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Faraj J, Mander J, Burnett JR, Prentice D. Filiarial chyluria with nephrotic-range proteinuria and associated hypoalbuminaemia and hypogammaglobulinaemia secondary to bilateral lymphorenal fistulae. BMJ Case Rep 2017; 2017:bcr-2017-221114. [PMID: 28978592 DOI: 10.1136/bcr-2017-221114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-year-old man of Indian descent, presented to the emergency department with a 2-year history of passing 'milky' white urine, associated with dysuria, urinary retention, bilateral flank pain and 15 kg weight loss. He had migrated to Australia from India at the age of 16, with no overseas travel since, and denied having any fevers, rigours or chills. He was found to have chyluria and nephrotic-range proteinuria with marked hypoalbuminaemia and hypogammaglobulinaemia. Due to his ethnic origin and by diagnostic exclusion, a presumptive diagnosis of filariasis was made. With bilateral lymphorenal disconnection, as definitive management, the patient's chyluria and proteinuria resolved with restoration of normal plasma protein and immunoglobulin levels.
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Affiliation(s)
- Joseph Faraj
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Julian Mander
- Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John R Burnett
- Department of Clinical Biochemistry, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - David Prentice
- Department of Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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Abstract
Chyluria is the passage of chyle in the urine. The cause seems to be the rupture of retroperitoneal lymphatics into the pyelocaliceal system, giving urine a milky appearance. This communication is caused by the obstruction of lymphatic drainage proximal to intestinal lacteals, resulting in dilatation of distal lymphatics and the eventual rupture of lymphatic vessels into the urinary collecting system.This condition, if left untreated, leads to significant morbidity because of hematochyluria, recurrent renal colic, nutritional problems due to protein losses and immunosuppression resulting from lymphocyturia.In this review, we summarize the state of the art of this condition and the newest treatments available.
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Bally S, Demey A, Arrivé L, Rullier C. Chylurie révélée par un « pseudo-syndrome néphrotique » : démarche diagnostique et thérapeutique. Prog Urol 2016; 26:1153-1156. [DOI: 10.1016/j.purol.2016.09.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/05/2016] [Accepted: 09/28/2016] [Indexed: 11/27/2022]
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Burden of lymphatic filariasis morbidity in an area of low endemicity in Brazil. Acta Trop 2016; 163:54-60. [PMID: 27427218 DOI: 10.1016/j.actatropica.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 01/13/2023]
Abstract
The Global Programme to Eliminate Lymphatic Filariasis has two main components: interrupting transmission of lymphatic filariasis (LF) and managing morbidity and preventing disability. However, interventions to prevent and manage LF-related disabilities in endemic communities have been of limited extent. The aim of this study was to describe the prevalence of morbidity and its correlation with filarial infection, thereby filling a gap that existed regarding the data on morbidity in Brazil. Presence of Wuchereria bancrofti microfilaria was investigated using the thick smear technique. Information on parasitosis-related clinical manifestations was obtained using a questionnaire applied by community health agents with previous training and capacitation to know about and identify the disease. To analyze correlations, Pearson's correlation coefficient was used with the corresponding statistical significance test. 23,673 individuals were investigated: 323 presented microfilaremia (1.36%) and 741 (3.13%) had clinical complaints that were attributable to LF. Acute dermatolymphangioadenitis (ADLA) was the most prevalent condition (2.2%). Lymphedema, ADLA and chyluria were more commonly reported among female patients. There were positive associations between all the clinical complaints reported and filarial infection. Hydrocele presented the most strongly positive association (r=0.699; p<0.001). The present study showed that there is an association between clinical condition reported and the rate of infection among people living in an area of low endemicity for LF. It contributes data that might provide support for healthcare systems and thus optimize disease management, through incorporating surveillance measures directed towards preventing disability and reducing the psychosocial and economic impact of the disease on poor populations living in areas endemic for LF.
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Mahmood K, Ahmad A, Kumar K, Singh M, Pankaj S, Singh K. Chyluria in pregnancy-a decade of experience in a single tertiary care hospital. Nephrourol Mon 2015; 7:e26309. [PMID: 25883913 PMCID: PMC4393552 DOI: 10.5812/numonthly.26309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/04/2015] [Accepted: 01/22/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Chyluria i.e. passage of chyle in urine, giving it milky appearance, is common in many parts of India but rare in west. Very few case of chyluria in pregnant female has been reported in literature. Persistence of this condition may have deleterious effects on health of child and mother. In the present study 43 cases of chyluria during pregnancy and their management seen over a period more than 10 years have been presented. Objectives: The study aims to present our experience of managing 43 cases with chyluria during pregnancy over a period of ten years from July 2003 to June 2014. Patients and Methods: Forty three pregnant patients with chyluria, who presented between July 2003 to June 2014 to the department of Urology, Indira Gandhi Institute of Medical Sciences, Patna were included. Patients underwent conservative management and/or sclerotherapy after evaluation. Follow-up of all patients was done by observation of urine color, routine examination of urine and test for post prandial chyle in urine up to 3 months after delivery. Results: Conservative management by dietary restriction of fat and physical rest was successful in six patients. Thirteen patients improved after first course of sclerotherapy with 10% povidone iodine and 25% dextrose and 19 patients improve after second session. In non-responders, three patients who were near term underwent caesarian section while two patients opted for medical termination of pregnancy at their own will. After sclerotherapy, minor complications like clot retention, fever, hematuria, and abdominal pain were observed in small number of patients and managed symptomatically. Conclusions: Sclerotherapy for symptomatic relief of chyluria during pregnancy showed high response rate (86.2%) in short term follow-up. Sclerotherapy with 10% povidone iodine and 25% dextrose combination have been proved safe and effective during pregnancy. Medical termination of pregnancy and cesarean section (those near term) may be the options in resistant cases not responding to sclerotherapy.
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Affiliation(s)
- Khalid Mahmood
- Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ahsan Ahmad
- Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
- Corresponding author: Ahsan Ahmad, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Tel: +91-9431457764, E-mail:
| | - Kaushal Kumar
- Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Mahendra Singh
- Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sangeeta Pankaj
- Department of Gynaecology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Kalpana Singh
- Department of Gynaecology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Sunder S, Jayaraman R, Mahapatra HS, Sathi S, Venkataramanan K, Prabhu K, Gupta A, Sethi S. Analysis of case series of milky urine: A single center and departmental clinical experience with emphasis on management perspectives: A prospective observational study. Urol Ann 2014; 6:340-5. [PMID: 25371613 PMCID: PMC4216542 DOI: 10.4103/0974-7796.141002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 09/25/2013] [Indexed: 11/15/2022] Open
Abstract
Background: Milky urine can be due to chyluria or lipiduria due to nephrotic syndrome. Filarial chyluria usually responds to medical management while non-filarial cases may require surgical intervention. Aim: To perform a prospective observational study in patients presenting with milky urine in our centre over a period of one year from July 2011 to June 2012, a complete biochemical work up and imaging to find out the site of leakage of lymph if it is a case of chyluria, its response to medical management and the requirement of surgical intervention. Materials and Methods: Routine blood and urine investigations, 24 hour urine protein excretion, USG abdomen, serum lipid profile and rapid filarial antigen test were done in all. MRI abdomen was done in affordable patients. Renal biopsy was done in some chyluria patients for academic purpose and in milky urine with negative urine ether test. Sclerotherapy was done with 50% dextrose and 0.2% povidone iodine. Patients were followed up with 24 hour urine protein and triglyceride estimation. Results: 18 cases of milky urine were encountered. 8 were filarial chyluria, 9 non- filarial and 1 MCD. Mean urine TG level and median 24 hour urinary protein excretion were 37.2 ± 24.6 mg% and 4.96 g respectively. The mean age for filariasis (22.9 ± 4.5 years) was significantly different from that of non-filarial etiology (31.5 ± 4.8 years) (P = 0.005). The mean 24 hour urinary protein for normal MRI cases (4.64 ± 0.70 g) was significantly different from those with dilated lymphatics (8.15 ± 2.55 g) (P = 0.02). All the non- filarial and 4 filarial cases required sclerotherapy. One patient required a second sitting. Conclusion: Milky urine is most commonly due to chyluria and occasionally due to nephrotic syndrome. Nephrotic syndrome is managed in its own way while chyluria not amenable to pharmacological intervention is managed with sclerotherapy.
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Affiliation(s)
- Sham Sunder
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajesh Jayaraman
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Himanshu Sekhar Mahapatra
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Satyanand Sathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - K Venkataramanan
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - K Prabhu
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anurag Gupta
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Suman Sethi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Suh M, Cheon GJ, Seo HJ, Kim HH, Lee DS. Usefulness of Additional SPECT/CT Identifying Lymphatico-renal Shunt in a Patient with Chyluria. Nucl Med Mol Imaging 2014; 49:61-4. [PMID: 25767624 DOI: 10.1007/s13139-014-0300-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022] Open
Abstract
Lymphoscintigraphy is known to be a useful and non-invasive modality for the evaluation of lymphatic abnormality. However, lymphoscintigraphy has limitations in evaluating chyluria because of its lack of anatomical information. Additional single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was considered to be potentially helpful in detecting the abnormal lymphatico-renal communication. A 20-year-old male patient was referred to our hospital for evaluation of recurrent chyluria. During the third recurrence of chyluria, additional SPECT/CT along with lymphoscintigraphy was performed for evaluation. From the combined SPECT/CT images, lymphatic drainage of radiotracers to the kidney was well visualized, helping diagnosis of a patient with chyluria.
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Affiliation(s)
- Minseok Suh
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 South Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 South Korea
| | - Hyo Jung Seo
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 South Korea ; Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University College of Mewdicine, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 South Korea ; Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University College of Mewdicine, Seoul, South Korea
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Shrestha A, Shrestha PM, Verma R. Is single dose povidone iodine sclerotherapy effective in chyluria? Int Urol Nephrol 2014; 46:1059-62. [PMID: 24420839 DOI: 10.1007/s11255-013-0622-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/01/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of single dose 0.2 % povidone iodine renal pelvic instillation sclerotherapy for the treatment for chyluria. METHODS In a prospective study from August 2010 till July 2013, 41 patients presenting with milky urine were included. Apart from ether test, the presence of lymphocytes in urine and urine triglycerides levels were also done to confirm chyluria. On a day care basis under local anesthesia, 5F open-ended ureteric catheter was introduced in the ureteric orifice of affected side. Freshly prepared 7-10 ml of 0.2 % povidone iodine solution was instilled with the patient in Trendelenburg position. RESULTS Total of 41 patients were enrolled (27 males and 14 females; mean age 40 years, SD 8.9, range 19-61) with a mean follow-up of 20 months. Immediate clearance was seen in all patients and recurrence in 7 (17 %). Mean disease-free duration was 18 months. Two patients had moderate to severe flank pain. CONCLUSION Single dose 0.2 % povidone iodine sclerotherapy is safe and effective treatment for chyluria. As it offers treatment on a day care basis, continuous ureteral and urethral catheterizations can be avoided.
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Affiliation(s)
- Anil Shrestha
- Urology Unit, Department of Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal,
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Triffoni-Melo AT, Diez-Garcia RW, Barros Silva GE, Garcia Caldas FDF, Wichert-Ana L, Corte Denardi R, Kato M, Júnior Lucca L, Dantas M. Good response of low-fat/high-protein diet in a patient with chyluria. Ren Fail 2013; 36:453-6. [DOI: 10.3109/0886022x.2013.865485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Protéinurie de débit néphrotique et urines laiteuses : chylurie ou glomérulopathie ? Cas clinique et analyse de la littérature. Nephrol Ther 2009; 5:642-7. [DOI: 10.1016/j.nephro.2009.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 06/08/2009] [Accepted: 06/08/2009] [Indexed: 11/23/2022]
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Cluskey SA, Myatt A, Ferro MA. The treatment of chyluria secondary to advanced carcinoma of the prostate. Prostate Cancer Prostatic Dis 2007; 11:102-5. [PMID: 17667966 DOI: 10.1038/sj.pcan.4500994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chyluria has not been previously reported as being associated with carcinoma of the prostate. The most common cause is lymphatic filariasis, a parasitic disease. Non-parasitic chyluria is rare. We describe a case of chyluria associated with carcinoma of the prostate. We describe our successful management in this case and highlight how urologists may overcome problematic chyluria in patients with advanced carcinoma of the prostate.
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Affiliation(s)
- S A Cluskey
- Department of Urology, Huddersfield Royal Infirmary, Huddersfield, UK.
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Cheng JT, Mohan S, Nasr SH, D'Agati VD. Chyluria presenting as milky urine and nephrotic-range proteinuria. Kidney Int 2006; 70:1518-22. [PMID: 16871246 DOI: 10.1038/sj.ki.5001703] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J-T Cheng
- Department of Medicine, Harlem Hospital Center, New York, New York, USA
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Palacio AM, Lichstein DM, Vaamonde CA, Tamariz L. Parasitic chyluria. South Med J 2003; 96:110-1. [PMID: 12602744 DOI: 10.1097/01.smj.0000049855.82132.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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