General

Synonym/Acronym:
Antegrade pyelography, excretory urography (EUG), intravenous urography (IVU, IUG), IVP.

Rationale
To assess urinary tract dysfunction or evaluate progression of kidney disease such as stones, bleeding, and congenital anomalies.

Patient Preparation
There are no activity restrictions unless by medical direction. Instruct the patient to fast and restrict fluids for 8 hr, or as ordered, prior to the procedure. Fasting may be ordered as a precaution against aspiration related to possible nausea and vomiting. The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at www.asahq.org.

Instruct the patient to take a laxative or a cathartic, as ordered, on the evening before the examination; the bowel must be cleansed to achieve good visualization of the kidneys.

Pediatric and Older Adult Considerations: Special considerations regarding fluid restrictions may apply to patients experiencing chronic dehydration, including older adult patients in whom dehydration is common; considerations may also be given to pediatric patients. Fluid restrictions for pediatric patients may be adjusted based on age and weight.

Note: Protocols regarding the use of iodinated contrast medium in patients with impaired kidney function and who are receiving metformin or drugs containing metformin for type 2 diabetes may vary by facility; the drug may be discontinued on the day of the test and continue to be withheld for 48 hr after the test. Kidney function should be assessed per facility protocol before use of metformin is resumed (e.g., Cr, eGFR, hydration or clinical assessment).

Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.

Normal Findings

• Normal size and shape of kidneys, ureters, and bladder.
• Normal bladder and absence of masses or renal calculi, with prompt visualization of contrast medium through the urinary system.

Critical Findings and Potential Interventions
N/A