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PubMed1984

Pediatric urography: comparison of metrizamide and methylglucamine diatrizoate.

A non-ionic contrast medium (metrizamide) was compared to an ionic agent (methylglucamine diatrizoate) for pediatric urography. Fifty children were divided into two age groups: under 5, and 5 to 10. In younger children, metrizamide gave more excellent images (19% vs. 0%) and fewer inadequate images (0% vs. 18%) than methylglucamine diatrizoate (p = 0.06). In older children, metrizamide likewise gave more excellent images (44% vs. 14%) and fewer inadequate images (0% vs. 7%). The same pattern was seen when the two groups were combined (excellent, 28% vs. 8%; inadequate, 0% vs. 12%) (p = 0.05). Differences with respect to changes in hematocrit, serum osmolality, serum sodium, and SGOT were statistically significant, but not adverse reactions. In terms of both efficacy and safety, the authors conclude that metrizamide is preferred for pediatric urography.

Child↗
PubMed1985

Excretory urography in current practice: evidence against overutilization.

Excretory urography could be performed less frequently if some combinations of genitourinary signs and symptoms were found to be predictive of either a specific disease or normality. To explore this possibility, the authors conducted a prospective study involving more than 3,000 patients at three institutions (a teaching hospital, a community hospital, and a health maintenance organization). Predictive algorithms were obtained by application of a polychotomous logistic regression model but did poorly at differentiating normal from abnormal patients or arriving at a specific diagnosis. Selection of patients on the basis of the logistic model would have required testing 90% of all patients in order to detect 95% of those with abnormal urograms. These results suggest that current clinical selection criteria for excretory urography are effective, and that present frequency of utilization is appropriate.

Diagnosis, Differential↗
PubMed1986

Clinical intravenous urography: comparative trial of ioxaglate and iopamidol.

A comparative trial of ioxaglate sodium meglumine and iopamidol in excretory urography was undertaken. The study failed to demonstrate any statistically significant differences between the two media in terms of urographic quality. Diagnostically adequate urograms were obtained in 92.6% of patients receiving ioxaglate and 89.6% of patients receiving iopamidol. There were no intermediate, major, or fatal reactions with either media. Minor reactions were slightly more common with ioxaglate. Both media are good, safe urographic agents, and either can be advocated when excretory urography with low-osmolar agents is indicated.

Adolescent↗
PubMed1986

Excretory urography with iohexol: evaluation in children.

A multicenter clinical study was conducted using iohexol, a second-generation nonionic contrast medium, for excretory urography performed in 130 children. Doses of iohexol (300 mg iodine/ml) ranged between 150 and 660 mgI/kg (0.5 and 2.2 ml/kg). Iohexol was tolerated well, and no significant adverse reactions occurred. Sixty-five iohexol urograms were evaluated to determine the minimum dose for adequate visualization of the kidneys and collecting systems. A dose greater than 300 mgI/kg (1.0 ml/kg) always resulted in a urogram of diagnostic quality, while visualization was insufficient for diagnosis in 10% of studies done with doses of 150-300 mgI/kg (0.5-1.0 ml/kg). Another 65 iohexol urograms were compared in a blinded manner with a similar number of studies performed using iothalamate meglumine at comparable iodine concentration and dose. Visualization of calyces and pelvoinfundibular structures achieved with iohexol was rated better with statistical significance, but there was no difference in visualization of the renal parenchyma or ureters. Use of iohexol in excretory urography may be advantageous in children who are at greatest risk for an adverse reaction to contrast media or in those most likely to benefit from use of a low osmolality contrast agent.

Adolescent↗
PubMed1988

Nephroblastomatosis: comparison of CT with US and urography.

A review of the imaging studies of five children with Wilms tumor and nephroblastomatosis demonstrated that contrast-enhanced computed tomography (CT) can show the multifocal involvement of nephroblastomatosis more accurately than either excretory urography or real-time ultrasound (US). In all five children, CT demonstrated multiple areas of nephroblastomatosis along the renal cortex. US showed a single intrarenal mass in each child (one bilaterally) but did not show the cortical nephroblastomatosis. Excretory urography also demonstrated only the dominant mass of the Wilms tumor. The superiority of CT is attributed to better spatial resolution and soft-tissue contrast differentiation and clear demarcation between nonenhanced nephroblastomatosis and enhanced normal renal parenchyma. Contrast-enhanced CT is therefore recommended for the evaluation of clinically abnormal and contralateral kidneys in all children with suspected Wilms tumor.

Child, Preschool↗
PubMed1978

Intravenous urography in experimental acute renal failure. Nephrograms and pyelograms in saline-loaded rats.

We studied renal opacification during intravenous urography in 20 rats subjected to glycerol-induced acute renal failure, with and without prior saline loading. Animals drinking saline suffered less severe renal impairment (mean plasma creatinine 175 mumol/l) than those drinking tap water (mean 341 mumol/l). Nephrograms occurred during intravenous urography in 19 rats at all levels of renal impairment, but were only followed by pyelograms in 8 with mild plasma creatinine elevation (mean 84 mumol/l). The occurrence of a pyelogram was determined not by whether an animal was drinking saline or tap water, but only by the level of renal impairment. The presence of the nephrogram throughout the range of functional impairment in acute renal failure argues against glomerular filtration as the principal route by which contrast medium reaches the nephron to produce this clinically very useful sign.

Acute Kidney Injury↗
PubMed1979

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.

Adult↗
PubMed1980

Diuretic urography in the assessment of obstruction of the pelvi-ureteric junction.

Twenty adult patients with urographic evidence of unilateral, moderately wide renal pelves were examined by routine and diuretic urography. Planimetry of the corresponding calyx system of the two examinations was performed. An increase in size by more than 20 per cent following osmotic diuresis indicated an obstruction of the pelvi-ureteric junction in kidneys with moderately wide renal pelves. Diuretic urography may be useful to diagnose obstruction as a cause of moderately wide renal pelves and to assess operative results.

Adult↗
PubMed1984

Subtraction nephrotomography during urography of transplanted kidneys.

Hypocycloid tomography with photographic subtraction was applied during the early nephrographic phase of urography in 48 transplanted kidneys. The quality of demarcation between cortex and medulla in the subtracted nephrotomogram was evaluated and categorized into 4 groups: Excellent, good, poor, and absent demarcation. The renal function determined by 24-h endogenous creatinine clearance did not correlate with the quality of demarcation. Among 30 cases with excellent or good demarcation only one patient experienced rejection within 8 days after the urography. In 18 cases with poor or absent demarcation 9 had an episode of rejection. Absence of demarcation was only observed in this group of patients. Segmental renal infarcts were demonstrated occasionally on the subtracted early nephrotomogram. Thus, tomographic demonstration of the initial distribution of contrast medium in a transplanted kidney may prove to be of value in the diagnosis both of rejection of transplanted kidneys and renal infarcts.

Creatinine↗
PubMedDate not supplied

Kidney size in children assessed by ultrasonography and urography.

The accuracy of ultrasonographic evaluation of kidney size using the parameter of kidney length was compared with radiographic kidney length assessment by urography. The examination was performed in 102 children 0 to 14 years old in which 427 length comparisons for the right and left kidney were made. Approximately 85 per cent of all differences noted were within a variation interval of 0 to 1.0 cm which was considered to be a good accuracy and consistent with results previously reported. Ultrasonography was therefore regarded as a reliable and suitable alternative to urography in periodic controls of kidney size and growth in children.

Adolescent↗
PubMedDate not supplied

Accuracy of repeated kidney size estimation by ultrasonography and urography in children.

The accuracy of repeated sonographic and urographic kidney length measurements in kidney size evaluation was investigated in 80 children 0 to 14 years of age, mean age 4.5 years. At sonography 250 kidney lengths were compared. A difference of 0 to 1.0 cm in repeated length measurement was considered to be good accuracy and 94 per cent of right and 96 per cent of left kidney lengths were found within this interval--a better result than for urography with 76 per cent of repeated right kidney and 79 per cent of kidney lengths within the same interval (94 lengths). Both methods display a variation of kidney length which may lead to under- and overestimation of kidney size and growth. The investigation thus indicates good accuracy for repeated sonographic kidney size assessment which should be repeated often enough to establish a growth chart displaying the trend rather than rely too much on single measurements. Sonography can be highly recommended as a convenient and harmless alternative to urography.

Adolescent↗
PubMed1979

Intravenous urography in neonates and infants. What dose of contrast should be used?

The dose of contrast to be used for IV urography in neonates and infants is discussed. Toxic levels are only just above the currently accepted doses of 2-4.4 ml contrast medium per kg bodyweight. The dangers of expressing the dose of contrast medium as a volume of contrast related to the patient's age are discussed. A case is presented who had a severe reaction following an acceptable dose expressed as volume for age, but probably excessive when expressed as ml per kg bodyweight. It is concluded that for IV urography in neonates and infants the dose of contrast must be related to weight of patient and not its age; no dehydration should be used; and the injection should be slow, taking about three minutes.

Age Factors↗
PubMed1981

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.

Acute Kidney Injury↗
PubMed1988

Adverse reactions during intravenous urography: are these due to histamine release?

The effects of four different radiographic contrast media (Urovison 58%, Hexabrix 320, Iopamiro 370 and Omnipaque 300) have been examined with respect to histamine release, cardiovascular changes and adverse drug reaction (ADR) in a group of 200 patients undergoing intravenous urography. Each patient received only one of the four agents, which were allocated on a random basis. Urovison produced the greatest number of ADRs. Iopamiro caused the least. No significant correlation between the magnitude of the change in plasma histamine following injection of radiographic contrast medium and the production of a particular ADR could be demonstrated. Heart rate increased significantly following the administration of Urovison, Hexabrix and Iopamiro in the absence of any appreciable change in blood pressure. These results and our earlier findings would favour the use of the low-osmolality contrast media in intravenous urography to minimize ADRs, histamine release and patient discomfort.

Blood Pressure↗
PubMed1995

A randomized, double-blind, parallel group trial of iomeprol, iohexol and iopamidol in intravenous urography.

The aim of this study was to compare the safety, tolerance, and diagnostic efficacy of iomeprol 350 mg I ml-1, iohexol 350 mg I ml-1, and iopamidol 370 mg I ml-1 in 90 adult patients undergoing intravenous urography. Radiographs obtained 5, 10 and 15 min after contrast injection were blindly graded for quality on a four point scale as: 0, non-diagnostic; 1, diagnostic but of limited quality; 2, diagnostic and of good quality; 3, fully diagnostic and of very good quality. The sum of these scores indicated the overall diagnostic quality (0-4, non-diagnostic; 4-8, diagnostic; 9-12, good or excellent). Contrast tolerability was evaluated by discomfort (heat or pain) associated with injection of the test compounds, and patients were monitored and questioned for adverse experiences. The quality of the individual radiographs was assessed as diagnostic and good or fully diagnostic and very good in most cases, with no significant differences between the three study groups, and overall scores were predominantly good or excellent (p = 0.55). All adverse reactions were transient and non-serious, and most of them were reported as mild in intensity. There were no significant differences between the three groups for heat sensation (p = 0.29). Pain at the injection site was reported only in the iohexol group (p = 0.104). It is concluded that iomeprol 350 mg I ml-1 is at least as safe and effective as iohexol 350 mg I ml-1 or iopamidol 370 mg I ml-1 when used for intravenous urography.

Adolescent↗
PubMed1996

Image quality and safety after iodixanol in intravenous urography; a comparison with iohexol.

A double-blind, randomized phase III study compared intravenous urography in 100 adult patients receiving iodixanol 320 mgI ml-1 (Visipaque) with 99 patients receiving iohexol 350 mgI ml-1 (Omnipaque). The aim of the study was to investigate differences in image quality between a non-ionic dimeric contrast medium (CM) and a non-ionic monomer at 40 ml per patient and 60-100 ml per patient volume levels. There were no statistically significant differences between iodixanol and iohexol with respect to overall diagnostic information, which was found to be optimal in 86% and 79%, respectively. Immediately after the injection, the renal border was better delineated with iohexol than with iodixanol (p = 0.0001). Marked papillary blush occurred more often in the iodixanol group (16%) than in the iohexol group (0%), as did visualization of the collecting ducts (24% vs 5%) (p = 0.001). The incidence of adverse events was similar and low for both contrast media. In patients who received the higher doses of CM (60-100 ml), the frequency of discomfort was significantly lower after iodixanol than after iohexol (p = 0.006). We conclude that, in intravenous urography, iodixanol provides at least as good image quality as does iohexol. Iodixanol may cause less discomfort than iohexol, in particular when larger volumes of CM are injected.

Adult↗
PubMedDate not supplied

Digital fluoroscopic excretory urography, digital fluoroscopic urethrography, helical computed tomography, and cystoscopy in 24 dogs with suspected ureteral ectopia.

The purpose of this study was to determine the diagnostic utility of helical computed tomography (CT) for the diagnosis of ectopic ureters in the dog and to compare these findings with those of digital fluoroscopic excretory urography and digital fluoroscopic urethrography. Ureteral ectopia was confirmed or disproved based on findings from cystoscopy and exploratory surgery or postmortem examination. Of 24 dogs (20 female, 4 male) evaluated, 17 had ureteral ectopia. Digital fluoroscopic excretory urography and CT correctly identified ureteral ectopic status and site of ureteral ectopia (P < .05). Urethrography did not reliably detect ureteral ectopia. No false-positive diagnoses of ureteral ectopia were made in any of the imaging studies. Cystoscopic findings significantly agreed with findings during surgery in determining ureteral ectopic status and ectopic ureter site. One false-positive cystoscopic diagnosis of unilateral ureteral ectopia was made in a male dog. Kappa statistics showed better agreement between CT and both cystoscopy and surgical or postmortem examination findings with regard to presence and site of ureteral ectopia compared with other imaging techniques. CT was more useful than other established diagnostic imaging techniques for diagnosing canine ureteral ectopia.

Animals↗
PubMed1975

Evaluation of pelvic masses during infusion excretory urography.

Infusion excretory urography not only clearly delineates the urinary tract structures, but provides additional information about the type of pelvic mass present. Benign uterine fibroids show contrast enhancement in a significant number of cases, whereas endometrial and cervial malignancies give no specific pattern. Cystic and mixed ovarian neoplasms show rim opacification in over 50 per cent of cases, and the presence of this rim sign points strongly to an ovarian lesion. The opacification of solid ovarian tumors cannot be differentiated from that of uterine fibroids unless other identifying features such as specific calcification or visualization of a normal uterus are present. Pelvic inflammatory disease shows no specific type of opacification. Excretory urography is part of the preoperative evaluation in most patients with pelvic mass lesions. By utilizing the infusion method, high quality excretory urograms are obtained, and, in addition, helpful information is obtained regarding the type of pelvic mass present.

Adolescent↗