High-dose Urography Research Articles

Annotation: Renal failure radiology — 1987

A patient presenting with newly diagnosed renal failure usually undergoes radiological evaluation to assess the number of kidneys, their size, shape and position, and whether they are obstructed and perfused. An underlying cause such as calculi, retroperitoneal fibrosis or polycystic disease should also be sought. The development of new imaging techniques, particularly real time ultrasound together with advances in interventional uroradiology in the past 10 years have revolutionised the management of the renal failure patient. These advances have led to the rapid identification and treatment of the most important group, those with surgically remediable causes. Prior to the mid sixties, retrograde pyelography reigned supreme as the primary investigation. Whilst it had the potential disadvantage of invasiveness leading to sepsis, and the need for general anaesthesia and urological expertise, it did have the advantage of rapid and reliable diagnosis of obstructive uropathy. It also gave an indication of renal size, and thus the chronicity of the process, and demonstrated pelvicalyceal abnormalities, e.g., papillary necrosis, and the distorted architecture of polycystic disease. The use of this technique in renal failure was stongly advocated by Kingston and colleagues as recently as 1977, suprisingly, the last article on renal failure in Clinical Radiology. Prior to the landmark paper by Schwartz and colleagues (1963) highlighting the 'benignity' of intravenous urography in renal insufficiency, the procedure had always been considered both dangerous and unrewarding in this group of patients. Subsequent authors (Mahaffy et al., 1969, Brown et al., 1970) confirmed that even in advanced renal failure both calyceal systems and renal outlines could be visualised in over 90% of all patients, and high dose urography rapidly became the cornerstone of renal failure radiology. Good renal failure urography however demands a high dose of contrast medium (600 mg Iodine/kg), no dehydration, linear tomography pre- and post-injection of contrast medium, delayed films up to 24 h, low and constant kilovoltage setting for maximum contrast, and above all a meticulous radiographic technique. Obtaining the latter was not helped in our hospital by most new renal failure patients arriving on Friday, and thus urograms were sometimes performed over the weekend by changing shifts of radiographers. Never were so many films taken by so many different people for such a long time for the benefit of so few with so little supervision. Initial enthusiasm was somewhat dampened by reports, mostly from the United States of America, that contrast medium might precipitate further renal impairment. Although mainly a problem in America, Webb et al. (1981) showed transient deterioration of function in three out of 40 patients (7.5%) with renal failure after intravenous urography. Rahimi et al. (1981) however, showed no deterioration of function in a group of 15 patients who had varying degrees of renal failure and were monitored for 3 days after the procedure. Risk factors which have been identified include myeloma, diabetes mellitus, hyperuricaemia, dehydration or fluid restriction before the urogram, large doses of contrast medium, repeated contrast examination over a short period, and elderly patients. Dawson (1985) in a review concluded that contrast medium nephrotoxicity was a real entity and stated that caution should be exercised in the high risk group. The radiologist who is concerned about the risks of intravenous contrast medium should always convince himself that the study is absolutely necessary before proceeding. There must also be adequate hydration before, during and after the procedure. There is a recommendation that the limited number of high dose urograms now being performed should be carried out with low osmolar contrast media (Grainger, 1984). Despite the cost, this is no doubt prudent because of the less significant haemodynamic effects of these agents and their lower toxicity. We have studied a group of 30 patients with uraemia who were randomly allocated to undergo high dose urography using ioxaglate or iohexol by carrying out pre-examination serum creatinine, urea, urinary N acetyl-B glucosaminidase and B 2 microglobulin estimations and repeating these

The value of ultrasound in previously undiagnosed renal failure.

Rapid advances in equipment and diagnostic criteria have made ultrasound sufficiently sensitive to replace high-dose urography (with its attendant risks and often lengthy examination time) as the initial imaging modality in renal failure. A prospective study was carried out in 56 patients (109 kidneys). All hydronephroses were accurately detected on ultrasound. 80% were due to obstruction, but showed no features that distinguished them from other causes of hydronephrosis. A diagnostic pathway is suggested.

Can Ultrasound and Computed Tomography Replace High-dose Urography in Patients with Impaired Renal Function?

Ninety-one patients with unexplained impaired renal function were investigated by high-dose urography, ultrasound and computed tomography (CT) without contrast. The aim was to evaluate the role of ultrasound and CT in renal failure, in particular their ability to define renal length and to show collecting system dilatation. In the majority of patients, renal length could be measured accurately by ultrasound. Measurements were less that those at urography because of the absence of magnification. Renal measurement by CT was not a sufficiently accurate indicator of renal length to be of clinical use. Both ultrasound and CT were sensitive detectors of collecting system dilatation: neither technique missed any case diagnosed by urography. However, in the presence of staghorn calculi or multiple cysts, neither ultrasound nor CT could exclude collecting system dilatation. CT was the only technique which demonstrated retroperitoneal nodes or fibrosis causing obstruction. It is proposed that the first investigation when renal function is impaired should be ultrasound, with plain films and renal tomograms to show calculi. CT should be reserved for those patients in whom ultrasound is not diagnostic or in whom ultrasound shows collecting system dilatation but does not demonstrate the cause. Using this scheme, ultrasound, plain radiography and CT would have demonstrated collecting system dilatation and, where appropriate, shown the cause of obstruction in 84 per cent of patients in this series. Only 16 per cent of patients would have required either high-dose urography or retrograde ureterograms.

Computed tomography in surgical complications following renal transplantation.

Satisfactory computed tomograms were obtained in 57 of 64 patients with impaired function of renal allograft transplants. Surgical complications such as urinary obstruction or obstruction of arterial inflow, hemorrhage, urinoma, lymphocele, or abscess were found in 21 of 57 patients. Lymphocele was the most frequent. Although best demonstrated following intravenous contrast medium injection, 17 of 21 lesions could be diagnosed on precontrast scans. Noninvasive methods such as precontrast computed tomography (CT) or ultrasound (US) have replaced urography as the primary procedure in the diagnostic workup of these patients. If CT or US are inconclusive with regard to the size of the renal pelvis or if urinoma is suspected, high dose urography should be performed.

Renal function after high dose urography in patients with renal failure

A retrospective study of 40 patients with moderate to severe renal failure who had high dose urography showed that none developed oliguric acute renal failure after the urogram. In 37 patients there was no worsening in renal function attributable to the urogram. This group included five patients in whom renal function was already deteriorating at the time of the urogram. In three patients a transient rise in serum creatinine without oliguria occurred in the week following urography. Differences between the British and North American experience are discussed.

Metrizamide in High-Dose Urography

The non-ionic water-soluble contrast medium metrizamide (Amipaque) was used for high-dose urography in 11 patients with apparently normal renal function. Films of good quality were obtained. Adverse reactions and the effect on pulse and blood pressure as well as a large number of blood and urine laboratory parameters were recorded. Only clinically insignificant effects occurred, and the medium is recommended for further use in urography.

High dose urography: incidence and relationship to spontaneous peripelvic extravasation

A prospective study was undertaken to determine the incidence of spontaneous extravasation of contrast in 82 patients with acute renal colic. The extravasation rate among 37 patients receiving 75 ml of contrast was 8.1%, while the rate among 45 patients receiving either 300 ml of 30% solution by infusion or a 140 ml bolus dose was 24.4%; overall the rate was 17%. Thus the incidence of extravasation was shown to increase with higher doses of contrast media. The primary dose in acute renal colic or other forms of obstructive uropathy should be in the low range (20-25 g 1-); reinjection after screening can be undertaken if necessary.

Tomography of pelvic-abdominal masses during intravenous urography. An added dimension.

Experience with a wide variety of pelvic-abdominal masses indicates that good quality tomography during high dose urography permits separation of solid from cystic lesions in almost all cases, even with minimal mass opacification. Evaluation of surface contour, absence or presence of a wall and its features, opacification, calcification, and uterine status provides the framework for characterization of the mass. Multiple masses can be identified and evaluated separately. While titration of the above criteria permits an accurate assessment independent of the clinical diagnosis, the latter information is important in separating a probable abscess from other cystic lesions. Since urography continues to be a pivotal preoperative roentgenologic investigation (ureteral status, pelvic kidney exclusion, etc.), the addition of tomography provides an added dimension to its usefulness. With the exception of the premenopausal female in whom radiation exposure is a consideration, tomography appears to preclude the routine necessity for subsequent ultrasound study which has been used to separate cystic from solid lesions.

Radiology of the urinary tract: some physiological considerations. Annual oration in memory of John S. Bouslog, M.D., 1890-1973.

This paper reviews some of the fundamental technical and diagnostic problems in clinical uroradiology, such as (a) the reason for the obstructive nephrogram; (b) why high-dose urography gives better studies than low-dose; (c) why the Trueta phenomenon has not been demonstrated in man; (d) the case for an intrarenal arterial collateral pathway via the pericalyceal network (these vessels can be demonstrated in man and must not be misinterpreted as tumor vessels or vascular malformations). One of the most baffling problems sometimes occurs with the sudden partial block of a single segmental vessel: the kidney ceases to excrete urine and eventually becomes atrophic even though some excretory function returns. To date, there is no satisfactory explanation for this course of events.

Some aspects in the radiological assessment of renal and ureteral duplication.

SUMMARY Fifty-six cases of duplicated renal systems have been observed by us. Abnormal peristalsis was seen in a high percentage of patients in die present series and in one of these patients pain was of sufficient severity to warrant surgical treatment. The late sequelae of chronic pyelonephritis, renal cortical destruction, pyonephrosis and non-function of an ectopic segment in a duplicated kidney is the direct result of neuromuscular dysfunction of the smooth muscle of the ureter and pelvicalycine system. Recurrent urinary infection and unexplained renal pain have been the common symptoms in adults while vesico-ureteric reflux, urinary tract infection and failure to thrive have been the main features in children. Voiding cysto-ureterography, high dose urography and cinefluorography have been proved to be of value in the diangnosis and subsequent management of our patients.

High-dose urography in advanced renal failure. II. Influence on renal and hepatic function.

High-dose urography in advanced renal failure. II. Influence on renal and hepatic function.

High-Dose Urography in Oliguric and Anuric Patients.

This monograph deals essentially with the value and limitations of high-dose urography in diseases associated with severe renal impairment. It presents personal studies and an in-depth review of the recent literature on this and related subjects. There are chapters dealing with physiologic aspects of excretion of contrast media in the normal and diseased states, effects of hemodialysis, pathways of extrarenal excretion of contrast media, and considerations of dosages and technique of radiologic examination. The quality of the illustrations is moderately good. The authors conclude that impairment of renal or liver function no longer represent a contraindication to the use of urographic contrast media. The most important reason for performing urography in oliguric and anuric patients is to demonstrate or exclude extra-renal obstructive lesions, which may be amenable to surgical treatment. The book is recommended for urologists, internists, and radiologists particularly interested in the problem of evaluating renal function in the

Polycystic kidneys, renal hamartomas, their variants and complications

In polycystic renal disease, the cysts progressively increase in size, destroying the surrounding renal tissue. The cysts may become very large. Not only may renal failure ensue but haemorrhage and infection may also lead to serious complications. Occasionally the condition may be complicated or mimicked by hamartomas or neoplasms. Hamartomas may be single or multiple, and are most commonly multiple in tuberose sclerosis, giving an appearance on pyelograms similar to polycystic kidney. Their presence may sometimes be suspected on plain radiographs by their high fat content. Nephrotomograms during the nephrogram phase of high dose urography will demonstrate the defects in the nephrogram due to the cysts or more solid masses. Angiograms, if performed, will show defects in the nephrograms more clearly and may show abnormal vascularity, hamartomas having characteristic ‘beaded’ vessels. Cysts or tumours may also be present in the liver and pancreas.

High-dose urography in advanced renal failure. I. Evaluation of diagnostic value.

High-dose urography in advanced renal failure. I. Evaluation of diagnostic value.

Book Reviews

British Journal of UrologyVolume 45, Issue 3 p. 330-334 Book Reviews First published: June 1973 https://doi.org/10.1111/j.1464-410X.1973.tb12166.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Book reviewed in this article: Congenital Deformities of The Testis and Epididymis. By C. G. Scorer and G. H. Farrington, Vesicoureteral Reflux and Pyelonephritis. By John A. Hutch and Arjan D. Amar. Ureteral Dynamics. By S. Boyarsky and P. C. Labay. Genetics and the Urologist. By John K. Ormond, Dale R. Drew and Kenneth L. Urwiller, High-dose Urography in Oliguric and Anuric Patients. By Paul F. G. M. van Wales. Scientific Basis of Surgery. 2nd Edition. Edited by W. T. Irvine, Progress in Biochemical Pharmacology. Series Editor: Paoletti, R. (Milan). Vol. 7: Drugs Affecting Kidney Function and Metabolism. Volume Editor: Edwards, K. D. G. Clinical Organ Transplantation. Edited by R. Y. Calne. Radiology in Renal Disease. Ed. T. Sherwood. Problems in Paediatric Urology. Edited by J. H. Johnston and R. J. Scholtmeijer. Metabolic Bone and Stone Disease. By B. E. C. Nordin. Volume45, Issue3June 1973Pages 330-334 RelatedInformation

High-Dose Urography in Oliguric and Anuric PatientsHigh-Dose Urography in Oliguric and Anuric Patients.van WaesPaul F.G.M.. Paper, $16.25; DF1. 52.00. Pp. 166, with numerous figures. Amsterdam, Excerpta Medica, 1972.

HomeRadiologyVol. 107, No. 2 PreviousNext Book ReviewHigh-Dose Urography in Oliguric and Anuric PatientsJoshua A. BeckerJoshua A. BeckerJoshua A. BeckerPublished Online:May 1 1973https://doi.org/10.1148/107.2.272MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: May 1973 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 107, No. 2 Metrics Altmetric Score PDF download

Roentgen Diagnosis of Multicystic Renal Dysplasia in Infancy by High Dose Urography

No AccessJournal of Urology1 Dec 1972Roentgen Diagnosis of Multicystic Renal Dysplasia in Infancy by High Dose Urography John C. Leonidas, Lotte Strauss, and Irwin H. Krasna John C. LeonidasJohn C. Leonidas Current address : Children’s Mercy Hospital, 24th at Gillham Road, Kansas City, Missouri, 64108. More articles by this author , Lotte StraussLotte Strauss More articles by this author , and Irwin H. KrasnaIrwin H. Krasna More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)60920-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1972 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBloom D and Brosman S (2018) The Multicystic KidneyJournal of Urology, VOL. 120, NO. 2, (211-215), Online publication date: 1-Aug-1978.De Klerk D, Marshall F and Jeffs R (2018) Multicystic Dysplastic KidneyJournal of Urology, VOL. 118, NO. 2, (306-308), Online publication date: 1-Aug-1977.Warshawsky A, Miller K and Kaplan G (2018) Urographic Visualization of Multicystic KidneysJournal of Urology, VOL. 117, NO. 1, (94-96), Online publication date: 1-Jan-1977. (2018) CommentJournal of Urology, VOL. 117, NO. 1, (96-96), Online publication date: 1-Jan-1977.Wexler H and Poole C (2018) Renal Cyst Puncture: A Non-diagnostic Procedure in the InfantJournal of Urology, VOL. 115, NO. 3, (328-330), Online publication date: 1-Mar-1976. Volume 108Issue 6December 1972Page: 963-965 Advertisement Copyright & Permissions© 1972 by The American Urological Association Education and Research, Inc.MetricsAuthor Information John C. Leonidas Current address : Children’s Mercy Hospital, 24th at Gillham Road, Kansas City, Missouri, 64108. More articles by this author Lotte Strauss More articles by this author Irwin H. Krasna More articles by this author Expand All Advertisement PDF downloadLoading ...

UROGRAPHIC CONTRAST MEDIA IN UREMIA: Physiology and Pharmacology

High-dose urography should be considered an essential part of the management of most patients with advanced uremia. With increased acceptance and use of doses in the range of 1 ml. per pound, the acquisition of useful diagnostic information has been the rule rather than the exception. When high doses were first used, there were a number of contraindications to the procedure, but as favorable experience has accumulated, these contraindications have been relaxed. The few reports of serious adverse responses to urography in uremic patients can be attributed, in large part at least, to fluid deprivation or hypovolemia preceding the examination.

An evaluation of the effect of high-dose urography on previously impaired renal and hepatic function in man.

HomeRadiologyVol. 97, No. 2 PreviousNext ArticlesAn Evaluation of the Effect of High-Dose Urography on Previously Impaired Renal and Hepatic Function in ManAlan J. Davidson22, Joshua Becker33, Neville Rothfield44, George Unger55, Donald R. Ploch66Alan J. Davidson22, Joshua Becker33, Neville Rothfield44, George Unger55, Donald R. Ploch66Author Affiliations 1600 Divisadero St. San Francisco, Calif. 94115Alan J. Davidson22Joshua Becker33Neville Rothfield44George Unger55Donald R. Ploch66Published Online:Nov 1 1970https://doi.org/10.1148/97.2.249MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe authors studied the effects of three common urographie contrast agents on the renal and liver functions of 82 patients with renal and/or liver disease as evaluated by standard function tests. Gross “before-and-after” measurements as well as a correlation of the log of the serum iodine with each laboratory test serially obtained during the period of excretion of contrast medium failed to reveal any systematic effect. The data suggest that angiographic procedures and the levels of contrast medium utilized in infusion urography are safe even when applied to patients with liver or renal failure.Article HistoryAccepted: Apr 1969Published in print: Nov 1970 FiguresReferencesRelatedDetailsCited ByMagnetic Resonance Imaging Clinics of North America, Vol. 25, No. 4ISRN Radiology, Vol. 2013American Journal of Roentgenology, Vol. 171, No. 4Clinical Radiology, Vol. 41, No. 6The British Journal of Radiology, Vol. 58, No. 686Urologia Journal, Vol. 51, No. 2Urologia Journal, Vol. 49, No. 3Urologia Journal, Vol. 49, No. 4Kidney International, Vol. 18, No. 5Enzyme changes after coronary angiographyCardiovascular Radiology, Vol. 1, No. 3The American Journal of Medicine, Vol. 65, No. 1The British Journal of Radiology, Vol. 51, No. 607The British Journal of Radiology, Vol. 51, No. 607The American Journal of Medicine, Vol. 63, No. 6Excretory urography in acute and chronic renal failureUrology, Vol. 5, No. 3American Heart Journal, Vol. 90, No. 1New England Journal of Medicine, Vol. 291, No. 12Acta Radiologica. Diagnosis, Vol. 15, No. 1, Vol. 13 / 1Journal of Urology, Vol. 110, No. 1Radiologic Clinics of North America, Vol. 10, No. 3Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 97, No. 2 Metrics Altmetric Score PDF download

Correspondence

Recent enthusiasm for drip infusion urography, or high dose urography, has been marred by confused thinking about the chemical and physiological factors involved. The “Comparative Trial”, by Duré-Smith (1966), attempts to compare the results of two series, to which two quite different, and in no way comparable, methods of dose assessment were applied. The Routine Intravenous Urogram was based on use of a fixed volume of solvent, containing a fixed percentage of the solute, regardless of the size of the patient, with no direct indication of the amount of opaque elemental iodine injected: the Drip Infusion Urogram on the other hand was based on a variable volume of solvent, in direct proportion to the body weight of the patient, again using a fixed percentage of the crystalline solute.