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

Abstract

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.

Chyluria: what does the clinician need to know?

“…This clinical condition is typically managed by a number of different specialities including nephrology, general medicine, infectious diseases and urology. 1 Whilst still uncommon in the United Kingdom (UK) and the Western world, it is useful to understand the pathophysiological abnormalities that result in chyluria, in order to be able to formulate a practical approach to its diagnosis and management. The objective of our review is to provide such as understanding.…”

A Patient with Milky Urine: Nonparasitic Chyluria and Silver Nitrate Sclerotherapy

“…Sudan III test is also can be used to confirm fat globules in the urine. However, assessment of triglyceride levels in urine is by far the most accurate test to confirm chyluria when it is more than 15 mg/dl (1,3).…”

Idiopathic Chyluria with Nephrotic-range Proteinuria and Hypothyroidism

“…Most patients with chyluria have infectious diseases, such as filariasis and granuloma (2,3). Non-infectious cases are rare and have mainly been described in case reports.…”

“…In cases with heavy proteinuria, the diagnosis of chyluria is confirmed by a urine examination. The presence of urinary triglyceride is 100% sensitive and specific for a diagnosis chyluria (2,13). The gross examination of urine (milky urine) and the absence of fatty cast cells and/or lipid-laden oval bodies differentiate chyluria from nephrotic syndrome (12).…”

“…The most common causes of nonparasitic chyluria are traumatic factors, infectious disease, and tumors. Nonparasitic chyluria without any history of significant trauma (including surgical therapy) is very rare (2). In addition, the natural history and pathophysiology of nonparasitic chyluria are not well known.…”