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 pelvicalyceal structures, and the excretory ability of the kidneys. Visually assess anatomical structure possible through passing a special preparation along the urinary tract - the process is recorded on the pictures.

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

Intravenous urography is used to determine a large number of pathologies in the urine. excretory system organs.

The technique has the following capabilities:

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

The diagnostic method is especially popular in pediatrics because of the 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.

With the help of the study, you can determine the following diseases:

hydronephrosis of the kidneys;
traumatic lesions of the renal tissues;
malignant or benign formations;
the formation of stones;
foreign bodies, diverticula in the bladder cavity;
violations of the function of emptying the bladder;
anomalies in the development of the kidneys;
kidney tuberculosis.

Indications for intravenous urography:

violations of the excretory work of the kidneys;
anomalies in the development of one or two kidneys;
urolithiasis disease;
chronic pathologies of organs;
suspicion of tumor-like formations of a malignant or benign nature;
change in the functionality of the bladder;
inflammation.

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

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

When prescribing intravenous urography to diabetic patients, the doctor needs to be aware of the drugs taken: the drug Glucophage, which contains metformin, when combined with an iodine-containing contrast agent, provokes a sudden increase in the level of lactic acid in the patient's blood, which causes acidosis.

Also, with diagnosed diabetes, it is necessary to control the release of contrast and accelerate its removal from the body.

Patient preparation

The technique requires some preparation, which should be started 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, therefore, compliance with the instructions is mandatory.

Preparation for intravenous urography:

Collection of anamnesis.
Cleansing the intestines stool, gases (lavage, enema). The procedure must be done twice - in the evening, on the eve of the examination, and 3 hours before the appointed time.
3 days to go to diet food, which prevents increased gas formation. It is necessary to exclude pastries, confectionery, carbonated drinks, fresh vegetables and fruits dairy products, legumes.
The day before the analysis, limit the amount of fluid 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 acceptable, excluding too high-calorie foods and foods that increase gas formation.
If the patient is anxious, fearful of manipulation, he is prescribed sedatives in individual dosage.

Preparation is necessary to obtain highly accurate data and minimize the risk of complications during the administration of contrast fluid. 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.

Nuances to pay attention to:

Bedridden patients swallow a large number of air, so they are recommended to be more often in vertical position before the procedure.
For young people, diet is important during the preparation stage.
Elderly people, patients with intestinal atony require cleansing enemas for a quality diagnosis.

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

The essence of the method and features of the drugs used

The contrast agent, which is administered to the patient, is well reflected in the urograms made, and allows you to evaluate the work of each of the kidneys, ureters, excretory tracts, bladder, urethra. It is important to record changes as the material is processed by the kidneys and the fluid stained with a contrast agent passes through the body (in order to find out about deviations by comparing the data with established standards).

The choice of the drug must be approached responsibly, because not only the information content 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 exchange process.

AT modern medicine use such finished preparations: Urografin, Visipak, Cardiotrast, Trijombrast. In addition to 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 carried out?

Before the introduction of the drug containing iodine, it is necessary to make sure that individual tolerance, the absence of an allergy in the patient to the components of the drug. The night before, you need to do an allergy test (skin test), or inject up to 3 ml of the drug subcutaneously.

The procedure is performed in the supine position. The patient lying on the couch is injected with up to 30 ml of a contrast agent intravenously. It is important to administer the drug slowly, 2-3 minutes, and at this time observe the patient's well-being. special attention require patients with cardiac, 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 pictures fix the state of the organ at the 10th, 20th, 45th minutes and an hour later.

For the accuracy and informativeness of the method, the data are recorded both lying down and standing. Changing the position of the patient's body during the study will help to identify disorders such as kidney prolapse.

The number of images and the frequency of fixation of changes depend on the preliminary diagnosis. If pathologies are suspected, exciting urethra, the 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 the introduction of contrast;
violation of the respiratory process;
iron taste in the mouth;
rash;
swelling of the lips;
kidney failure.

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

Pros and cons of the technique

Excretory urography is popular in the diagnosis various pathologies urinary system organs. In comparison with 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, bladder;
diagnostics is practically painless (no discomfort, except for a puncture for the introduction of a contrast agent);
enables the examination of patients with severe injuries
does not require anesthesia.

Cons of the technique:

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

Intravenous urography has many advantages over innovative technologies and therefore 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 start treatment as soon as possible.

The method is available everywhere and does not require large material costs, but at the same time allows you to get 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 the function of the kidneys and urinary tract, 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, to detect a variety of pathologies (neoplasms, stones, foci of inflammation).

Urography happens:

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

As a contrast in excretory urography, iodine-containing preparations are used. 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 is required. Testing is performed in an outpatient setting under the supervision of medical staff. With the development of allergies (urticaria, runny nose, swelling), the patient immediately receives qualified help. In this case, the introduction of a contrast agent is strictly contraindicated.

Preparation for urography

Within 3 days before urography, it is necessary to 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 reception may be prescribed on the eve of the procedure. activated carbon.

8 hours before the examination, you can not eat or drink a lot of liquid.

Immediately prior to urography, the bladder and stomach must 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 anomalies of the kidneys;
pathological mobility of the kidneys;
traumatic injuries;
control after surgical treatment.

Contraindications

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

allergy to iodine-containing drugs;
pregnancy at any time;
various bleeding;
decreased blood clotting;
renal failure (acute or chronic form);
glomerulonephritis (acute course);
thyrotoxicosis;
therapy diabetes drug "Glucophage";
pheochromocytoma (hormonally active tumor medulla adrenals).

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

The decision on the advisability of replacing or supplementing 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, it is necessary to sign an official consent to conduct urography. This can be done by the patient himself or his relatives. Then you need to remove all metal objects from yourself and change into disposable medical clothes. If the patient is worried severe pain or a feeling of fear, he may be offered sedatives and painkillers.

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

Excretory (intravenous) urography

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

When the contrast is slowly removed, delayed shooting is possible (at 45, 60 minutes). How many pictures you need to take is determined by the radiologist, taking into account the characteristics of the disease.

Side effects

Often, during the injection 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 the contrast and neutralize the received dose of radiation on the first day after the examination, it is recommended to drink more liquid, better milk and fruit juices.

Since a sensitivity test was made before the introduction of a full dose of a radiopaque preparation, an allergy to it develops extremely rarely.

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

Kidney urography in children is one of the most widely used studies. It provides an objective picture of the state of organs. Based this survey the doctor can conclude whether there are affected tissues, whether the functioning of the ureters and bladder is impaired. However this species diagnostics has its own characteristics. They must be taken into account in order to properly prepare children for the study.

Survey characteristics

What is urography? This diagnostic is an X-ray examination that shows the condition of the urinary system in a child.

The essence of the method is based on the introduction of a contrast agent into the kidneys. That is why the study is called contrast urography. The introduced substance is capable of delaying x-rays.

Initially, it accumulates in the kidneys. At this time, the doctor can assess their condition from the pictures. Then the substance passes into the urinary system. Thus, this diagnosis gives an idea of the functioning of the ureters, the bladder.

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

When is an examination scheduled?

The main indications for this procedure are pathologies:

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

There are several types of urography, each of which has its own indications, the degree of information content and the specifics of the conduct.

Types of urography

There are the following varieties:

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

Contraindicated x-ray examination with the use of a contrast agent for children who are diagnosed with:

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

Another obstacle to such a diagnosis is hypersensitivity in children to iodine-containing substances.

Research objectives

Reveal various lesions kidney or malfunction urinary tract in children is quite difficult, since the symptoms of some kidney diseases are very similar to other pathologies. Such signs can indicate colds, SARS, problems with the gastrointestinal tract, heart, and even diseases of the spine.

Therefore, in order for the doctor to be able to correctly diagnose, it becomes necessary to check the functioning of the kidneys. It is urography that can solve this problem.

This event allows you to determine the parameters of the kidneys, which are directly related to their functioning:

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

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

Study preparation

Before urography, you will have to take blood biochemistry. Such analysis allows to exclude such pathology as kidney failure, in which the diagnosis is categorically contraindicated.

Preparation for the study consists of the following activities:

3 days before the procedure, foods rich in fiber and carbohydrates should be excluded from the diet. Babies are being put on a diet.
Older children are advised to take activated charcoal. Babies are given this remedy exclusively on doctor's orders. This measure allows excellent adsorption of gases.
A laxative should be taken 1 day before urography. The doctor will prescribe it. Before going to bed, the child is given an enema.
If the procedure is done to teenagers, it is recommended to refrain from eating in the morning. Small children are allowed to eat a small piece of meat with white fried bread. After eating, you should again put an enema.

Mechanism of urography

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

Various substances are used for diagnosis:

triombrin,
urotrast,
verografin,
triiodtrust.

All of them are strong allergens. Therefore, initially the doctor calculates required amount contrast agent. It takes into account the age, weight of the child, the state of the liver, kidneys.

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

The doctor will definitely explain how the diagnosis is done. During urography, 5 pictures are taken. It is very important that they succeed 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 babies. After all, the slightest movement can affect the quality of the pictures. It is quite difficult to determine in such a situation a renal ailment. One-year-old children can be anesthetized.

Consequences of the procedure

The child may experience negative reactions for contrast agent:

feeling of heat;
nausea;
slight dizziness;
hives.

These reactions usually go away on their own. Sometimes an additional antihistamine medication may be needed.

More serious consequences of the procedure, which are extremely rare, are:

respiratory failure;
a sharp drop in pressure.

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

doctor pays attention

The procedure is completely painless. It takes, as a rule, 45 minutes. Before the examination, all metal objects must be removed.
Indoors during diagnosis, especially in infants, the temperature should be maintained at 30-35 degrees. The rays of heat lamps should be directed to the table on which the examination takes place.

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

Video for the article

More and more doctors are diagnosing various diseases kidneys.

To put final diagnosis patients undergo whole line laboratory and instrumental studies.

Doctors prescribe ultrasound procedure, magnetic resonance imaging and urography. These methods allow specialists not only to determine the external lesions of the kidneys, but also their internal changes.

Urography (cystography) is an X-ray study that studies structural changes kidneys and determining urolithiasis pathologies. Urography is carried out specialized specialists. Thanks to the results of urography, the doctor will be able to finally make a diagnosis and prescribe the appropriate treatment.

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

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

What does an overview view of urography show

Survey urography of the kidneys is carried out 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 you can see all the organs of the abdominal cavity is considered. Thus, the doctor determines or excludes other pathological processes.

In what cases is urography prescribed?

Urography has been developed in order to assess the functionality of the kidneys. Therefore, in almost all cases when there is a suspicion of a pathological process, doctors prescribe this diagnostic method.

With the help of a survey urography, doctors can determine:

the presence of a good or malignant neoplasm or tumor lesions;
structural changes in the renal tissue;
stones and small stones 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 (expansion of the renal pelvis caused by impaired outflow of urine) and tuberculosis;
causes of blood in the urine.

Doctors may order a survey urogram if they suspect urinary tract infections. infectious processes caused by renal colic. Also, you can get an accurate picture kidney work after surgery.

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

In what cases is it forbidden to conduct a survey urography

Like others x-ray studies, urography is not performed for women during the gestation period. Experts do not recommend such a diagnosis for patients who have recently undergone contrast gastroscopy.

In such cases, the contrast medium makes it difficult to visualize the kidneys. If all the same there are indications for survey urography, then it is carried out a few days after the previous study.

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

women during the period of bearing a baby;
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 passes a test in advance to determine the 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 study, it is forbidden to eat fresh vegetables and fruits that have not been previously thermally processed;
it is strictly forbidden to consume cereals and beans, sweets and fresh pastries in two days;
per day, it is necessary to reduce the amount of fluid consumed to a minimum.

By following these simple rules you can achieve an increased concentration of urine, which in turn, increase the contrast in the picture.

Before the diagnosis, you can not eat enough. It is better to eat 10 hours before urography, and it is desirable if it is a light meal.

If a diagnostic study appointed for the morning, then before going to bed and in the morning it is desirable to do an enema. This clears the stomach intestinal tract. 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 conducting a survey urography, it is very important that the intestines are not filled with gases. Therefore, it is necessary to eat a few days before the study dietary products. Also, doctors prescribe activated charcoal or polyphelan.

You should not eat up before the procedure, but you should not be hungry, as in empty stomach gases may form. Be sure to do two enemas - in the morning and before the study.

With the help of excretory urography, doctors determine the morphology of the kidneys. In this case, the presence of gases in the intestines can misinform the specialist.

The day before, doctors recommend drinking 30 gr. castor oil(about three teaspoons). This allows you to reduce gas formation in the intestines. Get rid of increased gas formation can be done with activated charcoal. To do this, you need to drink six tablets in the morning and six in the evening.

Before intravenous urography just a few days is enough proper nutrition. Eliminate fatty, spicy and sweet. Thus, the gastrointestinal tract is cleansed and the pictures become clearer and more accurate.

How is kidney urography performed?

Conducted overview urography does not take much time and is easy to carry out. The patient takes a supine position, and a pillow is placed under the head. This is the maximum comfortable posture for a patient in which the main muscle groups do not strain. Before the diagnosis itself, the doctor talks with the patient, finding out the expressed discomfort and unpleasant sensation experienced by the patient in recent years.

If the doctor does not ask, then the patient must tell him about all the medicines that he has taken during last month. The doctor directs x-ray so that it is slightly lower than the xiphoid process.

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

Is survey urography harmful?

The human body may react negatively to the fact that an urographic study was carried out, namely:

burning in the veins into which the contrast agent was injected;
nausea;
flush of heat;
dizziness;
taste of iron 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 if it is 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 conduct survey urography for young children, since this type of study is absolutely safe. Only the dosage of the contrast agent is determined by the weight of the child 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. Not to happen allergic reaction children additionally take an antihistamine drug.

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

How analyzes of survey urography are deciphered

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

The organs of the abdominal cavity are deployed towards the spine. The ureters and bladder were not found on the x-ray. If the patient has urolithiasis, then the stones are clearly defined. "Humpbacked" kidney is considered the norm. In 42% of patients, one kidney is not visible.

Otherwise, the contrast agent should visualize the kidneys well. Bladder and ducts should be in a conspicuous place. At healthy kidney homogeneous structure.

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

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