In the part of the NHS I work in we can get an IVU quite easily outside
office
hours but an ultrasound is a very different matter.
(I dont do my own ultrasound examinations).
It is not my practice to request Urea and Creatinine analysis before IVU
nor was
it the practice of the (Adult) Urologists I worked for during my basic
surgical
training.
Andrew Hobart
East London
Fiona Jewkes wrote:
> Sorry, I have to beg to differ about a good history and examination giving
> a good indication of renal failure - in my experience, it may be impossible
> to diagnose except biochemically until it is very advanced indeed.
>
> Ultrasound is an extremely reliable way of finding stones because they all
> cause echogenic shadows, even the radio lucent ones. Although it may be
> difficult to define the exact anatomy and stone size, it will clearly show
> obstruction and the location of the stone. Thus I would argue an IVU is
> rarely necesssary anyway, if you do an U/S (+/- KUB for size of stone and
> more precise location). If you have a non radio opaque stone (ie visible on
> U/S but which won't show up on straight KUB) or evidence of obstruction on
> U/S you may need a limited IVU to get more detail.
>
> If you've done an U/S before the IVU and there is only unilateral
> disease, the creatinine will be normal (unless there is some pathology going
> on in the other kidney that the ultrasound didn't hint at which would be
> rare indeed). I wouldn't do a creatinine just because of the IVU because
> I'd do an U/S first. I'd do it if there was bilateral disease on U/S or
> some other very good reason.
>
> Best wishes
>
> Fiona Jewkes
> ( for those who don't know me, until recently cons. paediatric
> nephrologist!)
>
> ----- Original Message ----- givi
> From: "John Ryan" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Sunday, August 12, 2001 9:19 AM
> Subject: Rnal colic and function
>
> > Do list members request a creatinine before an I.V.U. in patients with
> > suspected renal colic ? Is this common practice, it is not a practice I
> > subscribe to but maybe I have just been lucky ? A good history and
> > examination is going to give an indication of renal failure which an
> > injection of contrast might exacerbate. A good topic for a 'BET' perhaps.
> >
> > Dr John Ryan
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