What Is Chyluria?
Chyle mainly consists of lymph and fat droplets. The lymph vessels carry chyle to the bloodstream, and from there, lymph and fat are transported to different areas of the body by the blood. If there is any interference in the normal functioning of lymph vessels, the chyle will not reach the blood and may leak to other places. One such condition is chyluria.
Chyluria is a medical condition characterized by the presence of chyle in the urine. Due to the presence of chyle in urine, the urine has a milky white appearance. In this condition, lymphatic fluid leaks into the kidneys, which causes chyle to appear in the urine. It is most commonly associated with the parasite, Wuchereria bancrofti. The chyluria may last several days to months, and appearance is often irregular. However, there are some non-parasitic etiologies for the disease, too. It is usually associated with urinary tract infection, blood in urine, and loin pain. The treatment is generally given depending on the cause.
What Are the Causes of Chyluria?
Both parasitic and non-parasitic causes can cause Chyluria. The most common parasite associated with the condition is Wuchereria bancrofti. Taenia echinococcus, Taenia nana, Ankylostomiasis, etc., are the other parasites that can cause chyluria. Diseases like tuberculosis (an infectious disease affecting the lungs), fungal infection, and leprosy (chronic infectious skin disease) may also lead to chyluria. Chyluria also can appear as a late manifestation of lymphatic filariasis (infection caused by parasites).
The non-parasitic causes include;
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Trauma.
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Surgeries like partial nephrectomy (removal of kidney).
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Tumor in the abdomen region.
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Infections.
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Kidney transplant.
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Radiation.
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Defects at time of birth.
What Are the Signs and Symptoms of Chyluria?
The patient can remain asymptomatic in some cases, whereas the patient may be symptomatic in others.
The main signs and symptoms of chyluria include:
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Urine appears milky white.
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Blood in urine is observed when blood vessels rupture in the urinary tract.
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Pain while urinating.
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Pain in the loin region.
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Weight loss.
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Hypoproteinaemia (a decrease in protein levels in the body) occurs due to the excessive secretion of proteins in urine. The lymphatic fluid contains proteins like albumin. When lymphatic fluid leaks into the urinary tract, proteins are excreted in the urine, leading to a decrease in protein levels in the body. In the case of chyluria, the excretion of protein in urine increases with a fatty meal.
According to studies, 50 percent of patients will experience spontaneous remission of chyluria. If there is a long interval of remission without any complications, patients may not require treatment.
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Weakness.
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Malnutrition (lack of vitamins and minerals) leads to weakness and lethargy. However, if chyluria is persistent, it can lead to malnutrition due to excessive body loss of proteins and fats.
How to Diagnose Chyluria?
Chyluria diagnosis includes assessment of symptoms, laboratory examination of urine, endoscopy, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), and X-ray.
1. Laboratory Investigations—Generally, in chyluria, the urine appears milky and may have blood and fibrin clots. Urine after eating is generally recommended for laboratory investigations. When the urine is centrifuged, it remains turbid, and when it is allowed to settle, it separates into layers of fat, fibrin (protein), and cellular debris. Determining the number of chylomicrons (fatty acids) is the most specific and sensitive test for chyluria. Higher levels of fatty acids lead to the haziness of urine.
2. Radiological Investigations – Any abnormalities in the urinary tract can be identified by ultrasonography. A CT scan can identify fat in the bladder and possible dilated lymphatics. A fistula (an abnormal passage) in the ureter or bladder can be observed using magnetic resonance imaging. Lymphangiography (special X-ray of lymph vessels) also provides information about the site, size, and number of fistulous communications. It is generally not recommended as this is a time-consuming and challenging procedure.
3. Endoscopy – This serves as both a diagnostic and therapeutic process. During endoscopy, any fistula in the urinary tract can be identified.
How to Treat Chyluria?
The treatment for chyluria includes conservative methods like changes in diet, pharmacological methods, minimally invasive procedures, and surgical management.
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Conservative Management: Conservative management includes high fluid intake and a diet that involves high protein, multivitamins, and green leafy vegetables. Generally, a diet with less or no fat content is preferred. According to studies, 50 percent of the cases can be resolved with certain diet modifications. However, if the symptoms worsen, other treatment measures should be taken.
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Medical Management: Medical management involves the use of analgesics and anti-inflammatories. It provides only symptomatic relief. If the patient suffers from a parasitic infection, dietary modifications, such as Albendazole, Diethylcarbamazine, and Benzathine Penicillin, are recommended.
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Sclerotherapy: Minimally invasive techniques are used when the patient does not respond to conservative and medical management. Minimally invasive procedures include sclerotherapy. In sclerotherapy, a solution is injected into the vessels. It irritates the blood vessel lining, leading to clot formation in the blood vessel. This procedure can be used to close the fistulous tracts. Generally, two or three sessions of sclerotherapy are advised.
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Surgical Management: Surgical management is recommended when all the above treatments fail. The surgical methods have a success rate of 95 percent. The surgical methods include disconnecting the chylolymphatic connection, auto-transplantation or removing the kidney.
What Should an Individual Eat Suffering From Chyluria?
The dietary recommendations for people suffering from chyluria are as follows:
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Low-fat foods.
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Lean proteins.
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Fruits and vegetables.
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Whole grains.
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Stay hydrated.
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Limit high-fat foods.
What Are the Preventive Measures for Chyluria?
The preventive measures for chyluria are as follows:
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Practice hygiene practices by regular handwashing.
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Avoid exposure to mosquitoes.
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Wear protective clothing.
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Use insect repellent.
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Treatment of parasitic infection.
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Seek healthcare advice.
Conclusion:
There can be a recurrence of chyluria in most cases. After the conservative management, the chances of reoccurrence are quite high. Regular check-ups are necessary. Patients should be reported immediately to the doctor if they observe any symptoms. The proper diagnosis of the cause of chyluria is very crucial for the effective treatment of chyluria. By following proper diet modifications and invasive methods, chyluria is well cured, even in severe cases.