If your kidneys are acting up, they definitely need to be examined. Often, in the diagnostic plan drawn up by the doctor, you can see urography. Along with other instrumental tests, it will help visualize the kidneys and identify their main problems. What is kidney urography using contrast agent, what indications and contraindications this procedure has, and how the patient can prepare for it: let’s figure it out.

The essence of the method

Excretory urography of the kidneys is a method of x-ray examination that allows you to obtain visual control over the area of ​​the kidneys, ureters and bladder.

The use of a radiopaque contrast agent helps to make the image of the organs of interest clearer, and taking a series of images at certain intervals allows you to monitor the dynamic processes of urine excretion.

The essence of the procedure is the intravenous administration of contrast agents, which are secreted by the kidneys:

• Cardiotrust;
• Urographina;
• Triombrasta;
• Visipaka.

Subsequently, when most of the contrast reaches the nephrons and penetrates the pyelocaliceal system, and then into the ureters and bladder, a series of x-rays. It allows you to assess the filling of the internal structures of the kidneys with contrast and the presence of pathological contents in them.

Indications for urography

Using this diagnostic test, you can identify the presence of inflammatory foci, benign and malignant tumors, stones (calculi), and also find out the cause of hematuria (blood in the urine). Since kidney urography with contrast allows you to get a clear picture internal structure organ, the procedure has wide range indications:

• neoplasms - to clarify the size, location, contours and characteristics of the blood supply of the tumor;
• infectious-inflammatory, autoimmune and other structural changes in renal tissue;
• stones in the pyelocaliceal system, including small ones;
• congenital anomalies of the urinary organs;
• possible consequences of injuries;
• chronic pyelonephritis;
• glomerulonephritis;
• hydronephrosis;
• kidney tuberculosis and other diseases;
• the recovery period of patients after kidney surgery.

Using an x-ray examination of the kidneys with a contrast agent, you can reliably determine the type and extent of urine damage excretory system, as well as the stage pathological process. All this allows the doctor to draw up a plan for effective and comprehensive treatment of the disease.

Preparing for the study

In order for the test result to be as informative as possible, it is necessary to reduce the risk of possible errors. Preparation for urography consists of:

1. Reduced intestinal pneumatization (for better visualization of the urinary organs). A few days before the kidney examination, give up foods that cause flatulence - bread, milk and dairy products, cabbage, potatoes, legumes. To cleanse the intestines, use sorbents (activated carbon, Polyphepan). The procedure is carried out on an empty stomach, the last meal is allowed no later than 16:00 the previous day.
2. Immediately before intravenous (excretory) urography of the kidneys, the colon is cleansed using an enema and the bladder is completely emptied.
3. At increased nervousness or the patient's excitability for 3-7 days, it is recommended to prescribe a mild sedative(eg Persen).
4. Be sure to tell your doctor if you are allergic to any medications.
5. Before starting urography, the patient signs informed consent to carry out the procedure.

The urography procedure itself takes no more than 30-40 minutes and consists of several stages:

1. preparation and completion of medical documentation;
2. the patient takes supine position on a special table;
3. introducing contrast into peripheral vein(at this time, slight discomfort in the form of burning is possible);
4. a series of sequential x-rays of the lower back every 5-10 minutes. If it is necessary to diagnose diseases of the bladder and urethra, several photographs can be taken an hour and a half after the administration of contrast.

Features of x-ray examination of the kidneys in children

Previously, X-ray examinations of children presented certain difficulties and required complete immobility (even holding their breath) little patient, then today the use of modern equipment allows us to make clear and diagnostic significant photo in a split second.

However, with pronounced nervous and motor excitement, kidney urography in children can be performed under general anesthesia. In this case, in addition to the radiologist, there must be a qualified anesthesiologist in the room who will monitor the child’s condition.

Contraindications and undesirable effects of urography

There are few absolute contraindications to the procedure. These include:

• allergy, individual intolerance radiopaque contrast agent components;
• acute and chronic renal failure;
• acute urinary retention.

Side effects usually develop when contrast is administered too quickly. Among them are:

• nausea, vomiting;
• feeling of heat in the face;
• headache, dizziness;
• hypotension (low blood pressure), collapse.

When discomfort Be sure to inform your doctor during the administration of a radiopaque contrast agent. The specialist will reduce the rate of administration of the substance or, if necessary, begin providing first aid.

Excretory urography remains one of the most effective methods diagnostics of the excretory system in children and adults. Its high effectiveness makes it possible to determine the development of a tumor, inflammatory or urolitic process in early stage, and start treatment on time.

Urography is an effective, safe diagnostic method. The study is prescribed if there is a suspicion of the development of renal pathologies, damage to the bladder, or problems with filtration and urine output. The technique allows you to identify stones, tumors, cysts, and determine the structure of the kidney tissue.

Before undergoing the procedure, patients should understand that the doctor did not accidentally choose a method such as urography. What is it? What does the study show? How does contrast urography differ from survey urography? How to properly prepare for the procedure? The answers are in the article.

General information

X-ray examination allows you to identify disturbances in the functioning of important organs performing excretory, filtration and excretory functions. To get a more complete picture of the negative changes, the doctor first injects a contrast agent and then undergoes an examination. During survey urography intravenous administration no medications are given. The examination is permitted at any age; there are no complications or serious discomfort during the procedure.

Advantages of the modern technique:

• provides reliable data on the degree of kidney damage and the type of pathology;
• The image clearly shows parenchymal structures, stones, and the pyelocaliceal system;
• shows the stage of the disease, the quality of kidney function;
• does not cause pain to the patient;
• there is no tissue injury;
• suitable for identifying various pathologies, including congenital ones;
• adverse reactions pass quickly enough, severe complications No;
• foci of inflammation are clearly visible;
• the procedure is prescribed for both adults and children;
• Several types of examination allow the doctor to select best option to clarify the nature of the pathology in a particular patient;
• the preparation is simple, no expensive medications are needed;
• During the study, the patient receives a minimal dose of radiation;
• Urography is a highly informative diagnostic method with reliable results.

Indications for the study

X-ray examination is prescribed to identify:

• small and large;
• benign and malignant tumors;
• hypertension arising against the background of renal pathologies;
• causes of hematuria;
• congenital pathologies of the structure of the urinary system;
• infectious diseases occurring in the organs of the genitourinary system;
• structural disorders in the tissues of important organs;
• control of problem areas during;
• to clarify the condition of organs after kidney surgery.

Contraindications

Survey, excretory and contrast urography are not suitable for all patients. Before the study, the doctor finds out whether there are any restrictions for a particular person. The patient is obliged to inform the urologist about all chronic pathologies, intolerance to certain substances, pregnancy.

Urography is not performed in the following cases:

• acute or chronic;
• pheochromocytoma;
• tendency to bleed;
• thyrotoxicosis, other pathologies thyroid gland;
• low blood clotting;
• pregnancy;
• severe forms of kidney or liver diseases;
• taking Glucophage medication during diabetes therapy;
• allergic reactions to iodine contrast agents;
• bleeding of various kinds;
• breastfeeding period.

What to do if the doctor forbids you to do urography? An alternative is safer research methods: CT, MRI, . These techniques give reliable results, although the information content of urography is higher.

Types of X-ray examination

X-ray examination is carried out in different ways. The choice of method is the competence of the urologist. The doctor selects the optimal way to study the tissues and functionality of the kidneys, depending on the nature of the disorders. Survey urography is often prescribed before a contrast study to clarify the data and obtain a more detailed picture of the internal renal structures.

Survey urography

Features:

• Doctors take most x-rays at the time the contrast agent is removed;
• the method allows you to reliably assess the excretory function of important organs, determine the rate of filling of the bladder, renal pelvis;
• during the examination, the stones, their size, shape, location are clearly visible;
• excretory type of examination is prescribed to identify tumors;
• The method gives an idea of ​​the structure of the organs of the urinary system.

Contrasting

Features of kidney urography using a contrast agent:

• to study the kidneys and bladder, a contrast agent is used, which is administered intravenously;
• the technique is based on renal filtration capacity, removal of processed materials, and release of metabolic products;
• the drugs Vizipak, Urografin, Cardiotrast are chosen as an X-ray contrast agent;
• after the administration of the components, the patient often feels heat in the body, a burning sensation in the vein, nausea, metallic taste in the mouth. Side effects disappear after a few minutes;
• Contrast urography is performed with an empty bladder. Pictures are taken during the period of accumulation of contrast agent from the blood at certain intervals: in the first 2 minutes, then after 5 minutes, 7 minutes after intravenous administration of a special drug;
• the technique shows the pelvis, ureters, kidneys, prostate, stones, cysts, tumors. The photographs show hydronephrosis and hyperplasia prostate gland, pathological stretching or wrinkling of the organs of the genitourinary system.

How to prepare: basic rules

Basic rules for preparing for urography:

• three days before urography, the patient should refuse food that provokes increased gas formation: legumes, fresh cabbage, carbonated drinks, fresh bread, baked goods, raw vegetables;
• if you are prone to flatulence, it is important to take activated charcoal once a day required quantity(per kilogram of weight - 1 tablet);
• It is necessary to do a test to determine if you are allergic to the X-ray contrast agent: Urografin, Triombrast, Vizipak, Cardiotrust and others. If there have been previous cases of a negative response to the listed drugs, then the patient is obliged to warn doctors about undesirable manifestations;
• no later than 8 hours before the X-ray examination, you need to eat; you should not drink too much liquid during the day;
• You should not eat food in the morning on the day of the procedure;
• in the office, the patient removes metal items, jewelry, and, as directed by the doctor, empties the bladder;
• If you are nervous or afraid of unpleasant sensations, you may take a sedative (sedative) shortly before urography.

Learn how to collect and what the results show.

About how to treat urolithiasis in men with the help of a diet it is written on the page.

How is the procedure performed?

Features of the study:

• How is urography performed? The first stage is survey urography, then excretory;
• The duration of the procedure depends on the severity of the pathology, detection of stones, number of stones, and other factors ( individual characteristics person);
• Survey urography is done in the standing position. To protect the chest and genitals, these areas are covered with heavy aprons with protective plates. The doctor directs a beam of X-rays to the zone of 3 and 4 vertebrae;
• To perform intravenous urography with an X-ray contrast agent, the patient lies on a special table, and the doctor injects the drug into the vein. The beginning of the procedure is sometimes accompanied by unpleasant sensations, after a short time the discomfort disappears;
• gradually the contrast penetrates into the renal tissue and ureters. During excretory urography, images are taken at a certain interval. One shot must be taken “standing”, the rest - in the “lying” position;
• if indicated, delayed images are taken several hours after filling the tissues with a contrast agent;
• the standard duration of the procedure is from 30 to 60 minutes;
• After the study, the patient can do his usual activities, eat, and drink fluids.

Important point! To conduct any type of study, the patient must empty not only the bladder, but also the intestines. Air bubbles and accumulation of processed products interfere with renal visualization and reduce the effectiveness of the method. If a person cannot cleanse the intestines on his own, an enema is performed to remove as much food and gases as possible.

Side effects

During survey urography, discomfort does not appear; unpleasant sensations occur for a short period at the time of administration of the X-ray contrast agent. After a few minutes side effects disappear.

The doctor is obliged to warn the patient about possible negative sensations:

• burning in the vein in the first minute;
• nausea;
• unpleasant taste in the mouth;
• dizziness;
• feeling of heat in the body.

To quickly remove the X-ray contrast agent, the patient after the procedure should drink more milk, natural fruit juices, and weak green tea.

Results

After the procedure, the doctor analyzes the images, clarifies and identifies:

• shape, size, location of the kidneys;
• condition of parenchymal structures;
• functionality of the collecting system;
• quality of filling of the pelvis with urine;
• rate of urine outflow;
• presence of stones;
• consequences of injuries suffered in the area urinary tract;
• kidney malformations;
• severe degree of hydronephrosis.

Urography - modern research to assess the condition of the urinary tract, renal parenchyma, identify inflammatory foci, problem areas, interfering with the free flow of urine. X-ray examination is safe for patients of any age. Proper preparation for contrast, excretory and survey urography increases the effectiveness of the method.

Learn more about kidney examination using urography after watching the following video:

The study of the kidneys using X-rays - urography, is aimed primarily at diagnosing nephrolithiasis (calculi, otherwise stones) and determining changes in the structure of organs. Depending on the suspected disease, the patient is prescribed excretory or survey urography.

The first type of examination is more focused on assessing the excretory functions of the kidneys, is carried out according to individual indications, and takes a fairly long period of time. The procedure is carried out using a special contrast agent, intravenous injection which provides a more detailed image on an x-ray.

Possibilities of overview urography

Survey urography does not involve the use of contrast. Essentially, this is the same x-ray focused on the lower part of the body. The capabilities of the method make it possible to determine the presence of stones of different chemical composition:

• oxalates. The source of formation is oxalic acid;
• loss. The most common type of stones are formed from uric acid salts;
• struvites. The source is ammonium phosphate;
• phosphates. Composed of calcium phosphate;
• carbonates. They are formed from calcium salts of carbonic acid.

Survey urography allows you to clarify the location of kidney stones

Carrying out the procedure

Diagnosis of renal pathologies using urography is carried out as a regular x-ray examination. The patient can be in a vertical or horizontal position, depending on the model of the device. The focus of the x-rays is projected onto the lumbar area L3–L4 (third and fourth vertebrae) at an angle of 90 degrees.

The procedure takes a short period of time (5 to 7 minutes) and is not burdensome for the patient. All that is required of the examinee is to maintain a static position and, at the command of a medical specialist, hold his breath for a few seconds. This is done to ensure that the image of the organs on the x-ray is clear, without blurred areas.

Excretory urography with the use of contrast involves the radiologist taking several sequential images with a time range of 15–20 minutes. The examination lasts about 50 minutes, and the patient may experience an uncomfortable burning sensation from the use of a contrast agent.

X-ray results

The department doctor decodes the results radiology diagnostics. The image is described sequentially according to a specific algorithm:

• condition of the spine and pelvic bones. In chronic renal pathology, there is a high probability of developing a frontal curvature of the spinal column;
• shadows of the buds and their location. According to the standard, the left shadow should be located from the 12th thoracic vertebra up to 2nd vertebra lumbar region spine, right - just below - from the 1st to 3rd lumbar vertebrae. When assessing shadows, the diagnostician describes their outlines, sizes and shapes;
• kidneys directly. Healthy organs must have clear outlines and a homogeneous structure. In the presence of a single cyst, a tubercle is visible; in polycystic disease, the kidney is enlarged, and the outline of the organ is wavy. The tumor is determined by the growth of the kidney and curved contours;
• lower back muscles. Blurred outlines indicate the presence of tumor formations and internal hematomas;
• hollow tubes connecting the kidneys to the bladder or ureters. These organs are visualized on the image only if there are other concomitant diseases;
• bladder. Normally, the urinary reservoir is not visible; its visibility is due to the presence of urine with any impurities in the organ.

According to the doctor's description, the patient receives examination results, including information: about the condition of the kidneys (size, shape, shape, location, structure) and the presence (absence) of stones. And also, about the degree of deformation (if any) pelvic bones, lower spine, and possible injuries to the lower back muscles. For an experienced radiologist, the description process takes no more than a quarter of an hour.

Analysis of the urography results is carried out by a radiologist, but the final diagnosis is made by the attending physician

Preparatory activities

In the absence of contraindications to urography, two days before the examination, the patient undergoes intravenous blood sampling for laboratory analysis, and a dietary ration is prescribed.

Nutrition

The need to prepare for survey urography of the kidneys is due to the fact that the study affects organs digestive tract. A full intestine will become an obstacle to clear visualization of the renal apparatus. The diet consists of simplifying the diet by excluding a number of foods from it. First of all, this concerns foods that can provoke increased gas formation in the intestines.

During the preparatory period, you should avoid the following dishes, drinks and food products:

• pickled, sauerkraut and raw cabbage;
• whole fresh milk;
• dishes made from beans, lentils, peas;
• baked goods yeast dough and sweet desserts;
• multi-ingredient yoghurts;
• kvass and sweet carbonated water, alcoholic drinks.

Fruits and fresh vegetables: radishes, radishes, cucumbers, apples, grapes, pears, as well as nuts, seeds and berries with small seeds. It is not recommended to use heavy, fatty foods and dishes processed by the culinary method of frying:

• mayonnaise-based fatty sauces;
• sausages;
• side dishes of pasta and potatoes;
• fatty fish and meats;
• hot seasonings and spices.

You should not eat salty and pickled foods, because the day before kidney urography drinking regime subject to limit. The amount of liquid you drink should be minimal and without added sugar. The limitation is introduced to achieve required level urine concentration. This condition of the patient contributes to the appearance of the maximum contrast pattern on the radiograph.

The examination is usually scheduled for the morning. In order for the gastrointestinal tract to completely process food, you need to have dinner no later than 10-12 hours before the procedure.

Medical training

Except dietary ration, preparatory measures before survey urography include bowel cleansing using special medicines and enema procedures. To carry out lavage (cleansing), laxatives are used that do not have an aggressive effect on the gastrointestinal tract. The basis of such medicines constitutes a linear polymer macrogol.

The most commonly used are Fortrans, Lavacol, Endofalk, etc. Medicines are available in powder form for the preparation of a solution. The drug is diluted with water at the rate of one packet per liter. Dosage liquid medicine is a liter for every 20 kg of patient weight. You should drink it in two doses: half at night, the rest in the morning. It is necessary to do an enema twice. The volume of liquid for rectal administration is two liters, the temperature of the water should correspond to body temperature. If desired, you can add a decoction of medicinal herbs to the water.

The use of sena-based medications is not recommended

Purpose of urographic examination and contraindications

Indications for the examination are the symptoms that the patient complains about, kidney disease previously diagnosed, confirmation of the doctor’s diagnosis. Diagnosed diseases include:

• dilation of the renal pelvis and calyces due to impaired urine outflow (hydronephrosis);
• renal anomaly of anatomical nature (displacement, doubling, mobility of the kidney);
• the presence of stones of various origins in the kidneys, ureter and bladder;
• various formations (tumor, cyst, abscess);
• presence of blood in the urine (hematuria);
• inflammatory damage to the renal tubular system (pyelonephritis);
• mechanical injuries of organs;
• syndrome acute pain V lumbar region.

Urography is not done if the patient is suffering radiation sickness, has a history of surgery to remove one kidney, in women during the perinatal period. The procedure is not recommended for children without clear indications. The examination should not be performed more than twice a year, since X-rays tend to accumulate in the body. If diagnostics are needed more often, you should resort to a more modern and safe method– magnetic resonance imaging.

At various pathologies renal and, in medical clinics Intravenous urography has been increasingly used.

The modern examination method allows you to obtain highly accurate results.

However, this procedure has its limitations for use, and it is also important to know a number of rules for proper preparation before intravenous urography.

Intravenous urography of the kidneys is prescribed by the attending physician in the presence of the following diseases and disorders:

• various pathologies of the genitourinary system;
• inflammatory process of the urinary tract;
• disruption of the integrity of the bladder;
• abnormal change in bladder functionality;
• abnormal location (prolapse) of the kidneys;
• (both benign and malignant);
• failure and slowdown in the excretory functioning of the kidneys.

A fairly extensive list of pathologies in which intravenous injection will help to determine the patient’s condition as fully as possible.

If the patient is suspected of slowing the excretory functioning of the kidneys, he is prescribed intravenous.

Also, intravenous urography is a mandatory procedure performed before any surgical intervention in the area of ​​the genitourinary system (for example, if surgery directly on the bladder itself or elimination is indicated).