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March 19, 1982

Vicarious Excretion of Contrast Media

JAMA. 1982;247(11):1608-1610. doi:10.1001/jama.1982.03320360058038

WHEN contrast media are injected intravenously for an intravenous urogram (IVU), prompt opacification of the urinary tract is anticipated. With modern urographic contrast media, and in the presence of normal renal function, this expectation is usually realized. Although the kidneys constitute the primary route of excretion of urographic contrast media (almost totally via glomerular filtration, with the exception of a new contrast medium, iodamide meglumine [Renovue-65 and Renovue DIP], of which reportedly one third is excreted by tubular secretion), they are not the only route. Urographic contrast media may be excreted by the liver in the bile, or directly by small-bowel mucosa. These "vicarious" pathways become important as routes of excretion in the presence of diminished renal function. They may lead to unexpected opacification of the gallbladder or the colon after contrast has been administered for an IVU or an angiogram. The circumstances and possible reasons for this are discussed