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Chyluria - Causes, Symptoms, Diagnosis and Treatment

Published on Mar 25, 2022   -  4 min read

Abstract

Chyluria is the presence of chyle (lymphatic fluid consisting of cells, proteins, and free fatty acids) in the urine. To know more, read the following article.

Contents

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.

Frequently Asked Questions


1.

Is Chyluria a Severe Condition?

The chyle is a milky-white fluid consisting of fat and lymph. The excretion of chyle in urine is referred to as chyluria, and it can last for days to months. The protein in the lymphatic fluid is also lost along with chyle leading to low protein levels in the body (hypoproteinemia), weakness, weight loss, and malnutrition. In a few patients, chyluria resolves spontaneously. However, it leads to complications in some due to excessive loss of proteins.

2.

How Is Chyluria Confirmed?

Chyluria is often diagnosed with the urine sample. The urine looks white, cloudy, and sometimes has blood. After the centrifugation process, the urine is allowed to settle, and it gets separated into different layers consisting of fat, protein, and cellular debris. The number of fatty acids in urine is also evaluated to confirm chyluria. Any abnormalities in the urinary tract that cause chyluria are also observed using imaging modalities like computed tomography (CT) scan and endoscopy.

3.

Is It Normal to Get White Urine?

The normal color of the urine is straw-yellow. Any changes like white, brown, or red color are considered abnormal. However, the cloudy urine clears off with a good diet and excess hydration. If it does not resolve within a few days, it can be due to a urinary tract infection or chyluria. The chyle is a milky-white fluid formed in the intestine during digestion. It is carried to the blood via lymph vessels. The abnormal functioning of lymph vessels leads to the leak of chyle into the kidneys. It is then excreted in the urine. Therefore the urine appears white in chyluria.

4.

What Are the Features of Chyluria?

Individuals with chyluria have the following signs and symptoms:

- Milky-white urine.

- Difficulty or pain during urination.

- Urge to urinate.

- Blood in the urine.

- Low levels of protein in the body.

- The other symptoms include weight loss, malnutrition, and weakness.

5.

Why Does My Child Pee White Urine?

The reasons for white urine are as follows:

- When children consume a diet rich in phosphorus like milk and dairy products, the excess phosphorus is excreted in the urine, giving it a white appearance.

- Urinary tract infection is more common in children, and it leads to the cloudy appearance of the urine.

- Chyluria is a condition in which the chyle is released in the urine. It is uncommon in children and can occur due to parasitic or non-parasitic infections.

6.

Is Chyluria Common?

The presence of chyle in urine is referred to as chyluria. It equally affects men and women. It is more common in groups with low socioeconomic status. However, chyluria is rare among children. The condition is caused by urinary tract infections, tumors in the abdomen, and radiation. The other leading cause of chyluria is a parasitic infection caused by Wuchereria bancrofti. The parasite causes filariasis, and chyluria is a late manifestation of this disease.

7.

How to Treat Chyluria?

The chyluria is managed as follows:

- Diet rich in green leafy vegetables, proteins, and vitamins. The chyluria mostly resolves with a good diet.

- Chyluria caused by parasitic infection is treated with Albendazole, Ivermectin, etc.

- Analgesics and anti-inflammatory drugs are also suggested.

- Procedures like sclerotherapy are done to reroute the lymphatic fluid, but it is not suggested due to its side effects.

- Surgical treatments like kidney removal or disconnecting the chylolymphatic bond are proven effective in treating chyluria.

8.

Which Foods Cause Cloudy Urine?

The cloudy urine increases due to fatty meals and other foods as listed down:

- Intake of foods that are rich in purines and phosphorus like milk and dairy products. The high phosphorus is released in the urine leading to a cloudy appearance.

- Meat and poultry are also rich in phosphorus.

- Purine-rich foods like seafood increase the uric acid in the urine, and it looks cloudy.

- Sugary foods also increase the uric acid in urine.

- Alcohol, tea, and coffee are also found to cause cloudy urine.

9.

What Does Turbid Mean in a Urine Test?

A urine test or urinalysis detects any kidney, liver, or urinary tract infections. The urine is tested for appearance and composition. The normal urine is clear and straw-yellow color. It is considered abnormal if the urine is cloudy or turbid. It occurs due to underlying medical conditions like dehydration, urinary tract infection, kidney stones, diabetes, or sexually transmitted disease.

10.

Does Stress Cause Cloudy Urine?

Stress is not directly linked with the production of cloudy urine. However, high stress increases the cortisol production from the adrenal gland—the excess cortisol decrease the body’s immune system to fight against infections. The body then acquires infections due to lowered immunity. The conditions like urinary tract infections are indirectly developed by stress that leads to the cloudy appearance of urine.

11.

Which Urine Color Is Observed in Individuals With a Kidney Infection?

The urine color is assessed during urinalysis to detect various health conditions. The color of the urine and the associated disorders are given below:

- The urine looks red when blood is excreted in urine due to urinary tract infection, kidney cyst, or stones. It also appears red in case of excessive food pigments released in urine.

- The urine looks dark-brown in color due to kidney or liver disorders or sometimes due to any medications.

- Kidney infections or stones make the urine appear cloudy and turbid.

Article Resources

Last reviewed at:
25 Mar 2022  -  4 min read

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