Chyluria - Causes, Symptoms, Diagnosis and Treatment

What Is Chyluria?

Chyle mainly consists of lymph and fat droplets. The lymph vessels mainly carry chyle to the bloodstream, from there, lymph and fats are transported to different areas of the body by the blood. If there is any interference in this normal functioning of lymph vessels, chyle will not reach the blood. It may leak to other places. One such condition is chyluria.

Chyluria is a medical condition characterized by the presence of chyle in the urine. Due to the presence of chyle in urine, the urine has a milky white appearance. In this condition, lymphatic fluid leaks into the kidneys, due to which chyle appears in the urine. It is most commonly associated with the parasite, Wuchereria bancrofti.

The chyluria may last for several days to months, and appearance is often irregular. However, there are some non-parasitic etiologies too for the disease. It is usually associated with urinary tract infection, blood in urine, and loin pain. The treatment is generally given depending upon the cause.

What Are the Causes of Chyluria?

Chyluria can be due to both parasitic and non-parasitic causes. Most of the parasitic causes are associated with Wuchereria bancrofti. Taenia echinococcus, Taenia nana, Ankylostomiasis, etc., are the other parasites that can cause chyluria.

The non-parasitic causes include;

1. Trauma.

2. Surgeries like partial nephrectomy (removal of kidney).

3. Tumor in the abdomen region.

4. Infections.

5. Kidney transplant.

6. Radiation.

7. Defects at time of birth.

8. Abscess.

9. Pregnancy.

The diseases like tuberculosis, fungal infection, and leprosy may also lead to chyluria. Chyluria also can appear as a late manifestation of lymphatic filariasis.

What Are the Signs and Symptoms of Chyluria?

The patient can remain totally asymptomatic in some cases, whereas the patient may be symptomatic in other cases.

The main signs and symptoms of chyluria include:

1. Urine appears milky white.

2. Presence of blood in the urine.

3. Pain while urinating.

4. Pain in the loin region.

5. Weight loss.

6. Hypoproteinemia.

7. Weakness.

8. Malnutrition.

The blood in urine is observed when there is a rupture of blood vessels into the urinary tract. Hypoproteinaemia (a decrease in protein levels in the body) occurs due to the excessive secretion of proteins in urine.

The lymphatic fluid contains proteins like albumin, when there is a leakage of lymphatic fluid to the urinary tract, proteins will be excreted in the urine leading to a decrease in protein levels in the body. The excretion of protein in urine increases with a fatty meal in the case of chyluria.

According to studies, there will be spontaneous remission of chyluria in 50 % of patients. If there is a long interval of remission without any complications, in that case-patients may not require any treatment. But if chyluria is persistent, it can lead to malnutrition due to excessive loss of proteins and fats from the body.

How to Diagnose Chyluria??

Chyluria diagnosis includes assessment of symptoms, laboratory examination of urine, endoscopy, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), and X-ray.

1. Laboratory Investigations – Generally, in chyluria, the urine appears milky and may have blood and fibrin clots. Urine after taking food is generally recommended for laboratory investigations. When the urine is centrifuged, it remains turbid, and when it is allowed to settle, it separates into layers of fat, fibrin (protein), and cellular debris. Determining the number of chylomicrons (fatty acids) is the most specific and sensitive test for chyluria. Higher levels of fatty acids lead to the haziness of urine.

2. Radiological Investigations – Any abnormalities to the urinary tract can be identified by ultrasonography. CT scan can identify fat in the bladder and possible dilated lymphatics. A fistula (abnormal passage) in the ureter or bladder can be observed using magnetic resonance imaging. Lymphangiography (special X-ray of lymph vessels) is also helpful in providing information about the site, size, and the number of fistulous communications. It is generally not recommended as this is a time-consuming and challenging procedure.

3. Endoscopy – This serves as both a diagnostic and therapeutic process. During endoscopy, any fistula in the urinary tract can be identified.

How to Treat Chyluria?

The treatment for chyluria includes conservative methods like change in diet, pharmacological methods, minimally invasive procedures, and surgical management.

The conservative management includes high fluid intake, a diet that involves high protein, multivitamins, and green leafy vegetables. Generally, a diet with less or no fat content is preferred. According to studies, 50% of the cases can be resolved with certain diet modifications. However, if the symptoms worsen, other treatment measures should be opted.

Medical management involves the use of analgesics and anti-inflammatories. It provides only symptomatic relief. If the patient is suffering from a parasitic infection, dietary modifications, along with Albendazole, Diethylcarbamazine, and Benzathine Penicillin are recommended.

Minimally invasive techniques are used when the patient does not respond to conservative management and medical management. Minimally invasive procedures include sclerotherapy. In sclerotherapy, a solution is injected into the vessels. It irritates the blood vessel lining, leading to clot formation in the blood vessel. This procedure can be used to close the fistulous tracts. Generally, two or three sessions of sclerotherapy are advised.

Surgical management is recommended when all the above treatments fail. The surgical methods have a success rate of 95 %. The surgical methods include disconnecting the chylolymphatic connection or auto-transplantation or removing the kidney.

Conclusion:

There can be a recurrence of chyluria in most cases. After the conservative management, the chances of reoccurrence are quite high. Regular check-ups are necessary. If the patients observe any symptoms, they should be reported immediately to the doctor. The proper diagnosis of the cause of chyluria is very crucial for the effective treatment of chyluria. By following proper diet modifications and invasive methods, chyluria is well cured, even in severe cases.