Test Overview

An intravenous pyelogram (IVP)
is an
X-ray test that provides pictures of the kidneys, the
bladder, the
ureters, and the
urethra (urinary tract). An IVP
can show the size, shape, and position of the urinary tract, and it can
evaluate the collecting system inside the kidneys.

During IVP, a
dye called
contrast material is injected into a vein in your arm.
A series of X-ray pictures is then taken at timed intervals.

IVP
is commonly done to identify diseases of the urinary tract, such as kidney
stones
, tumors, or infection. It is also used to look for problems with the
structure of the urinary tract that were present from birth (congenital).

An
ultrasound or a
computed tomography (CT) scan may be combined with an
IVP if more details about the urinary tract are needed. A computed tomography
intravenous pyelogram (CT/IVP) is usually done to look for the cause of blood
in the urine.

Why It Is Done

An intravenous pyelogram (IVP) is done to:

  • Look for problems with the structure of the
    urinary tract.
  • Find the cause of blood in the
    urine.
  • Find the cause of ongoing
    back or flank pain.
  • Locate and measure a
    tumor of the urinary tract.
  • Locate and measure a
    kidney stone.
  • Find the cause of recurring
    urinary tract infections.
  • Look for damage
    to the urinary tract after an injury.

How To Prepare

Before having an intravenous pyelogram
(IVP), tell your doctor if:

  • You are or might be pregnant.
  • You are breastfeeding. It’s safe to breastfeed your baby after you have had this test. The amount of dye that gets into your breast milk is tiny and will not harm your baby.
  • You
    have an
    intrauterine device (IUD) in place.
  • You
    are allergic to the iodine dye used as the contrast material for X-ray tests or
    to anything else that contains iodine.
  • You have ever had a serious
    allergic reaction (anaphylaxis), such as after being
    stung by a bee or from eating shellfish.
  • Within the past 4 days,
    you have had an X-ray test using barium contrast material (such as a
    barium enema).
  • You have had kidney problems
    in the past or have
    diabetes, especially if you take metformin
    (Glucophage) to control your diabetes. The contrast material used during an IVP
    can cause kidney damage in people who have poor kidney function. If you have
    had kidney problems in the past, blood tests (creatinine, blood urea nitrogen)
    may be done before the test to make sure that your kidneys are working
    properly.

You may need to stop eating and drinking for 8 to 12 hours
before the IVP. You also may need to take a laxative the evening before the test
(and possibly have an enema the morning of the test) to make sure that your
bowels are empty.

This test is often done in children to see if they may have an abnormal backflow of urine (vesicoureteral reflux). Prepare your child for exams and tests that are needed. Explain them in a simple way. Use positive words as much as possible. Doing so will help your child understand what to expect and can help reduce fears.

Talk to your doctor about any concerns you have regarding
the need for the test, its risks, how it will be done, or what the results will
mean. To help you understand the importance of this test, fill out the
medical test information form (What is a PDF document?).

How It Is Done

An intravenous pyelogram (IVP) is
usually done by a radiology technologist. The IVP pictures are interpreted by a
doctor who specializes in interpreting imaging tests (radiologist).

You will need to remove any
jewelry that might interfere with the X-ray picture. You will need to take off
all or most of your clothes, and you will be given a cloth or paper covering to
use during the test. You will be asked to urinate just before the test
begins.

During the test

You will lie on your back on an X-ray table. An X-ray
picture of your belly will be taken and reviewed by the radiologist before the
next part of the test begins.

The injection site on your arm will
be cleaned and the contrast material will be injected into a vein on the inside
of your elbow. The dye travels through the bloodstream, is filtered out by the
kidneys, and passes into the urine. The urine then flows into the tubes
(ureters) that lead to the bladder.

X-ray pictures are taken
several minutes apart as the dye goes through the urinary tract. Each picture
is developed right away. Sometimes more pictures are taken based on earlier
ones. You may be asked to turn from side to side or to hold several different
positions so the radiologist can take a complete series of X-rays.

During IVP, a compression device may wrapped around your belly to keep
the dye in the kidneys. The most common compression device is a wide belt
containing two inflated balloons that push in on either side of your belly to
block the passage of dye through the ureters. If you have recently had
abdominal surgery or have an abdominal disorder, the band will not be
used.

A special type of X-ray technique called
fluoroscopy may also be used during IVP. During
fluoroscopy, a continuous X-ray beam is used to display a moving image on a
video monitor.

IVP usually takes about an hour.

After the test

After the test is
over, you will need to drink plenty of liquids to help flush the contrast
material out of your body.

How It Feels

You will feel no discomfort from the
X-rays. The X-ray table may feel hard and the room may be cool. You may find
that the positions you need to hold are uncomfortable.

You will
feel a brief sting when the needle is inserted into the vein in your arm. When
the contrast material is injected, you may feel slight burning in your arm and
flushing throughout your body. You may also notice a salty or metallic taste in
your mouth.

The compression belt may feel tight. If it is painful,
tell the technologist and ask that it be readjusted.

You may feel
slightly weak, nauseated, or lightheaded for a short time after the
test.

Risks

There is always a slight chance of damage to
cells or tissue from radiation, including the low levels of radiation used for
this test. But the chance of damage from the X-rays is usually very low
compared with the benefits of the test.

There is slight risk of
having an allergic reaction to the contrast material. The reaction can be mild
(itching, rash) or severe (trouble breathing or sudden shock). Death
resulting from an allergic reaction is very rare. Most reactions can be
controlled with medicine. Be sure to tell your doctor if you have
asthma or allergies of any kind, such as hay fever,
iodine allergy, bee stings, or food allergies.

People with certain
conditions (such as diabetes,
multiple myeloma, chronic kidney disease,
sickle cell disease, or
pheochromocytoma) have increased chances of having
sudden kidney failure from IVP. Older adults and people taking medicines that
affect the kidney may also have increased chances for problems after an
IVP.

Results

An intravenous pyelogram (IVP) is an
X-ray test that provides pictures of the kidneys, the
bladder, the
ureters, and the
urethra (urinary tract). Your
doctor may be able to talk to you about some results right away. Complete
results are usually ready in 1 to 2 days.

Intravenous pyelogram (IVP)
Normal:

The kidneys, ureters, and bladder are normal
in position, size, and shape.

The contrast material reaches the kidneys in
a normal amount of time.

No blockage can be seen in the kidneys,
ureters, or bladder.

In men, the
prostate gland looks normal in position, size, and
shape.

Abnormal:

The kidneys, ureters, or bladder may be
abnormal in position, size, or shape. A kidney may be absent, or an extra
kidney or ureter may be present.

The kidneys are too large or too
small.

The
contrast material takes longer than normal to reach a
kidney.

An abnormal growth (such as a tumor), one or
more
cysts, an
abscess, or a
kidney stone is seen.

A kidney is
swollen with urine from a blockage such as a tumor or kidney stone.

Injury to the kidney, ureter, or bladder is
seen.

The kidney contains scarring.

In men, the prostate gland is too
large.

What Affects the Test

Reasons you may not be able to
have the test or why the results may not be helpful include:

  • Being unable to remain still during the
    test.
  • Having a large amount of stool (feces) or gas in the large
    intestine (colon).
  • Having a recent test with barium (such as a
    barium enema).

An intravenous pyelogram (IVP) is not usually done for a
pregnant woman because the X-rays could damage the growing baby. If a view of a
pregnant woman’s kidneys is needed, an
ultrasound test may be done instead.

What To Think About

  • A preliminary X-ray picture (KUB) of your abdomen will be taken before the
    intravenous pyelogram (IVP). This picture is reviewed by the radiologist before
    the next part of the test begins. An IVP test may not be done if these pictures
    show a problem.
  • Other tests that may be used instead of an
    intravenous pyelogram (IVP) include
    computerized tomography (CT scan),
    ultrasound, digital subtraction angiography, and,
    occasionally,
    MRI.

  • For people who have known kidney problems,
    diabetes, or who are dehydrated, steps may be taken to prevent kidney damage.
    Less contrast material may be used and additional fluids may be given before,
    during, and after the test.
  • If you have had kidney problems in the
    past, blood tests for creatinine and blood urea nitrogen may be done before the
    test to make sure that your kidneys are working properly.

  • Another test that may
    be done to look at the urinary tract is retrograde ureteropyelogram. Retrograde
    ureteropyelogram is done when IVP results do not help identify a problem or
    when IVP can’t be done because of poor kidney function or an allergy to the
    iodine contrast material.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Martin J. Gabica, MD – Family Medicine

Current as ofOctober 9, 2017