What is kidney urography in children? Survey, contrast, excretory urography: what is this procedure? Rules for preparation and results of x-ray examination

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

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

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

The technique has the following capabilities:

Allows you to assess the functioning of organs in case of detected pathologies (tuberculosis, pyelonephritis, trauma). The action is possible with a certain accumulation of contrast agent.
Can visualize focal inflammation, foreign bodies stones in tissues.
Gives you the opportunity to get full morphological picture processes of organ change as a result of disease development.

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

Using the study, you can identify the following diseases:

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

Indications for intravenous urography:

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

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

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

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

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

Patient preparation

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

Preparation for intravenous urography:

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

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

Points to pay attention to:

Bedridden patients swallow a large number of air, so they are recommended to stay in vertical position before the procedure.
Diet during the preparation phase is important for young people.
Elderly people and patients with intestinal atony require cleansing enemas for a quality diagnosis.

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

The essence of the method and features of the drugs used

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

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

The selected drug should not:

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

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

How is the diagnosis done?

Before administering a drug containing iodine, you must ensure individual tolerance, the patient is not allergic to the components of the medication. The night before, you need to do an allergy test (skin test), or inject up to 3 ml of the drug subcutaneously.

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

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

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

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

Side effects

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

Side effects after urography:

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

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

Pros and cons of the technique

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

does not require cystoscopy at the preparation stage;
available exact information about the morphological and functional state of the kidneys and bladder;
diagnostics is practically painless (no discomfort, except for a puncture to administer a contrast agent);
makes it possible to examine patients with severe injuries
does not require anesthesia.

Disadvantages of the technique:

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

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

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

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

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

The resulting urogram perfectly visualizes anatomical position 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) - used contrast agent, 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 immediately receives 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 intake may be prescribed on the eve of the procedure. activated carbon.

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 (hormonally active tumor medulla adrenal glands).

If it is not possible to perform urography (if there are contraindications) this method can be replaced by 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.

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

Characteristics of the survey

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

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

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

Urography with contrast is prescribed to a child only for serious indications. It is recommended if problems in the organs could not be detected using ultrasound of the kidneys and bladder. This diagnosis is decisive in detecting pathology.

When is the examination scheduled?

The main indications for this procedure are pathologies:

stones in the kidneys, ureters;
abnormal kidney development;
hematuria, tumors of unknown nature;
ailments – tuberculosis, pyelonephritis, etc.;
kidney injuries;
tumors.

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

Types of urography

The following varieties are distinguished:

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

Contraindicated x-ray examination using a contrast agent for children diagnosed with:

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

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

Objectives of the study

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

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

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

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

So that the diagnosis is carried out correctly and shows the maximum reliable results, children should be carefully prepared for urography.

Preparing for the study

Before urography you will have to undergo blood biochemistry. This analysis makes it possible to exclude pathologies such as renal failure, in which diagnosis is strictly contraindicated.

Preparation for the study consists of the following activities:

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

Mechanism of urography

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

Various substances are used for diagnosis:

triombrine,
urotrast,
verografin,
triiodotrust.

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

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

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

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

Consequences of the procedure

The child may experience negative reactions for contrast agent:

feeling of heat;
nausea;
slight dizziness;
hives.

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

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

breathing problems;
a sharp decrease in pressure.

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

Doctor pays attention

The procedure is completely painless. It usually takes about 45 minutes. Before the examination, all metal objects must be removed.
Into the room during diagnosis, especially in infants, the temperature should be maintained at 30-35 degrees. The beams of heat lamps should be directed towards the table on which the examination is taking place.

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

Video for the article

Every day doctors are increasingly diagnosing various diseases kidney

To put final diagnosis patients pass whole line 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) is an x-ray examination that studies structural changes kidneys and determining urolithiasis pathologies. Urography is performed subject matter experts. Thanks to the results of urography, the doctor will be able to definitively make a diagnosis and prescribe appropriate treatment.

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

With the help of 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 urinary system;
possible complications of kidney injury;
nephrogenic hypertension (persistent arterial 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. Also, you can get an accurate picture renal work after surgery.

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

In what cases is it prohibited to conduct survey urography?

Like others x-ray studies, 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:

two days before the diagnostic test, it is forbidden to eat fresh vegetables and fruits that have not been previously 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 diagnostic test If it is scheduled for the morning, it is advisable to do an enema before going to bed 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 You can use activated carbon. To do this, you need to take six tablets in the morning and six in the evening.

Before intravenous urography it's enough to stick with it for a few 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 maximum comfortable position for the patient in which the main muscle groups do not tense. 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, then the patient himself must tell him about all the medications he took during the last month. The doctor directs x-ray 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 of examination is 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. So that it doesn't happen allergic reaction, children additionally take an antihistamine drug.

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. The ureters and bladder were not detected on 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. Bladder and the ducts must be in a visible place. U healthy kidney 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.