Chyluria Associated With Nephrotic-Range Proteinuria

Abstract

Chyluria is the presence of chyle in the urine and is associated with some degree of proteinuria. We report two patients with chyluria who presented with milky urine, weight loss, and edema and were found to have nephrotic-range proteinuria. Although filarial antigen was detected in only one of the patients, flexible cystoscopy could demonstrate chyle efflux from the left ureter in first patient and from both the ureters in the second patient. Both patients received endoscopic sclerotherapy with 0.2% povidone-iodine, which resulted in the clearance of milky urine in three to five days and complete resolution of nephrotic-range proteinuria on follow-up. They remained symptom-free until the six-month follow-up. We deferred renal biopsy in both patients, as proteinuria was confirmed to be non-glomerular in origin.

Case of chyluria mimicking nephrotic syndrome

“…Chyluria may be associated with dysuria or haematuria due to rupture of small blood vessels adjacent to fistulous communication and proteinuria that may extend into nephrotic range (due to high-protein concentration of chyle). Some patients may develop severe malnutrition and weight loss due to continuous urinary losses of fat, proteins and fat-soluble vitamins 3. Causes of chyluria can be divided into parasitic and non-parasitic causes; Wuchereria bancrofti accounts for almost 95% of parasitic causes.…”