The Clinical Significance of Proteinuria in Patients With Nonparasitic Chyluria

Lai, Kar Neng; Siu, D.L.S.; Chan, Kin Wai; Lai, Fernand Mac‐Moune; Yan, K W

doi:10.1016/s0272-6386(86)80086-5

Cited by 10 publications

(4 citation statements)

References 11 publications

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“…In chyluric patients with hematuria, which is caused by the rupture of blood vessels into the urinary tract during the formation of lymphaticourinary fistula, the red cells in the urine sediment are typically isomorphic, and no red blood cell casts or white blood cell casts are observed. The presence of dysmorphic red cells in the urinary sediment associated with significant proteinuria, oval fat bodies, granular casts, or cellular casts in a patient with chyluria should raise the suspicion of a coexistent glomerular disease [13]. (Table 1) compares the clinical features of nephrotic proteinuria and chylous proteinuria.…”

Section: Discussionmentioning

confidence: 99%

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

Abdallah

Helal

et al. 2018

ETUN

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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.

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Section: Discussionmentioning

confidence: 99%

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

Abdallah

Helal

et al. 2018

ETUN

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“…Glomerular disease is by far the main cause of high proteinuria levels and lipiduria, but not of chyluria, although the coexistence of both diseases has been described. 5 Cholesterol ester is the major component rather than triglyceride in lipiduria found in the nephrotic syndrome, 6 and these lipids are recognized as either droplets or crystals in urine. Lipid droplets are spherical, translucent, and yellow, and exhibiting different diameters.…”

Section: Discussionmentioning

confidence: 99%

Good response of low-fat/high-protein diet in a patient with chyluria

et al. 2013

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Chyluria is an inappropriate urinary excretion of chyle that turns the urine milky. A nutritional approach based on low-fat/high-protein content diet associated or not with medium-chain triglyceride (MCT) showed to be an efficient conservative treatment to improve the milky urine appearance in a patient with chyluria. Case report: A 30-year-old female patient was admitted with chyluria of unknown etiology. An ureteropyeloscopy revealed a single lesion in each kidney, both with linear aspect and measuring 5 mm in extension. These lesions were located close to the renal papillae and were leaking a cloudy and milky fluid. Both lesions were laser cauterized followed by improvement of the milky urine. However, the chyluria relapsed after few months and a low-fat/high-protein content diet with 10 g of soybean oil to meet the requirements essential fatty acids (EFA) and with MCT from coconut oil as alternative to prepare foods was started. Few weeks later the patient returned reporting consistent improvement of the milky urine appearance related with the use of the diet. However since the diet was tasteless and time consuming to prepare, she reported low compliance to diet with MCT and the milky urine relapsed. The MCT was discontinued and the diet with EFA source was maintained with better compliance. Since then the chyluria remains in remission. In conclusion, the dramatic improvement of the milky urine with low-fat/high-protein diet with EFA source observed in our patient demonstrates that this nutritional approach is efficient with fast results to treat chyluria during long term.

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“…The presence of dysmorphic red cells in the urinary sediment associated with significant proteinuria, oval fat bodies, granular casts, or cellular casts in a patient with chyluria should raise the suspicion of a coexistent glomerular disease. 13 Table 1 compares the clinical features of nephrotic proteinuria and chylous proteinuria.…”

Section: Discussionmentioning

confidence: 99%

Chyluria presenting as milky urine and nephrotic-range proteinuria

Cheng

Mohan

Nasr

et al. 2006

Kidney International

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CASE PRESENTATIONA 41-year-old woman was admitted to Harlem Hospital Center for the evaluation of nephrotic-range proteinuria, microhematuria, hypoalbuminemia, and edema. The patient was born in the Dominican Republic and came to the United States 10 years ago. She gave a history of episodic cloudy urine for the past 28 years. Five years before admission during her last pregnancy, she was noted to have proteinuria (2 g/24 h). Two years before admission, she was treated for filariasis at another hospital, and after 1 year, she was admitted to the same hospital for edema and was found to have chronic active hepatitis C infection with incipient cirrhosis by liver biopsy. For the past 3 months, the patient noted progressive swelling of both lower extremities associated with episodic passage of cloudy urine and flank pain. There was no history of diabetes mellitus, hypertension, renal stones, or gross hematuria. She was on no medications and denied alcohol, illicit drug, and tobacco use.Physical examination revealed a thin and malnourished woman weighing 55.5 kg with a temperature of 371C, pulse 92/min, and blood pressure 104/60 mmHg. There was no skin rash. The heart and lung examinations were normal. The abdomen was soft with the liver palpable 3 cm below the right costal margin. The spleen was not palpable and there was no shifting dullness. There was 3 þ pitting bilateral pedal edema.Laboratory data on the current admission included hematocrit 46% (reference interval, 42-52%), white blood count 6.6 Â 10 9 /l (reference interval, 4.0-10.5 Â 10 9 /l) with normal differential, platelet count 381 Â 10 9 /l (reference interval, 150-500 Â 10 9 /l), blood urea nitrogen 7 mg/dl (2.5 mmol/l) (reference interval, 7-18 mg/dl, 2.5-6.4 mmol/l), serum creatinine 0.7 mg/dl (63 lmol/l), total protein 4.1 g/ dl (41 g/l) (reference interval 6.0-7.8 g/dl, 60-78 g/l), albumin 1.9 g/dl (19 g/l) (reference interval 3.5-5.0 g/ dl,35-50 g/l), bilirubin 0.

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The Clinical Significance of Proteinuria in Patients With Nonparasitic Chyluria

Cited by 10 publications

References 11 publications

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

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

Good response of low-fat/high-protein diet in a patient with chyluria

Chyluria presenting as milky urine and nephrotic-range proteinuria

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