Chyluria with proteinuria or filarial nephropathy? An enigma

Gulati, Shilpa; Gupta, Naresh; Singh, N. P.; Batra, Swaraj; Garg, Sandeep; Beniwal, Pankaj; Kumar, Sachin

doi:10.1016/j.parint.2007.03.002

Cited by 21 publications

(9 citation statements)

References 10 publications

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“…97 Kidney involvement manifests as chyluria (passage of "milky" urine) and hematuria, which occur because of obstruction of the central lymphatic channels by filarial worms leading to dilatation and rupture of lacteals into the collecting system. 98,99 Chylous urine tests positive for protein and may lead to a mistaken diagnosis of nephrotic syndrome.…”

Section: Other Infectionsmentioning

confidence: 99%

CKD and Infectious Diseases in Asia Pacific: Challenges and Opportunities

Jha

Prasad

2016

American Journal of Kidney Diseases

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The exact number of patients with chronic kidney disease (CKD) in Asia Pacific is uncertain. In numeric terms, the region is home to the largest population of patients with untreated chronic kidney failure. The climatic, geographic, social, cultural, economic, and environmental diversity within this region is higher than in any other part of the world. Large parts of the region face a climate-related burden of infectious diseases. Infections contribute to the development and progression of CKD and complicate the course of patients with pre-existing CKD (especially those on dialysis therapy or who are immunosuppressed), increase the cost of CKD care, and contribute to mortality and morbidity. Kidney involvement is a feature of several infectious diseases prevalent in Asia Pacific. Examples include malaria, leptospirosis, scrub typhus, tuberculosis, hepatitis B and C virus, dengue hemorrhagic fever, and Hantaan virus infections. The contribution of infection-associated acute kidney injury to the overall burden of CKD has not been evaluated systematically. Research is needed to quantify the impact of infections on kidney health by undertaking prospective studies. Nephrologists need to work with infectious disease research groups and government infection surveillance and control programs.

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Section: Other Infectionsmentioning

confidence: 99%

CKD and Infectious Diseases in Asia Pacific: Challenges and Opportunities

Jha

Prasad

2016

American Journal of Kidney Diseases

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“…Filariasis classically causes massive limb lymphedema, a condition called ‘elephantiasis’, and scrotal swelling in men, while the occurrence of chyluria is an unusual manifestation of a long-standing disease. Other parasitic forms include cysticercosis, echinococcosis, malaria and ascariasis [2]. …”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Chyluria Associated with Nephrotic-Range Proteinuria: Pathophysiology, Clinical Picture and Therapeutic Options

Graziani¹,

Cucchiari²,

Verdesca³

et al. 2011

Nephron Clin Pract

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Chyluria denotes the urinary excretion of chyle, which is a lymphatic fluid rich in chylomicrons. Chyle flows from the intestinal lacteals to the left subclavian vein through the thoracic duct. When an abnormal connection between these structures and the urinary tract develops, chyluria appears. The syndrome is often associated with a nephrotic-range proteinuria, and this could be a wrong indication to perform renal biopsy. Chyluria is classified as parasitic or nonparasitic, the former being induced by lymphatic filariasis, whereas the latter is caused by medical, traumatic or inherited diseases. The patient usually reports excretion of milky urines, monolateral flank pain, malnutrition, weight loss and weakness. Urinalysis demonstrates lymphocyturia associated with chylomicrons and triglycerides in the supernatant. The diagnostic approach is aimed to define the site of lymphourinary fistula. A selective ureteral catheterization allows to collect urine samples from each kidney, demonstrating a monolateral source of proteins and lipids and making renal biopsy superfluous. Other diagnostic tools include nuclear magnetic resonance urography and lymphoangiography. Many therapeutic options have been proposed. Sclerosing solution instillation into the renal pelvis and laparoscopic renal pedicle disconnection are the invasive procedures most commonly employed. Among the medical alternatives, a low-fat diet supplemented with medium-chain triglycerides is often followed by complete clinical and biochemical remission.

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“…Chyluria has also been associated with fungal infections, malignancy, trauma, pregnancy and congenital abnormalities of lymphatic vessels. [5][6][7] The term urinary tract infection (UTI) comprises of asymptomatic bacteriuria, cystitis, prostatitis and pyelonephritis. It is more common in females than males.…”

Section: Discussionmentioning

confidence: 99%

Milky white urine: a look into the differentials

Manappallil

2016

Int J Adv Med

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Urine analysis is one the simplest means to evaluate renal diseases. Physical and chemical characteristics and microscopic examination provide information regarding the status of kidneys and urinary tracts. The colour, odour, turbidity and specific gravity are the parameters considered under physical examination of urine. This is a case of a 40 year old diabetic lady, who presented with history of dysuria and low grade fever. Her urine was milky white in colour, usually seen in chyluria. On evaluation, she was found to be in sepsis due to urinary tract infection, and her urine analysis was suggestive of pyuria. This form of white urine has rarely been reported with pyuria. This report also looks into the differential diagnosis of white coloured urine.

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Chyluria with proteinuria or filarial nephropathy? An enigma

Cited by 21 publications

References 10 publications

CKD and Infectious Diseases in Asia Pacific: Challenges and Opportunities

CKD and Infectious Diseases in Asia Pacific: Challenges and Opportunities

Chyluria Associated with Nephrotic-Range Proteinuria: Pathophysiology, Clinical Picture and Therapeutic Options

Milky white urine: a look into the differentials

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