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To the Editor.—
In response to a question from a New York physician regarding contraindications and risks of retrograde pyelography as a first procedure in a patient with toxic drug reaction to the kidneys, the responding consultant, Chester C. Winter, MD (1982;247:2152), did not make a comment on retrograde pyelography in that particular clinical situation. The procedure was done on the patient to rule out obstructive uropathy. As stated by Dr Winter, retrograde pyelography is associated with considerable risks, both of the procedure itself and the associated anesthesia. Some of the risks are serious. A renal ultrasonogram, with modernday equipment and technical and interpretive expertise, has been shown to be a sensitive method by which obstructive uropathy can be ruled out. Moreover, it is a noninvasive method without associated risks from surgical procedure and anesthesia. It is also cheaper and less time consuming than retrograde pyelography. In the opinion of
Patel RB. Evaluation of Kidney Morphology. JAMA. 1982;248(21):2837. doi:10.1001/jama.1982.03330210029025