Chyluria


Chyluria

Description, Causes and Risk Factors:

Chyluria is a condition caused by lymphatic fluid (chyle) passing into urine which results in the appearance of "milky" urine. The lymphatic fluid leaks into the urinary tract through a fistulous connection, which is a hole between the two systems. Etiologically it has been classified as parasitic and nonparasitic (rare).

A numbers of parasites besides Wuchereria bancrofti have been incriminated by various workers as a cause of chyluria eg. Eustrongylus gigas, Taenia echinococcus, and malarial parasite. Taenia nana, Ascaris, S. Haematobium, and Ceronomas hominis. It is not clear, however, as to whether these parasites are actually responsible or whether their presence is merely coincidental. By far the most important and the most common cause-effect relationship of chyluria is with Wuchereria bancrofti. The endemic occurrence of chyluria in filaria infested regions and demonstration of parasites in the blood, lymph or urine of chyluric individuals by various workers supports this view.

Nonparasitic conditions are rare causes of chyluria are usually associated with a process of stenosis or obstruction of the thoracic duct or retroperitoneal lymphatics. The common causes are tuberculosis, reteroperitioneal abscess and neoplastic infiltration of retroperitional lymphatics, trauma and pregnancy. A case of chyluria has been reported following an aortoiliac bypass graft and another in a patient following percutaneous nephrolithotomy.

The anatomical basis of chyluria has been explained by many authors but has remained a subject of speculation till recently. The lymphatics of the kidney follow the renal vein and end in the lateral aortic glands. The efferents from the lateral aortic glands form the lumbar trunks. The intestinal trunks comprise the large vessels, which receive lymph from stomach, intestine, pancreas, spleen and from the lower and the anterior part of the liver. The lumbar trunks and the intestinal trunks drain into the cisterna chylii. The dilatation and varicosities of retroperitoneal, intestinal and renal lymphatics has long been recognized. This has been explained by two theories.

The manifestation of chyluria depends upon the site of involvement and the anastomotic variation of lymphatic system in the individual patient. The anastomotic variation primarily occurs at the cisterna chyli where the lumbar trunks and the intestinal trunks join. The classical cisterna chylii as described above is seen in only about 47% of normal individuals, and the intestinal trunk in such cases drains in the lumbar trunks of one side or directly in the thoracic duct either as a single trunk or as multiple smaller ones. This may explain the presence of unilateral chylous oedema of only one extremity or unilateral chyluria. The unilateral findings are more common on the left side.

By far the most important and most common cause effect relationship of chyluria is with Wuchereria bancrofti. The issues in diagnosis making of chyluria include: confirmation of chyluria, localization of site of leakage in urinary tract, identifying the cause of chyluria and assessing as to how bad is the disease? A number of biochemical and radiological diagnostic tests are available for the same. Since this is 'a disease of the poor', there is a need to modify the approach of diagnostic evaluation and therapeutic protocols in order to curtail the overall cost of treatment.

Symptoms:

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 hematochyluria.Usually the condition is self-limiting and can sometimes lead to complications. If left untreated, chronic chyluria can lead to malnutrition and vitamin deficiency.

Chyluria

Diagnosis:

Chyluria investigations are aimed at detection and confirmation of the presence of chyle in the urine and location of the lymphourinary fistulae apart from other routine investigations for the general assessment of the patient. Unless complications are present, renal function in usually unaffected. Microfilaria may or may not be demonstrated in urine and/or blood. Although eosinophilia is an accepted feature, most of investigators have not observed absolute eosinophilia in their patients. Leukocytosis has been reported in acute filarial manifestations.

Chyluria is best studied immediately after it has been voided. A fatty diet a day or night before has been used to enhance chyluria. On gross inspection, classic chylous urine is like milk, frequently containing a semisolid gel. Blood and fibrin clots are frequently observed in most of the samples. When kept in the test tube, it usually settles down into three layers, the fat being lighter gets deposited as the top layer, the fibrin clots from the middle layer and cells together with debris settle in the bottom layer.

Treatment:

Homeopathy can have a definite role to play in the chyluria treatment, due to parasitic origin, trauma, abscesses, tuberculosis, etc. In these cases homeopathy can help to reduce the swelling of the lymphedematous limb as well control its progress. Homeopathy can also help in preventing superadded infection of the lymphedematous limb. Congenital cases in which structural abnormalities of the lymphatics are evident may not be helped much with medical treatment. Chyluria due to tumors may also have to be treated surgically and homeopathy may have only a supportive role to play in such cases. A fair trail with homeopathy is suggested for all cases especially those that have not responded well to conventional treatment.

Supportive management of Chyluria may include:

    Dietary modification: A diet excluding fat, supplemented by medium chain triglycerides (MCT) and high protein content.

Management of swollen lymphedematous limb:

    Bed rest and high amount of fluid intake.

  • Elevation of affected limb.

  • Application of elastic bandage.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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