Intravenous pyelogram
Excretory urography; IVP
An intravenous pyelogram (IVP) is a special x-ray exam of the kidneys, bladder, and ureters (the tubes that carry urine from the kidneys to the bladder).
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.
This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.
An intravenous pyelogram is performed by injecting contrast material into a vein in the arm. A series of x-rays are taken at timed intervals as the contrast material goes through the kidneys, the ureters (the tubes connecting the kidneys to the bladder), and the bladder. The procedure helps to evaluate the condition of the kidneys, ureters, and bladder.
How the Test is Performed
An IVP is done in a hospital radiology department or a health care provider's office.
You may be asked to take some medicine to clear your bowels before the procedure to provide a better view of the urinary tract. You will need to empty your bladder right before the procedure starts.
Your provider will inject an iodine-based contrast (dye) into a vein in your arm. A series of x-ray images are taken at different times. This is to see how the kidneys remove the dye and how it collects in your urine.
You will need to lie still during the procedure. The test may take up to an hour.
Before the final image is taken, you will be asked to urinate again. This is to see how well the bladder has emptied.
You can go back to your normal diet and medicines after the procedure. You should drink plenty of fluids to help remove all the contrast dye from your body.
How to Prepare for the Test
As with all x-ray procedures, tell your provider if you:
- Are allergic to contrast material
- Are pregnant
- Have any drug allergies
- Have kidney disease or diabetes
Your provider will tell you if you can eat or drink before this test. You may be given a laxative to take the afternoon before the procedure to clear the intestines. This will help your kidneys to be seen clearly.
You must sign a consent form. You will be asked to wear a hospital gown and to remove all jewelry.
How the Test will Feel
You may feel a burning or flushing sensation in your arm and body as the contrast dye is injected. You may also have a metallic taste in your mouth. This is normal and will go away quickly.
Some people develop a headache, nausea, or vomiting after the dye is injected.
The belt across the kidneys may feel tight over your belly area.
Why the Test is Performed
An IVP can be used to evaluate:
- An abdominal injury
- Bladder and kidney infections
- Blood in the urine
- Flank pain (possibly due to kidney stones)
- Tumors
What Abnormal Results Mean
The test may reveal kidney diseases, birth defects of the urinary system, tumors, kidney stones, or damage to the urinary system.
Risks
There is a chance of an allergic reaction to the dye, even if you have received contrast dye in the past without any problem. If you have a known allergy to iodine-based contrast, a different test can be done. Other tests include retrograde pyelography, MRI, or ultrasound.
There is low radiation exposure. Most experts feel that the risk is low compared with the benefits.
Children are more sensitive to the risks of radiation. This test is generally avoided during pregnancy.
Considerations
Computed tomography (CT) scans have replaced IVP as the main tool for checking the urinary system. Magnetic resonance imaging (MRI) is also used to look at the kidneys, ureters, and bladder.
References
Bishoff JT, Rastinehad AR. Urinary tract imaging: basic principles of CT, MRI, and plain film imaging. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 3.
Gallagher KM, Hughes J. Urinary tract obstruction. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 58.
Sakhaee K, Moe OW. Urolithiasis. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Taal MW, Skorecki K, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 38.
Version Info
Last reviewed on: 1/1/2023
Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
