Chyluria Presenting as a Non Glomerular Origin of Nephrotic-Range Proteinuria

Abstract

Background: Chyluria (excretion of chyle from the urinary tract) is a rare condition that can be mistaken for nephrotic syndrome because of its presentation with heavy proteinuria, hypoalbuminemia, and edema. We report a case of chyluria presented with milky urine and nephrotic-range proteinuia.Case presentation: A 36-year-old Bangladesh woman gave a history of episodic cloudy urine for the last 2 years (2014 after 2nd pregnancy). history of 3 month abortion 2015. During her last pregnancy (2014), she was noted to have proteinuria (5g/24 h). Physical examination was normal. Renal function test was normal, absolute esinophilia. Urine analysis revealed milky urine, protein 5g/l, no cast, no dysmorphic RBCS, urine cholesterol 0.52mmol/l (n 0-0.26), urine triglycerides 7.04mmol/l (n 0-0.1). A 24-h urine collection was 6.8g of protein. Anti nuclear antibody, anti DS DNA and ANCA were -ve. Complement C3 and C4 were normal. Hepatitis C antibody and hepatitis B surface antigen were -ve. An abdominal ultrasound showed the kidneys were normal in size, position and echotexture. Differential diagnosis of the nephrotic-range proteinuria was membranous nephropathy or minimal change disease or chyluria. Kidney biopsy findings of intact foot processes and absence of glomerular histologic abnormalities are helpful to exclude intrinsic renal disease and should prompt an appropriate work-up for chyluria. Conclusion:Chyluria should be considered in the differential diagnosis of the patient who presents with cloudy or milky urine.