Chyluria or Chylous Urine: Causes, Symptoms, Diagnosis, Treatment- Sclerotherapy, Surgery
Discharge of milky white urine is known as Chyluria or Chylous Urine. Chyluria or Chylous Urine is caused by parasite infection and other causes not associated with parasite infection. In this article, we will discuss cases, symptoms and treatment of Chyluria.
What Is Chyluria or Chylous Urine?
- Most common cause of Chyluria or Chylous Urine is infection caused by filarial resulting in disease known as filariasis.
- Mosquitos transmit filariasis.
- Disease is observed in Africa and Indian subcontinent.
- The appearance of Chyluria or Chylous Urine is usually irregular and intermittent.
- Chyluria or Chylous Urine is a self-limiting condition and may last for several weeks and sometimes even months.
- Chyluria or Chylous Urine is more common in male (86%) than female (14%).
- Disease if continue causes lymphatic obstruction in leg results in elephantiasis leg.1
Causes of Chyluria or Chylous Urine
A. Chyluria or Chylous Urine Due to Parasite Infection-
- Infection is known as Filariasis.1
- Parasite causing infection is known as Wuchereria Bancrofti.
- The parasite lies and lodges in lymph node
- Over 120 million people worldwide suffer with a lymphatic filariasis.
B. Chyluria or Chylous Urine During Pregnancy or Childbirth
- Chyluria is occasionally seen during pregnancy
- Self-limiting disease in pregnancy.
- Symptoms disappear after delivery.
C. Chyluria or Chylous Urine Due to Manual Strenuous Overwork
- Chyluria occurs after overwork.
D. Chyluria or Chylous Urine Due to Emotional Stress
- Causes of Chyluria in few patients is not known
- Emotional stress causing Chyluria are as follows-
- Mental tension
Symptoms of Chyluria or Chylous Urine
a. Milky White Urine (Chyluria)
- White lymph leaks into urine causing discharge of white urine.
- Lymph leaks from lymphatic vessels following blockade of channels.
- Obstruction of lymphatic vessels causes enlargement of lymphatic vessels known as lymphatic varieces.
- Milky urine contains protein, lipids, cholesterol and triglycerides
b. Grades of Chyluria-
- Mild Chyluria- 1/3rd of patients suffer with mild and intermittent Chyluria.
- Moderate Chyluria- Over 1/3rd of patients complaints of moderate discharge of milky urine.
- Severe Chyluria- Less than 1/3rd of patients discharge severe amount of Chyluria.
- Blood sometimes mixes with the urine resulting in haemato-chyluria.
- Nutritional deficiency
- Weight loss
e. Vitamin Deficiency
f. Urinary Complaints
- Urine quantity is often low
- Frequent urination
Diagnosis of Chyluria or Chylous Urine
Examination of Chyluria or Chylous Urine
- Milky appearance of the urine contains gel, blood and fibrin clots.
- Examination of urine after sometime indicates separation of layers. Top layer consist of fat, middle layer contains fibrin and bottom layer contains cells and debris.
Lab Tests to Diagnose Chyluria or Chylous Urine
- Ether Test
- Chyluria when mixed with ether the opacity disappears.
- Methylene Blue Test
- Test shows presence of lymphocytes.
- Sudan III Test
- Sudan III indicator is ingested with fatty food. Urine sample is collected after 2 to 6 hours. Urine color is orange-pink.
Immunoelectrophoresis for Chyluria or Chylous Urine
- Immunoelectrophoresis shows intestinal origin immunoprotein known as an ilioprotein.
Cystourethroscopy for Chyluria or Chylous Urine
- Cystoscopy and urethroscopy is performed to evaluate the source of chyles in urine. Urine samples from ureter and bladder are tested for chyles.
Radiological Studies for Chyluria or Chylous Urine
- Intravenous pyelography
- CT scans of kidney, ureter, bladder and urethra.
- MRI Scan- Kidney, Ureter and bladder
- Renal Biopsy
Treatment for Chyluria or Chylous Urine
Conservative Treatment For Chyluria or Chylous Urine2-
- Dietary modification-
- Use of very little oil in diet
- Use of coconut oil
- Use of skimmed milk
- Fried food products
- Dry fruits
- Sweet and carbohydrate-
- Reduce intake of sweet and carbohydrate.
- High protein diet
- 70% of the acute cases treated with conservative treatment become asymptomatic (symptom free) in 3 to 6 months
Medication Treatment for Chyluria or Chylous Urine
- Anti-filarial drug- Diethylcarbamazine can be used for Chyluria.3
- Antianxiety medications
Sclerotherapy for Chyluria or Chylous Urine
- Silver nitrate with iodide is applied over bladder surface, which is leaking lymph.
- The treatment causes inflammation of lymph vessels that follows scarring and closing of lymph channels.
- Treatment is tried when all conservative treatment and medications failed to stop Chyluria.
Surgery for Chyluria or Chylous Urine4
- In case there is significant damage to the lymph channels then surgery may be required.
- Indication for Surgery-
- Significant Weight Loss
- Severe Hypoproteinemia
- Failed Conservative Treatment
- Failed Sclerotherapy
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1. Chyluria due to lymphatic filariasis: case report and review.
Lim JT1, Fraser SL.
Hawaii Med J. 2004 Jul;63(7):206-7.
2. Factors affecting response to medical management in patients of filarial chyluria: A prospective study.
Goyal NK1, Goel A1, Sankhwar S1, Singh V1, Ali W2, Natu SM2, Singh BP1, Sinha RJ1, Dalela D1.
Indian J Urol. 2014 Jan;30(1):23-7
3. Response of chyluria and circulating microfilaria to treatment with diethylcarbamazine citrate--a case report.
Raina VK1, Kumar A.
J Commun Dis. 1993 Mar;25(1):45-6.
4. Surgical management of intractable chyluria: a comparison of retroperitoneoscopy with open surgery.
Zhang Y1, Zeng J, Zhang K, Jin F, Ye J, Wu G, Wang G, Nie Z.
Urol Int. 2012;89(2):222-6.