Carrying out urography. X-ray method of examining a paired organ - urography of the kidneys with the use of a contrast agent: indications and contraindications, features of the preparation and conduct of the procedure. Types of X-ray examination

Survey urography kidney is used in urology to detect calculi, formations of the pyelocaliceal system of the kidneys.

On the urogram, urate stones are clearly visible, weaker - oxalate. Phosphate calculi are rare in plain urography.

The image obtained during the study is fixed on a 30x40 cm radiograph.
This film size allows visualization of the following anatomical formations:

Iliac bones;
Spine;
Small pelvis;
kidneys;
Bladder;
Dense foreign bodies.

On the overview urogram, intestinal loops are traced. If they are filled with gas or feces, the visibility of the kidneys is impaired. The qualitative interpretation of the results depends on the preliminary preparation of the patient, the degree of cleansing of the gastrointestinal tract.

The overview picture shows a shadow of enlarged kidneys with an expansion of the pelvicalyceal system. An attentive radiologist will detect an increase in the renal hilum. The shadow of the kidneys on the radiograph may be shifted to the side, and its Bottom part turned outward.

Coral stone of the right kidney on the urogram

Dilatation (expansion) of the kidneys is characterized by spherical protrusions on the surface. The display of formations is not clear. Gentle renal darkening in pathology looks more massive than normal. Can move beyond the midline of the abdomen.

All of the above changes are not clearly visible on the x-ray. The definition of pathology in urography depends on the qualifications of the radiologist.

The essence of the method

The essence of the survey urography method is to perform an overview image for the patient abdominal cavity in a standing position after bowel cleansing stool.

On the urogram, the skeletal system is traced, soft tissues, spine, which should also be evaluated by a doctor.

The study has many other subtleties, but it is always performed before intravenous urography.

Most often, after undergoing a survey urography, the doctor prescribes deeper X-ray studies. and possible allergic reactions to the contrast agent - read here.

Read about the treatment of renal colic at home, as well as in a hospital setting.

And here everything is about how hydronephrosis is diagnosed in children and what methods of treatment are used. How dangerous is the operation and is it possible full recovery renal function.

Indications

Indications for survey and excretory urography:

Hydronephrosis of the right kidney on x-ray

tumor stones;
Foreign bodies;
Kidney and ureter stones;
Injuries of the lower back and abdomen;
Renal colic.

There is an emergency surgical indications for conducting survey urography.

With a sharp back pain lasting several hours, a study is performed to establish the localization of the calculus and assess its size.

Contraindications

The study is contraindicated for pregnant women (as well as all types of x-ray studies).

A relative contraindication is the study of patients who have recently undergone a procedure of contrast gastroscopy, the passage of barium through the intestines.

The contrast agent in the gastrointestinal tract will make it difficult to visualize the kidneys. Such patients need several days to clear the intestines of excess barium.

Absolute contraindications for survey urography:

Conception and bearing a child;
Absence of one kidney;
Chronic radiation sickness.

Concerning urography works general rule for all x-ray examinations: the benefit of the procedure must outweigh the harm.

Training

The basis of preparation for a survey urography of the kidneys is diet therapy for cleansing the gastrointestinal tract. The basic principles of the diet before the overview x-ray of the kidneys:

Exclusion of products causing flatulence(sugar, bread, milk, legumes, potatoes);
Cleaning the intestines with sorbents (activated carbon, polyphepan, carbolen);
Refusal to eat in the evening and in the morning before the procedure;
Breakfast with tea without sugar.

An example of an overview urogram of a patient with kidney stones

Classical urography requires checking the condition of the patient's intestines by fluoroscopy. In practice, in order to reduce the patient's exposure, an overview image is taken immediately after the person visits the X-ray room.

To prevent flatulence, you can not drink a lot of water.

According to European requirements, any x-ray examination must be carried out with the consent of the patient or his relatives.

For the suspicious and impressionable patients recommended sedatives, painkillers, analgesics.

There are 2 ways to prepare the intestines for the urogram:

Dissolve a bag of Fortrans in 2 liters of water. Drink the solution for the day;
Consume 4 times daily, 4 tablets activated carbon. Before the procedure, you need to make cleansing enemas with water;
In children, espumizan is used to eliminate intestinal gasification.

In infants, urography is performed according to emergency indications. In a small child, due to constant contraction smooth muscle gastrointestinal tract increases the risk of accumulation of feces and gases in the intestine.

How is a survey urography performed?

The procedure involves fixing the image of the kidneys, small pelvis on x-ray film (30x40 cm).

Kidney disease remains very common today. They are used to diagnose various methods- moreover, more modern ones, for example, ultrasound and magnetic resonance imaging - are gradually replacing outdated and less informative ones. However, an x-ray examination of the kidneys, also known as urography, is still in demand due to the fact that it allows you to find out about changes in the structure of the organ and make the correct diagnosis.

Types of urography

There are several types of x-ray examination of the kidneys. Which method to use in each specific case decides. The doctor must choose best way studying the tissues of the kidneys and their functionality, depending on what kind of violations are present.

This procedure is prescribed to the patient if the doctor saw any evidence of kidney disease. As a rule, it precedes all other, more complex studies. Plain urography is a common X-ray the part of the body where the kidneys are located.

Particularly informative this diagnosis cannot be named, but with its help you can check the location of the organ, as well as identify big stones and some other problems. The undeniable advantage of this method is the fact that no additional equipment this study does not require, but carry it out in any clinic. This method requires some preparation of the patient, which will be discussed below.

Plain urography allows a specialist to consider the structural state of the kidneys, starting with their upper division before the beginning of the excretory canal of the bladder. In addition, the doctor sees the bones of the pelvic region, and can also “as a first approximation” assess the condition and performance of the ureters and bladder.

Intravenous diagnostics

Intravenous urography is an X-ray examination that involves the use of contrast medium. As a rule, it contains iodine and. This solution is injected into the patient's vein, provided that his bladder is empty. After that, several pictures are taken.

Preparation for intravenous urography is that the patient must empty the bladder. In total, there are three methods of intravenous urography: excretory, compression and infusion.

Excretory urography

Much like a review. The only difference between these diagnostic methods is that a contrast agent is used in the excretory study. The first picture is taken one to two minutes after its introduction, the second after five minutes, and the third after seven minutes. The study allows you to assess the intensity with which the bladder and renal pelvis are filled with fluid, and also allows you to evaluate the shape and structure of the kidneys, the location of stones and cystic tumor neoplasms.

Compared to survey urography, the method is more informative, and the picture itself is more clear. Among the disadvantages of this technique is the possibility allergic reaction for contrast agents. Doctor in without fail should find out if the patient suffers from an individual intolerance to any drugs. Even if the answer is negative, a test is performed before the injection of the substance: 0.1 ml of a contrast agent solution is injected intradermally into one forearm, and into the other forearm - saline. Then the doctor compares the reaction.

Compression urography

This type is a more complex procedure. During it, the patient's ureters are artificially clamped. The image is very clear, however, it is impossible to assess the condition of the ureters on them due to the fact that they are clamped. Therefore, experts recommend combining the compression method with the excretory one, so that the result is as informative as possible. A significant drawback of the procedure is the fact that this research method is very painful.

Infusion urography

Usually given to people with handicapped and also for those who cannot move. A contrast agent is injected through the catheter, and the study is performed on the patient in a supine state.

Depending on where exactly the contrast agent is injected, urography is retrograde and antegrade. In a retrograde study, a contrast agent is injected directly into the ureters under general anesthesia. After that, an overview urography is performed. This method makes it possible to study the ducts as clearly as possible.

In antegrade percutaneous urography, a contrast agent is injected through skin in upper part ureters. Going down them, the drug enables the doctor to study them properly. This method allows you to identify ruptures of the ureters, inflammation, neoplasms.

Each of the above methods has its own advantages and disadvantages. So, survey urography is fast and does not require the introduction of contrast, however, it cannot boast of high information content. With an excretory study, the image is not very accurate, but this method is simple and reliable. Compression urography also does not take much time, but the procedure is very painful. Infusion therapy suitable for people with disabilities, but requires a lot of time due to the need to be on a drip. Retrograde and antegrade methods provide an exhaustive amount of information, but require general anesthesia.

Possibilities of survey urography

The main purpose of a general X-ray examination of the kidneys is to identify stones on different levels urinary system. It could be kidney stones bladder and ureters. However, it should be taken into account that this method allows you to visualize not all types of stones, but only stones of urate and oxalate origin. Phosphate neoplasms in the pictures are most often invisible. In addition, the picture shows tuberculous foci and echinococcal cysts.

Also, using this method, the doctor can identify other pathological processes based on the data obtained. So, visualization of the kidney shadow will allow us to draw a conclusion about the size of the organ and its location. Based on the outlines of the lumbar muscle, one can judge the state of the surrounding kidneys. The doctor may also examine the lumbosacral spine, hip joints, the lower edges of the ribs, as well as the pelvic bones.

Indications and contraindications

As noted above, survey urography is the first procedure to which a patient is referred for suspected pathological processes in the kidneys.

The indications for the study are:

Congenital or acquired hydronephrosis of one or both kidneys.
Stones in the urinary tract: in the tissues of the kidneys, bladder and ureters.
Availability foreign bodies in the urethra or in the lumen of the bladder.
Lower back injuries, including torn back muscles.
Tumors and other pathological foci (cysts, abscesses, etc.).
Abnormalities in the development or location of the kidneys

At the same time, like any X-ray examination, the procedure has its own contraindications. So, the study is not carried out for pregnant women, patients suffering from radiation sickness, as well as those who have had one kidney removed, and the functionality of the second is impaired.

In addition, they try not to refer patients to urography who have recently undergone a study of the gastrointestinal tract with barium suspension. This is because barium remaining in the body significantly impairs visualization of the kidneys and urinary tract. Therefore, the interval between studies should be at least a week in order for the barium suspension to completely leave the body.

What can a survey urography show

This diagnostic method, as noted above, is initial stage study of the condition of the kidneys. The doctor prescribes this procedure if he has suspicions about the dysfunction of the organ or the presence of some pathological processes in it.

So, survey urography helps to identify:

Benign or malignant neoplasms
Changes in the structure of the organ tissue.
Stones.
Anomalies in the structure of the kidneys.
Pyelonephritis, glomerulonephritis, hydronephrosis, kidney tuberculosis.
Causes of blood in the urine.
Possible complications after surgery.

How to take a picture

There are several principles that must be followed in order for the x-ray image to be as informative as possible and for the specialist to be able to diagnose the pathological process.

First of all, you should not take an x-ray of only one kidney. Doctors are aware of situations when changes in the site of the pain syndrome cannot be detected, and violations are detected in the opposite organ.

A high-quality image is considered to be the one that maximally covers all the structures that are components of the urinary system: the kidneys and ureters and the bladder. Also, the picture should contain the contours of the eleventh and twelfth ribs and upper edge pubic articulation. A film measuring thirty by forty centimeters should be used.

How is the procedure carried out

Survey urography - the procedure is simple and does not take much time. Immediately after the patient enters the office, he is asked to remove Jewelry and metal objects. After this, the patient is asked to lie on his back, a pillow is placed under his head. The X-ray beam is directed strictly perpendicular to the surface of the body, a few centimeters below xiphoid process. Immediately at the time of the picture, the patient must hold his breath. This will help to avoid "double" images.

Special training

In order for the results to be as reliable as possible, the patient must prepare in advance for it.

So, it is often normal to visualize the processes that occur in the organs of the urinary system, sometimes swollen intestinal loops interfere. Therefore, it is extremely necessary to cleanse it of feces in advance.

To this end, patients are asked at least three days before the study to exclude from the diet food that can provoke flatulence. These are white flour bread, cereals and legumes, dishes from, fruits and dairy products.

Dinner the night before should be light. Sit down at the table should be no later than six o'clock in the evening. On the day of the urography, it is better to refrain from breakfast.

Refrain from using a large number liquids. On the day of the study, you can drink a glass of unsweetened tea.

Features of the procedure for children

The method of conducting survey urography for children is no different from how adult patients are examined. It is not recommended to conduct a study of babies under the age of one month.

Note that when performing urography with a contrast agent, you should carefully calculate the amount of the drug for small patients.

However, even with a survey urography, which is absolutely painless, parents should prepare the child in advance and explain to him that he will not experience discomfort and therefore should not be afraid.

Algorithm for describing the resulting image

The first step in describing a snapshot is to examine the state skeletal system. The thing is that pathological processes in the organs of the urinary system also affect the bones. So, for example, when chronic diseases kidneys, there is a so-called "compensatory scoliosis" of the spine towards a healthy organ.

In the event that the patient has carefully prepared for the procedure, the shadows of the kidneys are clearly visible in the picture. The norm is the location of the left kidney at the level of the twelfth thoracic and up to the second lumbar bodies vertebrae, and right - from the first to the third bodies of the lumbar vertebrae. What right kidney located below the left, due to the fact that the liver presses on it.

Describing the shadows of the kidneys, the specialist should indicate their shape, size and state of the contour, as well as comment on the density of the tissue of the organ.

The doctor is also interested in the condition lumbar muscles, their contours and symmetry. Any changes may indicate that an inflammatory process occurs in the retroperitoneal space or there are tumor foci.

As a rule, normal ureters are not visualized because they are hollow. If there is inflammation in their lumen or calculi are present, then the images show shadows that correspond to the location of the ureters.

The bladder is visible in the picture if concentrated urine is present in its lumen.

After the specialist has compiled a description of all the "natural" shadows and structures, he begins to study pathological and additional shadows that may indicate dysfunction in the body.

An alternative to survey urography

Despite its popularity, urography is considered an obsolete research method. Almost the same functions today are performed by ultrasound and MRI. They allow you to explore everything. internal organs, reveal inflammatory processes, tumors and calculi in the kidneys.

Urography is a radiopaque study of the function of the kidneys and urinary tract, which is used to diagnose most urological diseases.

The resulting urogram perfectly visualizes the anatomical position of the kidneys, their shape and size, allows you to assess the degree of functionality of the urinary organs, detect a variety of pathologies (neoplasms, stones, foci of inflammation).

Urography happens:

overview - without the introduction of contrast, in fact it is an x-ray of the kidneys and urinary tract;
excretory (intravenous) - a contrast agent is used, which is administered intravenously. This is done for better visualization.

As a contrast in excretory urography, iodine-containing preparations are used. Iodine is a substance that can cause an allergic reaction varying degrees gravity. Therefore, 1-2 days before the examination, a test for individual sensitivity to iodine is required. Testing is performed in an outpatient setting under the supervision of medical staff. With the development of allergies (urticaria, runny nose, swelling), the patient immediately receives qualified help. In this case, the introduction of a contrast agent is strictly contraindicated.

Preparation for urography

Within 3 days before urography, it is necessary to follow a diet that excludes foods that cause fermentation and gas formation in the intestines (vegetables, fruits, dairy products, carbonated drinks, black bread, etc.).

If necessary, on the eve of the procedure can be appointed cleansing enema and taking activated charcoal.

8 hours before the examination, you can not eat or drink a lot of liquid.

Immediately prior to urography, the bladder and stomach must be empty.

Indications

Urography is used to diagnose diseases of the urinary system and is prescribed by a urologist if there are certain indications:

chronic infections of the urinary system;
hematuria (blood in the urine);
urolithiasis disease;
obstruction (blockage) of the ureter;
congenital anomalies of the kidneys;
pathological mobility of the kidneys;
traumatic injuries;
control after surgical treatment.

Contraindications

Conditions in which urography is not desirable or completely contraindicated include:

allergy to iodine-containing drugs;
pregnancy at any time;
various bleeding;
decreased blood clotting;
renal failure (acute or chronic form);
glomerulonephritis (acute course);
thyrotoxicosis;
therapy diabetes drug "Glucophage";
pheochromocytoma (hormonally active tumor of the adrenal medulla).

If it is not possible to perform urography (if there are contraindications), this method can be replaced by other, less informative, but safer studies for a particular person: ultrasound kidneys and bladder, CT or MRI.

The decision on the advisability of replacing or supplementing one diagnostic method with another is made by the attending physician, based on individual features sick. In any case, all examinations are aimed at obtaining as much as possible reliable information about the condition of the kidneys and urinary tract.

The accuracy of the diagnosis and the effectiveness of the prescribed treatment depend on the completeness and quality of the information.

Urography technique

It is better to undergo urography in those clinics that specialize in the diagnosis and treatment of urological pathologies.

Before the examination, it is necessary to sign an official consent to conduct urography. This can be done by the patient himself or his relatives. Then you need to remove all metal objects from yourself and change into disposable medical clothes. If the patient is worried severe pain or a feeling of fear, he may be offered sedatives and painkillers.

Before the introduction of a contrast agent, an overview urography is performed - an x-ray of the kidneys and urinary tract.

Excretory (intravenous) urography

Shooting begins in the first minutes after the contrast has entered the blood, and lasts from 45 to 60 minutes. During this time, several shots are taken at regular intervals, for example, 5-7 minutes, then 12-15, 20-25, etc.

When the contrast is slowly removed, delayed shooting is possible (at 45, 60 minutes). How many pictures you need to take is determined by the radiologist, taking into account the characteristics of the disease.

Side effects

Often during the injection of a contrast agent, patients feel a burning sensation along the vein, nausea, dizziness, or a feeling of heat throughout the body. These reactions are considered normal, unpleasant symptoms pass on their own.

On a note: to speed up the process of removing the contrast and neutralize the received dose of radiation on the first day after the examination, it is recommended to drink more liquid, better milk and fruit juices.

Since a sensitivity test was made before the introduction of a full dose of a radiopaque preparation, an allergy to it develops extremely rarely.

If a Exploratory survey the patient was carried out competently and did not reveal any contraindications to urography, then these and other side effects usually not observed.

Timely and reliable diagnosis is of great therapeutic importance, since it directly affects the success of treatment. In the process of identifying kidney disease effective diagnostic method urography of the kidneys is considered.

Urography of the kidneys

Urography is called an X-ray study that allows you to evaluate the functionality of the kidney structures and the urinary system. The essence of the method is the introduction of a contrast agent to the patient, followed by an x-ray examination. Diagnostics allows you to detect the presence of inflammatory foci, calculi or tumor formations. The procedure is prescribed for patients of any gender and age, since it is one of the safest studies.

Indications for appointment

Urography shows how the patient's kidneys work, so it has a fairly wide range of appointments.

The study is indicated to identify:

Benign and malignant tumor lesions;
Structural changes in renal tissues;
Stones and small stones in the kidneys;
Abnormal structure of the urinary system and kidneys;
Likely consequences of renal injury;
Nephrogenic hypertension, pyelonephritis, glomerulonephritis and hydronephrosis, tuberculosis, etc.;
Reasons.

Urographic examination is prescribed for suspected genitourinary infectious processes, at renal colic, as well as to obtain a picture of the state of the kidneys after the surgical intervention. The method reliably determines the type and degree of damage, stages pathological process which allows the doctor to choose the most effective therapeutic tactics.

Kinds

There are several types of urographic diagnostics:

Infusion (intravenous with the use of a contrast agent);
Overview;
Excretory.

Infusion (contrast) urography involves intravenous administration contrast agent with a dropper. Typically, in such an examination, contrast is slowly introduced during the procedure, and images are taken on different stages diagnostics.

Overview

Plain urographic diagnostics is standard x-ray examination and performed without the use of contrast. As a result of the study, a rather poor picture of the disease is usually given, although the doctor, based on the results of survey urography, is able to detect large stones and determine overall structure kidneys. Usually similar procedure always given before contrast urography.

Plain radiography is prescribed for lumbar injuries and renal colic, urolithiasis and hydronephrosis, tumors, etc. In fact, during the study, the specialist performs an overview image of the abdominal organs, which also displays the spine and bone structures, soft tissues, etc.

excretory

This method is also called intravenous or contrast urography, since the procedure is performed using a radiopaque preparation. Usually, Cardiotrast, Urografin, Visipak, Trijombrast, etc. are used as a contrast. The method is based on the use of the filtration function of the kidneys, the excretion of processed materials and the release of metabolic substances.

The pelvicalyceal system is not visible during survey urography, therefore, to determine its condition and functionality a contrast is introduced, the choice of which determines the quality of the results obtained. In order for the study to give reliable and informative results, the contrast should not accumulate in tissues, be metabolized and participate in material exchange processes. In addition, the contrast agent should have minimal nephrotoxicity and maximum x-ray contrast.
On the video about excretory urography of the kidneys:

Infusion

Absolute indications for intravenous urography are:

urinary anomalies;
Chronic inflammatory renal lesions;
Tumor processes in the kidneys;
Functional bladder changes;
Urolithic pathology;
Kidney prolapse, etc.

Also, contrast urography is often prescribed before surgery.

Preparation for the procedure

Preparation for the survey and excretory urography of the kidneys is somewhat different:

A review study requires preliminary cleansing of the gastrointestinal tract. A few days before the study, it is necessary to refuse foods that contribute to flatulence, such as bread, legumes, milk and potatoes. Need to clear intestinal structures using sorbents (Polifepan, activated carbon). On the eve of the review procedure and in the morning on the day of the procedure, you will have to prepare by fasting; only unsweetened tea is allowed for breakfast. To avoid flatulence, it is not recommended to drink a lot of fluids.
Preparation for intravenous renal urography with contrast also requires cleaning of the GI tract so that renal imaging is as high as possible. The patient should exclude the same foods and follow the same rules as before the survey urography. Before the study, the patient is given an enema, then the patient must empty the bladder.

If the patient is worried about nervousness, it is recommended to take sedative drug. If you are allergic to any medications or chemical substances, then the doctor must be notified in advance. The patient is also required to sign consent for the diagnosis.

How is the procedure carried out

Survey urography of the kidneys for both adults and children is carried out in vertical position, X-rays direct beam to the area of 3-4 vertebrae. During the exposure chest and the genitals with limbs are covered with special protective equipment like an apron. After 5 minutes the patient can be free.

If we talk about how intravenous renal urography is done, then the procedure begins with the patient's position on a special table, after which a contrast agent is slowly injected into his vein. In the process of introducing a contrast agent to children or adults, the patient may feel some discomfort, such as a burning sensation. X-ray contrast gradually penetrates into the ureters and renal tissue. During excretory urography, several consecutive images are taken at approximately 5-10 minute intervals.

During this time, the patient is in horizontal position lying on the couch. Sometimes there is a need for delayed pictures, which are taken several hours after the introduction of contrast. Usually the duration of intravenous urography is about half an hour to an hour. After the procedure, the patient can go home and eat.

Introduction of contrast in infusion renal urography

Contraindications

Plain and excretory urography is not performed for all patients without exception, since the study has a number of contraindications:

Severe hepatic or renal damage;
Pregnancy, breastfeeding;
Pheochromocytoma;
Glomerulonephritis and other severe pathologies;
Thyroid pathologies like thyrotoxicosis, etc.;
Allergy to iodine contrast agents;
The presence of bleeding or a tendency to them;
Reduced blood clotting;
Kidney failure in acute or chronic form;
Treatment of diabetes with Glucophage.

With categorical contraindications to urography, such a diagnosis is replaced by more safe research, although less informative, for example, ultrasound diagnostics, magnetic resonance or computed tomography.

What is the harm

Urographic diagnosis of the kidneys may be accompanied by adverse reactions organisms, which usually manifest themselves in the following:

Burning sensation in the vein where the contrast was injected;
feeling of nausea;
Flushes of heat;
dizziness;
Iron taste in the mouth.

But such reactions are considered the norm and soon disappear on their own. In order to get the contrast out of the body faster, it is recommended to consume more fluids such as fruit juices, green tea or milk. If there are no contraindications to the urographic diagnosis of the kidneys, then there are no side effects, and possible harm reduced to short-term X-ray exposure.

Urography in children - safe procedure, it is carried out in them in the same way as in adults, only the dosage of the contrast is determined with particular rigor based on the weight of the child and the condition of his kidneys and liver. Because little kids can't long time stay in a stationary state, then they have X-ray contrast diagnostics carried out with a shorter time interval. To exclude the possibility of an allergic reaction, children are additionally given antihistamines.

results

Evaluating the results of urography, the doctor analyzes the location and shape of the kidneys, and also notes the rate of withdrawal of the radiopaque substance. Parenchymal structures are assessed, pelvicalyceal system and its functionality. Obstacles to normal urine flow, insufficient fullness of the pelvis with urine, etc. are revealed.

Examination of the kidneys by means of 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 rather long time period. The procedure is performed using a special contrast agent, intravenous injection which provides a more detailed image on the x-ray.

Possibilities of overview urography

Survey urography does not involve the use of contrast. In fact, this is the same x-ray, focused on the lower part of the body. The possibilities of the method allow to establish the presence of stones, different in chemical composition:

oxalates. The source of education 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. Formed from calcium salts of carbonic acid.

Plain urography allows you to clarify the location of kidney stones

Carrying out the procedure

Diagnosis of renal pathologies by urography is carried out as a conventional x-ray examination. The patient can be in a vertical or horizontal position, depending on the model of the device. The focus of 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 time period (from 5 to 7 minutes), and is not burdensome for the patient. All that is required of the subject is to maintain a static position and for a few seconds, on command medical specialist, hold your breath. This is done to ensure that the image of the organs on the radiograph is clear, without blurred areas.

Contrast-enhanced excretory urography involves the radiologist taking several consecutive images with a time range of 15–20 minutes. The examination lasts about 50 minutes, while the patient may experience discomfort burning sensation from the use of a contrast agent.

X-ray results

The doctor of the department is responsible for decoding the results radiodiagnosis. The snapshot is described sequentially according to a certain algorithm:

condition of the spine and pelvic bones. With chronic renal pathology there is a high probability of developing a frontal curvature of the spinal column;
shadows of the kidneys and their location. According to the standard, the left shadow should be located from the 12th thoracic vertebra up to 2nd vertebra lumbar spine, right - slightly lower - from the 1st to the 3rd lumbar vertebrae. Assessing the shadows, the diagnostician describes their outlines, sizes and shape;
kidneys directly. healthy organs should have a clear outline and a homogeneous structure. In the presence of a single cyst, a tubercle is visible, with polycystic disease, the kidney is enlarged, the outlines of the organ are wavy. The tumor is determined by the growth of the kidney and curved contours;
lumbar muscles. The blurring of the outlines indicates the presence of tumor formations and internal hematomas;
hollow tubes that connect the kidneys to bladder or ureters. These organs are visualized in the picture 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 the results of the examination, 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 lumbar muscles. For an experienced radiologist, the description process takes no more than a quarter of an hour.

Analysis of the results of urography 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 dietary intake is prescribed.

Food

The need to prepare for a review urography of the kidneys is due to the fact that the study affects the organs digestive tract. A full intestine will become an obstacle to a clear visualization of the renal apparatus. The diet consists in facilitating the diet by eliminating a number of products from it. First of all, this applies to food that can provoke increased gas formation in the intestine.

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

pickled, sauerkraut and raw cabbage;
whole fresh milk;
dishes from beans, lentils, peas;
sweets yeast dough and sweet desserts;
multicomponent 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 stones. It is not recommended to use heavy fatty foods and dishes processed by culinary frying:

fatty sauces based on mayonnaise;
sausages;
side dishes of pasta and potatoes;
fatty varieties of fish and meat;
spicy seasonings and spices.

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

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

medical training

In addition to the diet, preparatory measures before the survey urography include bowel cleansing with the help of special medications and enema procedures. For lavage (cleansing), laxatives are used that do not have an aggressive effect on gastrointestinal tract. The basis of such medicines makes up a linear macrogol polymer.

The most commonly used are Fortrans, Lavacol, Endofalk, etc. Medicines are available in powder form for preparing a solution. The drug is diluted with water at the rate of one package per liter. The dosage of liquid medicine is a liter for every 20 kg of the patient's weight. Drink should be in two visits: half - at night, the rest - in the morning. Be sure to do the enema twice. Liquid volume for rectal administration is two liters, the water temperature should correspond to body temperature. Optionally, you can add a decoction of medicinal herbs to the water.

The use of sena-based drugs is not recommended.

Purpose of urographic examination and contraindications

The indications for the examination are the symptoms for which the patient complains, kidney diseases diagnosed earlier, confirmation of the diagnosis alleged by the doctor. Diseases diagnosed include:

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

Urography is not done if the patient is suffering radiation sickness, has a history of surgery to remove one kidney, women in the perinatal period. The procedure is not recommended for children without expressed indications. The examination should not be carried out more than twice a year, since x-rays tend to accumulate in the body. If it is necessary to diagnose more often, one should resort to a more modern and safe method- magnetic resonance imaging.