed.
  
  
• If there is a blockage in the ureters, a stent can be placed to bypass the block for smooth flow of urine.
  
  
• Kidney stones are normally treated with lithotripsy, a shock wave treatment that fragments the stones into tiny pieces, to excrete easily.
  
  
• Enlarged prostate is treated with medication or surgery to remove part or whole of the prostate.
  
  
• If Hydronephrosis is caused due to kidney tumors, the same is treated with surgery, chemotherapy and radiation.
  
  
• Hydronephrosis in infants often resolves on its own and does not require any aggressive treatment except for some mild antibiotics to prevent infection.