Chyluria: what does the clinician need to know?

Abstract

Chyluria is secondary to the presence of chyle in the urine. The classical appearance on inspection is of milky white urine, which is caused by a fistulous communication between the lymphatic system and the urinary tract. Worldwide, it is most commonly associated with the parasite Wuchereria bancrofti, which is prevalent in Asia, most extensively in India but also China and Taiwan. However, in the United Kingdom, Europe and North America, where the condition is rare, non-parasitic aetiologies predominate. Chyluria is occasionally associated with other urinary tract symptoms including infection, loin pain and haematuria. It may also cause hypoproteinaemia, weight loss and cachexia. Management is based on identifying the aetiology and depends on the severity of the chyluria and presence of associated symptoms. Given its predominate symptom being urinary, cases in the West can fall under the care of the urologist. The aim of this article is to provide an overview and summary of the aetiology, assessment and management of chyluria based on the most up-to-date evidence available. This was achieved through a non-systematic review of world literature.

Uro-lymphatic fistula associated with urolithiasis: A case report

“…The uro-lymphatic fistula was considered to be associated with obstruction of the urinary system. This is a unique condition, as most uro-lymphatic fistulas are caused by obstruction of lymph vessels; in such cases, lymph fluid flows into the urinary system, leading to chyluria [1] . The patient described here did not have chyluria.…”

“…Uro-lymphatic fistulas are rare disorders involving communication between the renal collecting system and the lymphatic system. In most cases, these fistulas are clinically accompanied by chyluria [1] . The disorder is usually caused by parasitic renal or lymphatic infections, including filariasis, echinococcosis, cysticercosis, ascariasis, malaria, and renal tuberculosis [2] .…”

Persistent chyluria following renal cryoablation: A case report

“…Additional staining with Sudan III can help confirm the diagnosis of chyluria. [5,6] We present a case of chyluria following renal cryoablation. surveillance imaging, which demonstrated >5 mm growth over the course of 1 year and prompted the patient to seek treatment.…”

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

“…Parasitic chyluria is 95% caused by Wuchereria bancrofti which is transmitted by Culex mosquitoes. While non-parasitic chyluria is rare, there are several possible causes: trauma, complication of surgery, infections, malignancy, lymphatic malformation, radiation, abscess, congenital abnormalities, stenosis of the thoracic duct, and others [ 1 ]. Chyluria typically presents with milky white urine (70% of cases), dysuria, urgency, urinary retention due to chylous clots, and sometimes even clot colics.…”

“…It can also be completely asymptomatic. Weight loss, malnutrition, chills, and peripheral edema have been noted amongst systemic manifestations [ 1 - 3 ]. In this study, we report a rare case of non-parasitic nontraumatic chyluria in a 15-year-old girl with an emphasis on imaging techniques.…”