Nephrostogram: Visualizing the Kidneys and Urinary Tract with Contrast Imaging

Introduction:

Goodwin and his team performed the first percutaneous nephrostomy, a route for the drainage of pus and urine, in 1955, which marked the beginning of the revolution in percutaneous access. It was first used for high-risk patients and performed at specialist facilities in the late 1970s; it has been used in many locations over time. It has largely supplanted open surgery for the majority of patients with renal stones.

A nephrostogram is a medical imaging treatment to see the kidney and ureter's collecting system. In this test, a contrast substance is injected into the renal collecting system through a catheter, and the passage of the contrast through the urinary tract is imaged using X-ray technology. The nephrostogram is used to examine kidney function and spot any blockages or anomalies in the renal collecting system. Let us learn more about nephrostograms in detail in this article.

What Is a Nephrostogram?

A nephrostogram is an X-ray technique that uses water-soluble contrast to assess the upper collecting system through the nephrostomy catheter fluoroscopically. An antegrade pyelogram is another name for a nephrostogram. It is used to inspect the patient's nephrostomy catheter and ureteral flow of urine. A nephrostogram is done to ascertain if the nephrostomy catheter can be withdrawn or whether other operations are necessary.

What Are the Indications of a Nephrostogram?

With X-rays and a particular dye, a nephrostogram allows doctors to see the renal pelvis, calyces, and other parts of the urinary system (the funnel-like structures that collect urine produced by the kidney). It serves a variety of functions, including:

1. Identifying and treating urinary tract blockages, such as tumors or stones.

2. Examine the urinary system's structure before performing specific surgeries, including a kidney transplant.

3. Identifying and treating urinary tract congenital anomalies.

4. Tracking the success of a treatment, like the implantation of a stent in the urinary system.

It is significant to remember that the precise reasons for a nephrostogram might change depending on the patient's unique medical history and the doctor's discretion.

How Is a Nephrostogram Performed?

1. Preparation: Remove any clothing and jewelry from the region to be scanned as part of the preparation process. A gown will be given, and the patient will be requested to lie on an X-ray table.

2. IV Line Insertion: To give the contrast material, a clinician will put an intravenous (IV) line into a vein in the arm.

3. X-ray: A syringe containing iodinated "contrast" will be attached to the nephrostomy catheter. As X-ray images are captured, the contrast will be injected. The contrast makes it possible to view the kidney, ureter, bladder, and nephrostomy catheter clearly on X-ray images. The patient has to be as still as possible. The patient could occasionally be instructed to hold their breath.

4. If no additional steps are necessary, the nephrostomy catheter will be rejoined into the drainage bag once the images have been taken.

5. In order to make sure there are no undesirable responses to the contrast material, the patient will be observed for a brief period following the test.

6. Interpretation: The radiologist will evaluate the X-rays and write a report with the findings. The doctor will go through the report with the patient and go over the findings.

Please note that it is typical to feel warm or flushed while the contrast substance is injected. Describe any negative responses that are experienced from the contrast to the technician.

Is Nephrostogram Evaluation Painful?

The examination is painless. There might, however, be some minor discomfort. One can tell the doctor, nurse, or radiographer if there is a blockage in the contrast flow and if the patient is experiencing excruciating pain, they will unclamp the PCN (percutaneous nephrostomy) immediately.

What Are the Result of Nephrostogram?

Nephrostogram results can reveal the following:

1. Urinary tract obstructions or blockages.

2. Urinary tract fistulas or leaks.

3. The purpose of a transplanted kidney and its location.

4. The size and location of kidney stones.

5. Obstruction at the ureteropelvic junction.

A radiologist interprets a nephrostogram's findings and produces a report. The physician will review the report and go over the findings, along with any suggestions for additional research or medical care, with the patient.

What Are the Disadvantages of a Nephrostogram?

The following are some drawbacks of a nephrostogram:

1. Nephrostogram exposes patients to low levels of ionizing radiation, which over time and with repeated exposure, could raise their risk of developing cancer.

2. Using contrast material is necessary for the test, but doing so can be risky for those with allergies or kidney issues.

3. A nephrostogram may be costly, and not all insurance policies will pay for it.

4. The procedure requires time to complete, and there may be a waiting period before results are known, which can be inconvenient for some patients.

5. Nephrostogram may not provide a complete assessment of the urinary system and may miss some abnormalities or issues..

What Are the Advantages of a Nephrostogram?

The following are some benefits of a nephrostogram:

1. Accuracy: Accurate upper urinary tract images provided by a nephrostogram aid in diagnosing and treating urinary tract issues by healthcare professionals.

2. Non-invasive: The technique is non-invasive and exposes the patient to very little radiation.

3. Painless: The procedure is typically quick, it only takes a few minutes and is painless.

4. Time: Quick diagnosis and treatment of urinary tract issues is made possible by the immediate availability of test results, which are typically available.

5. Versatility: A nephrostogram is a versatile tool that can be used to assess a variety of urinary tract issues, such as blockages, leaks, and the operation of transplanted kidneys.

6. Low Risk: There are not many side effects from the surgery, which is regarded as low risk.

What Are the Potential Risks of the Nephrostomy Procedure?

The following are just a few potential risks and complications associated with this procedure.

1. Common Hazards: There are no known typical hazards.

2. Less Frequent Hazards: The less frequent dangers and issues are Infection, needing antibiotics, Adverse effects of contrast, and more care. A medication allergy needs further medical attention. The procedure might not be possible due to technical or medical issues.

3. Radiation Exposure: People are exposed to a small amount of radiation from the X-rays used in the procedure. Repeated radiation exposure over time can raise the chance of developing cancer.

4. Pain: Some people may feel minor pain or discomfort during or after the procedure.

5. Rare Risks and Issues: An elevated lifetime risk of developing cancer as a result of X-ray exposure. It is extremely rare for this procedure to result in death.

Conclusion:

To conclude, a nephrostogram is a useful diagnostic tool that offers significant details about the composition and operation of the upper urinary tract. It aids in the planning of treatments as well as the evaluation of various urinary tract issues. Contrast-enhanced US nephrostograms are quick and easy to perform, and they can show both ureteral patency and obstruction. An alternative to fluoroscopy for evaluating ureteral patency may be contrast-enhanced ultrasound. With the use of further diagnostic tests, clinical data, and test results, healthcare professionals may identify and treat a variety of urinary tract illnesses.