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Intravenous Pyelogram (IVP)

Test Overview

An intravenous pyelogram (IVP) is an X-ray test that provides pictures of the kidneys, the bladder, the ureters, and the urethra (urinary tract). An IVP can show the size, shape, and position of the urinary tract, and it can evaluate the collecting system inside the kidneys.

During IVP, a dye called contrast material is injected into a vein in your arm. A series of X-ray pictures is then taken at timed intervals.

IVP is commonly done to identify diseases of the urinary tract, such as kidney stones, tumors, or infection. See a picture of an IVP showing a kidney stone. It is also used to look for problems with the structure of the urinary tract that were present from birth (congenital).

An ultrasound or a computed tomography (CT) scan may be combined with an IVP if more details about the urinary tract are needed. A computed tomography intravenous pyelogram (CT/IVP) is usually done to look for the cause of blood in the urine.

Why It Is Done

An intravenous pyelogram (IVP) is done to:

Look for problems with the structure of the urinary tract.
Find the cause of blood in the urine.
Find the cause of ongoing back or flank pain.
Locate and measure a tumor of the urinary tract.
Locate and measure a kidney stone.
Find the cause of recurring urinary tract infections.
Look for damage to the urinary tract after an injury.

How To Prepare

Before having an intravenous pyelogram (IVP), tell your doctor if:

You are or might be pregnant.
You are breast-feeding. The contrast material used in this test can get into your breast milk. Do not breast-feed your baby for 2 days after this test. During this time, you can give your baby breast milk you stored before the test, or formula. Discard the breast milk you pump for 2 days after the test.
You have an intrauterine device (IUD) in place.
You are allergic to the iodine dye used as the contrast material for X-ray tests or to anything else that contains iodine.
You have ever had a serious allergic reaction (anaphylaxis), such as after being stung by a bee or from eating shellfish.
Within the past 4 days, you have had an X-ray test using barium contrast material (such as a barium enema) or have taken a medicine (such as Pepto-Bismol) that contains bismuth.
You have had kidney problems in the past or have diabetes, especially if you take metformin (Glucophage) to control your diabetes. The contrast material used during an IVP can cause kidney damage in people who have poor kidney function. If you have had kidney problems in the past, blood tests (creatinine, blood urea nitrogen) may be done before the test to make sure that your kidneys are working properly.

You may need to stop eating and drinking for 8 to 12 hours before the IVP. You also may need to take a laxative the evening before the test (and possibly have an enema the morning of the test) to make sure that your bowels are empty.

This test is often done in children to see if they may have an abnormal backflow of urine (vesicoureteral reflux). Prepare your child for exams and tests that are needed. Doing so will help your child understand what to expect and can help reduce fears.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

How It Is Done

An intravenous pyelogram (IVP) is usually done by a radiology technologist. The IVP pictures are interpreted by a doctor who specializes in interpreting imaging tests (radiologist).

You will need to remove any jewelry that might interfere with the X-ray picture. You will need to take off all or most of your clothes, and you will be given a cloth or paper covering to use during the test. You will be asked to urinate just before the test begins.

You will lie on your back on an X-ray table. An X-ray picture of your belly will be taken and reviewed by the radiologist before the next part of the test begins.

The injection site on your arm will be cleaned and the contrast material will be injected into a vein on the inside of your elbow. The dye travels through the bloodstream, is filtered out by the kidneys, and passes into the urine. The urine then flows into the tubes (ureters) that lead to the bladder.

X-ray pictures are taken several minutes apart as the dye goes through the urinary tract. Each picture is developed right away. Sometimes more pictures are taken based on earlier ones. You may be asked to turn from side to side or to hold several different positions so the radiologist can take a complete series of X-rays.

During IVP, a compression device may wrapped around your belly to keep the dye in the kidneys. The most common compression device is a wide belt containing two inflated balloons that push in on either side of your belly to block the passage of dye through the ureters. If you have recently had abdominal surgery or have an abdominal disorder, the band will not be used.

A special type of X-ray technique called fluoroscopy may also be used during IVP. During fluoroscopy, a continuous X-ray beam is used to display a moving image on a video monitor.

IVP usually takes about an hour. After the test is over, you will need to drink plenty of liquids to help flush the contrast material out of your body.

How It Feels

You will feel no discomfort from the X-rays. The X-ray table may feel hard and the room may be cool. You may find that the positions you need to hold are uncomfortable.

You will feel a brief sting when the needle is inserted into the vein in your arm. When the contrast material is injected, you may feel slight burning in your arm and flushing throughout your body. You may also notice a salty or metallic taste in your mouth.

The compression belt may feel tight. If it is painful, tell the technologist and ask that it be readjusted.

You may feel slightly weak, nauseated, or lightheaded for a short time after the test.

Risks

There is always a slight chance of damage to cells or tissue from radiation, including the low levels of radiation used for this test. But the chance of damage from the X-rays is usually very low compared with the benefits of the test.

There is slight risk of having an allergic reaction to the contrast material. The reaction can be mild (itching, rash) or severe (trouble breathing or sudden shock). Death resulting from an allergic reaction is very rare. Most reactions can be controlled with medicine. Be sure to tell your doctor if you have asthma or allergies of any kind, such as hay fever, iodine allergy, bee stings, or food allergies.

People with certain conditions (such as diabetes, multiple myeloma, chronic kidney disease, sickle cell disease, or pheochromocytoma) have increased chances of having sudden kidney failure from IVP. Older adults and people taking medicines that affect the kidney may also have increased chances for problems after an IVP.

Results

An intravenous pyelogram (IVP) is an X-ray test that provides pictures of the kidneys, the bladder, the ureters, and the urethra (urinary tract). Your doctor may be able to talk to you about some results right away. Complete results are usually ready in 1 to 2 days.

**Intravenous pyelogram (IVP)**
Normal:	The kidneys, ureters, and bladder are normal in position, size, and shape.
	The contrast material reaches the kidneys in a normal amount of time.
	No blockage can be seen in the kidneys, ureters, or bladder.
	In men, the prostate gland looks normal in position, size, and shape.
Abnormal:	The kidneys, ureters, or bladder may be abnormal in position, size, or shape. A kidney may be absent, or an extra kidney or ureter may be present. The kidneys are too large or too small.
	The contrast material takes longer than normal to reach a kidney.
	An abnormal growth (such as a tumor), one or more cysts, an abscess, or a kidney stone is seen. A kidney is swollen with urine from a blockage such as a tumor or kidney stone.
	Injury to the kidney, ureter, or bladder is seen.
	The kidney contains scarring.
	In men, the prostate gland is too large.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

Being unable to remain still during the test.
Having a large amount of stool (feces) or gas in the large intestine (colon).
Having a recent test with barium (such as a barium enema) or bismuth.

An intravenous pyelogram (IVP) is not usually done for a pregnant woman because the X-rays could damage the growing baby. If a view of a pregnant woman's kidneys is needed, an ultrasound test may be done instead.

What To Think About

A preliminary X-ray picture (KUB) of your abdomen will be taken before the intravenous pyelogram (IVP). This picture is reviewed by the radiologist before the next part of the test begins. An IVP test may not be done if these pictures show a problem.
Other tests that may be used instead of an intravenous pyelogram (IVP) include computerized tomography (CT scan), ultrasound, digital subtraction angiography, and, occasionally, MRI. For more information, see the topics CT Scan of the Body, Abdominal Ultrasound, Angiogram, and Magnetic Resonance Imaging (MRI) of the Abdomen.
For people who have known kidney problems, diabetes, or who are dehydrated, steps may be taken to prevent kidney damage. Less contrast material may be used and additional fluids may be given before, during, and after the test.
If you have had kidney problems in the past, blood tests for creatinine and blood urea nitrogen may be done before the test to make sure that your kidneys are working properly. For more information, see the topics Creatinine and Blood Urea Nitrogen.
Another test that may be done to look at the urinary tract is retrograde ureteropyelogram. Retrograde ureteropyelogram is done when IVP results do not help identify a problem or when IVP can't be done because of poor kidney function or an allergy to the iodine contrast material.

References

Other Works Consulted

Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.

Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

By	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Avery L. Seifert, MD - Urology
Last Revised	June 29, 2012

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Last Revised: June 29, 2012

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Avery L. Seifert, MD - Urology

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