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Max E. Dine, MD; Allen Shuster, MD
Worcester, Mass

JAMA. 1970;212(8):1377.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

We take serious issue with the statement made by Dr. Hellebusch in his Clinical Note "Renal Papillary Necrosis" (210: 1098, 1969). He stated, "obviously when azotemia is present, retrograde pyelography must be used."

Schwartz et al¹ in 1963 first called attention to the fact that in many patients with renal insufficiency, a double-dose intravenous pyelogram (IVP) frequently visualized the kidneys or collecting systems sufficiently to exclude or diagnose obstructive uropathy. Schencker² in the following year described the technique of drip infusion pyelography (DIP) in which a large dose of contrast medium is infused over six to ten minutes and x-ray films taken after the infusion is completed. He found satisfactory visualization of the kidney collecting system frequently in patients with significant azotemia (blood urea nitrogen level [BUN] as high as 120 mg/100 ml) in whom previous routine IVP showed nonvisualization. Subsequently, further refinement of DIP . . . [Full Text PDF of this Article]

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