| Chyluria | |
|---|---|
| Other names | Chylous urine |
 | |
| Urine from a patient with filarial chyluria. | |
| Specialty | Infectious disease |
Chyluria, also calledchylous urine, is a medical condition involving the presence ofchyle in theurine 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 ofAfrica and theIndian subcontinent.
Chyluria appearance is irregular and intermittent. It may last several days, weeks or even months. There are several factors that trigger Chyluria recurrence.
Once the lymph channels are blocked, one may open into the kidneyhilum orureter or sometimes into thebladder 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. Symptoms of chyluria can include dysuria (pain when urinating), hematuria (blood in urine), urinary tract infections; and, in more severe cases, weight loss, hypoproteinemia, and immunosuppression.[3] If left untreated, chronic chyluria can lead tomalnutrition and fat-solublevitamin deficiency.[4]
Chyluria is often caused byfilariasis due to the parasiteWuchereria bancrofti, a threadynematode which lodges thelymph channels.[2][5] 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.[6] Because of obstruction, subsequent local inflammation of the area leads to dilation of the lymph vessels and the development of a urinaryfistulae 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] Additionally, lymphatic malformations, blunt or penetrating trauma, surgery complications, non-parasitic infections, malignant tumors, and pregnancy are all possible non-parasitic causes of chyluria, with lymphatic channel malformations being the most common.[7]
In order to diagnose this condition, urinalysis, triglyceride tests, ultrasonography, lymphangiography, and/or endoscopy may be performed to identify the presence of fats in the patient’s urine.[8] Following a low fat and high fluid diet is recommend for managing symptoms.[9]
Medicines that inhibitcholesterol absorption in the small intestine, such asEzetimibe, may be effective treatments in some patients.[9]
An anti-filarial drug, such asdiethylcarbamazine, may be prescribed. Severe damage to lymph channels may requiresurgery.Sclerotherapy with instillation of 1% of silver nitrate or povidone iodine (2ml of 5% + 8ml distilled water).[4]