Two cases of spontaneous remission of non-parasitic chyluria

Robot-assisted staged bilateral reno-lymphatic disconnection for massive idiopathic chyluria: A case report

Chyluria, an abnormal lymphatic disorder, results in excessive abdominal lymph drainage into the urinary system, causing protein loss, nutritional deficiencies, and immune issues. Mainly linked to parasitic infections in developed countries, non-parasitic causes like trauma or tumors are rare. Typically appearing in adults with bilateral involvement, management options include conservative or surgical approaches. We present the case of a 13-year-old with congenital chyluria, treated with robot-assisted staged reno-lymphatic disconnection after failed interventional radiology. Bilateral scleroangiography followed, leading to persistently milky urine for a month. Finally, urine clarity improved, correlating with better urinalysis, emphasizing the need for a comprehensive, multi-disciplinary approach.

Renal pedicle lymphatic ligation for non-parasitic chyluria via retroperitoneal laparoscopic surgery: a single-center 12-year experience

Background

Chyluria is a rare disease in which chylous is excreted in the urine. Currently, management of chyluria includes conservative treatments and surgical measures. This study aimed to report our experience in treating non-parasitic chyluria with retroperitoneal laparoscopic ligation of the renal lymphatic vessels.

Methods

Data from 52 patients who underwent retroperitoneoscopic ligation of the renal lymphatic vessels for non-parasitic chyluria between December 2009 and May 2022 were reviewed. After general anesthesia, the patients were passively placed in the healthy lateral decubitus position and underwent three-port retroperitoneal laparoscopy. Detailed medical data, including demographic characteristics, intraoperative outcomes, postoperative data, and complications, were reviewed.

Results

Fifty-two patients received surgery treatment at our institution. The mean disease course was 89.3 months. The mean age was 58.8 years, with females accounting for 57.7% (30/52); the majority of patients (33/52) had the laterality of chyluria on the left and 9 (17.3%) had a history of previous thoracic or abdominal surgery. Compared with the urine and blood data before the operation and on the first day after the operation, urinary protein, urinary tract infection, urinary red blood cells, hemoglobin, albumin, and serum total protein significantly improved 3 months after the operation. However, there were no significant differences in blood creatinine and blood urea nitrogen levels among the three groups. The mean surgery time was about 110.0 minutes, and the estimated total blood loss was 81.2 mL. The postoperative drainage volume was 229.9 mL. The average time to start a liquid diet and to be out of bed were 1.5 and 1.9 days, respectively. Transient postoperative gross hematuria occurred in eight patients, and complications occurred in five patients after surgery. The mean length of hospitalization was 6.6 days. The follow-up duration ranged from 3 to 152 months, and except for three patients who did not respond to treatment, the remaining patients had no recurrence and did not require reoperation.

Conclusions

Our long-term follow-up results showed that renal pedicle lymphatic ligation via retroperitoneal laparoscopic surgery is an effective, safe, and reliable surgical option for patients with non-parasitic chyluria.

The Case of a 15-Year-Old With Non-Parasitic Chyluria

Chyluria is defined by the presence of chyle in urine, and is caused by a communication between the lymphatic and urinary system. Commonly, it is characterised by the excretion of milky white urine, which is present in up to 70% of chyluria cases. The prevalent cause for chyluria in Asia is filariasis with Wuchereria bancrofti. Non-parasitic chyluria is more common in western countries and is usually subsequent to traumatic factors, infections, or tumours. The occurrence of non-parasitic chyluria in the absence of trauma, iatrogenic or other, is exceedingly rare. The lymphatic system is rather challenging to visualize. Herein, we present a case of non-parasitic chyluria and our approach of combining different complementing imaging modalities, such as contrast-enhanced ultrasound (CEUS) retrograde pyelography and magnetic resonance (MR) lymphography.

Idiopathic Chyluria with Nephrotic-range Proteinuria and Hypothyroidism

The patient was a 75-year-old man who was admitted to our hospital because of fatigue, leg edema and heavy proteinuria. Due to his cloudy urine and elevated triglyceride level in his urine, he was diagnosed with chyluria. Tests for infectious disease were negative, and lymphoscintigraphy showed no blockage in the lymphatic system. He was therefore diagnosed with idiopathic chyluria. Hypothyroidism was also found and his cloudy urine and heavy proteinuria disappeared without dietary modifications after starting levothyroxine treatment for hypothyroidism. The patient is currently being followed up in an outpatient clinic and is doing well, with no recurrence of chyluria.

Chyluria in non-filarial endemic areas: an internist's perspective

A 60-year-old Chinese woman presented with intermittent, painless, gross haematuria and subsequently complained of persistent milky urine. The diagnosis of chyluria was confirmed after cystoscopy demonstrated ureteric milky fluid discharge which had elevated levels of triglycerides. The patient did not travel to filarial endemic areas and her serum circulating filarial antigen was negative. Intravenous pyelography with CT of the abdomen did not reveal any masses or obstruction. It was determined that her chyluria was non-parasitic in origin and her symptoms improved with a low fat, high-protein diet. However, her chyluria recurred 1 year later, resulting in hypoalbuminaemia and proteinuria. Her symptoms resolved and her albumin levels normalised with adherence to dietary modifications.