Chyluria

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Urine from a patient with filarial chyluria.
Chyluria
Classification and external resources
ICD-10 R82.0
ICD-9-CM 791.1
DiseasesDB 29455

Chyluria, also called chylous urine, is a medical condition involving the presence of chyle in the urine stream,[1] which results in urine appearing milky white.[2] The condition is usually classified as being either parasitic or non parasitic. It is a condition that is more prevalent among people of Africa and the Indian subcontinent.

Chyluria appearance is irregular and intermittent. It may last several days, weeks or even months. There are several factors that trigger Chyluria recurrence.

Causes[edit]

Chyluria is often caused by filariasis due to the parasite Wuchereria bancrofti, a thready nematode which lodges the lymph channels.[2][3] The parasitic infection can lead to obstruction of peripheral lymphatic vessels and increased pressure within the vessels causing collateral flow of the lymph, redirecting the lymph flow from the intestinal lymphatic vessels into the lymphatic vessels of the kidney and ureter.[4] Because of obstruction, subsequent local inflammation of the area leads to dilation of the lymph vessels and the development of a urinary fistulae due to rupture of the lymphatic vessel, which allows for the passage of white blood cells, fat, and fat-soluble vitamins into the urine.[2]

Chyluria flow during cystoscopy and ureteral catheterization.

Another cause of chyluria is pregnancy or childbirth.[5]

In the United States, one of the most common causes is partial nephrectomy or thermal ablation of a kidney lesion.

Symptoms[edit]

Once the lymph channels are blocked, one may open into the kidney hilum or ureter or sometimes into the bladder and chyle can leak into the urinary tract resulting in milky white urine. Blood sometimes mixes with the urine resulting in haemato-chyluria.

Usually the condition is self-limiting and can sometimes lead to complications. If left untreated, chronic chyluria can lead to malnutrition and fat-soluble vitamin deficiency.[6]

Treatment[edit]

Following a low fat and high fluid diet is recommend for managing symptoms.[7]

Medicines that inhibit cholesterol absorption in the small intestine, such as Ezetimibe, may be effective treatments in some patients.[7]

An anti-filarial drug, such as diethylcarbamazine, may be prescribed. Severe damage to lymph channels may require surgery. Sclerotherapy with instillation of 1% of silver nitrate or povidone iodine (2ml of 5% + 8ml distilled water).[6]

References[edit]

  1. ^ Chronic filariasis
  2. ^ a b c Saha M, Ray S, Goswami M, Kundu S, Saha P, Saha A, Maitra S, Talukdar A (2012). "An occult filarial infection presenting as chyluria with proteinuria: a case report and review of literature.". BMJ Case Reports. 2012: bcr0120125635. doi:10.1136/bcr.01.2012.5635. PMC 4542962Freely accessible. PMID 22669920. 
  3. ^ Dunavan, Claire Panosian (2008-05-22). "The white urine that held the key". Discover Magazine. 
  4. ^ Paul, Sagorika; Kumar, Manoj; Singh, Viswajeet; Sankhwar, Satyanarayan (2014-01-06). "Chyluria: is retrograde pyelogram mandatory prior to endoscopic sclerotherapy?". BMJ Case Reports. 2014: bcr2013200550. doi:10.1136/bcr-2013-200550. ISSN 1757-790X. PMC 3902324Freely accessible. PMID 24395870. 
  5. ^ Mahmood, Khalid; Ahmad, Ahsan; Kumar, Kaushal; singh, mahendra; pankaj, sangeeta; singh, Kalpana (2015-03-01). "Chyluria in Pregnancy-A Decade of Experience in a Single Tertiary Care Hospital". Nephro-Urology Monthly. 7 (2). doi:10.5812/numonthly.26309. ISSN 2251-7014. PMC 4393552Freely accessible. PMID 25883913. 
  6. ^ a b Guttilla, Andrea; Beltrami, Paolo; Bettin, Laura; Galantini, Andrea; Moro, Fabrizio Dal; Ficarra, Vincenzo; Zattoni, Filiberto (2016-09-01). "Non-Parasitic Chyluria: Our Experience With Sclerotherapy With Solution of Povidone-Iodine and Destrose and A Review of the Literature". Urology Case Reports. 8: 28–30. doi:10.1016/j.eucr.2016.05.010. ISSN 2214-4420. PMC 4925792Freely accessible. PMID 27413693. 
  7. ^ a b Tanaka, Shigeru; Tsuruya, Kazuhiko; Tsuchimoto, Akihiro; Eriguchi, Masahiro; Kitazono, Takanari (2012-10-01). "Successful treatment of massive proteinuria and severe chyluria by inhibition of cholesterol absorption with ezetimibe in a patient with filariasis". Clinical Kidney Journal. 5 (5): 449–452. doi:10.1093/ckj/sfs110. ISSN 2048-8505. PMC 4432420Freely accessible. PMID 26019826.