Urography in acute renal failure.
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Renal ultrasonography was compared with intravenous pyelography in order to establish the suitability and accuracy of the former investigation as a screening method for ureteric obstruction in patients with carcinoma of the uterine cervix. With a sensitivity of 96.30%, specificity of 96.75%, a positive predictive value of 87.64% and a negative predictive value of 99.09% calculated on a large sample of 420 kidneys, it is recommended that renal ultrasonography is the method of choice in screening for ureteric obstruction in patients with cervical cancer. At the very least it is a suitable and equivalent alternative to intravenous pyelography in such patients.
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In hypotensive patients with severe trauma including renal injuries, the preoperative urogram is generally of poor quality. In many instances these patients are taken to the operating room with no films at all. We have proposed a protocol for the resuscitation of severely injured patients, following which we performed a carefully monitored high-dosage urogram. We demonstrated in 16 patients that diagnostic films can be obtained even in severely injured patients who were initially in shock.
This study is a retrospective review of 30 patients with polycystic kidney disease analyzing the quantitative measurements of renomegaly reported in the literature and the correlation of radiographic findings with the clinical complications of uremia, hypertension, infection, and the need for dialysis. The only significant correlation noted was between renal size and the presence of infection. There was no significant correlation between renomegaly and the presence or development of hypertension, uremia, and the need for chronic dialysis.
A review of the literature reveals that patients with juvenile onset diabetes with azotemia, associated vascular disease, and proteinuria, are at great risk of sustaining acute renal failure following intravenous pyelography. Predisposing factors are identified, but the exact mechanism of acute renal failure remains obscure. Since no prophylactic measures or effective treatment exist, the benefits and risk must be weighed prior to the procedure.
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To determine cost-effective guidelines for the follow-up of patients with superficial transitional cell carcinoma of the bladder (STCCAB), we reviewed clinical histories, pathology reports, and intravenous pyelography results in 84 patients with Stage Ta or T1 disease. In 4 patients (4.8%) subsequent upper tract tumors developed with an average interval from initial presentation to the development of upper tract disease of 5.4 years. Three of these patients were treated successfully. We recommend upper tract surveillance in this group of patients with intravenous pyelography at diagnosis and every twenty-four months thereafter, or selection of those patients who are at high risk for development of upper tract disease (i.e., ureteral-vesical reflux) with voiding cystourethrography one month following each resection of tumors near a ureteral orifice. Refluxing patients should then either undergo surgical repair of their reflux or yearly pyelography.
Intravenous pyelography is the standard first-line investigation for suspected renal trauma. A faint, and/or delayed visualization, or nonvisualization of the damaged renal unit is not uncommon. Low-dose dopamine (3 micrograms/kg/min) increases renal blood flow without deleterious side effects. An experimental rat model was developed to evaluate the effects of low-dose dopamine on intravenous pyelograms in animals with unilateral renal trauma. A consistent and significant improvement in the visualization of the injured kidney was noted in the dopamine-treated animals compared with controls that received equivalent volumes of normal saline.
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We report a case of bilateral submandibular and parotid sialadenitis subsequent to the injection of 100 ml of iopamidol (Niopam 370, Bracco) for an intravenous urogram. Iodide 'mumps' has previously been reported as a rare sequela of ionic contrast media injection. It is a mild and short lived condition, usually requiring no treatment.