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.

Keywords:
Chyluria, Lymphangioma, Medium-chain triglycerides, Nephrotic proteinuria
1.
Taylor MG, Hoerauf A, Bockarie M: Lymphatic filariasis and onchocerciasis. Lancet 2010;376:1175–1185.
2.
Gulati S, Gupta N, Singh NP, Batra S, Garg S, Beniwal P, Kumar S: Chyluria with proteinuria or filarial nephropathy? An enigma. Parasit Int 2007;56:251–254.
3.
Chen KC: Lymphatic abnormalities in patients with chyluria. J Urol 1971;106:111–114.
4.
Ohyama C, Saita H, Miyasato N: Spontaneous remission of chyluria. J Urol 1979;121:316–317.
5.
Date A, John TJ, Chandy KG, Rajagopalan MS, Vaska PH, Pandey AP, Shastry JC: Abnormalities in the immune system in patient with chyluria. Br J Urol 1981;53:384–386.
6.
Golestaneh L, Karam S, Lawrence J, Yang S, Greenberg M: Hypercoagulability in a patient with chronic chyluria, proteinuria and hypoalbuminaemia. Nephrol Dial Transplant 2009;24:3240–3243.
7.
Cheng J-T, Mohan S, Nasr SH, D’Agati VD: Chyluria presenting as milky urine and nephrotic-range proteinuria. Kidney Int 2006;70:1518–1522.
8.
Neuwirt H, Eller P, Tiefenthaler M, Mayer G, Rosenkranz AR: A rare case of milky urine. Wien Klin Wochenschr 2010;122:596–600.
9.
Weil GJ, Ramzy RM: Diagnostic tools for filariasis elimination programs. Trends Parasitol 2007;23:78–82.
10.
Sharma S, Hemal AK: Chyluria – an overview. Int J Nephrol Urol 2009;1:14–26.
11.
Yamagami T, Masunami T, Kato T, Tanaka O, Hirota T, Nomoto T, Mikami K, Miki T, Nishimura T: Spontaneous healing of chyle leakage after lymphangiography. Br J Radiol 2005;78:854–857.
12.
Giordano M, Cirillo D, Baron I, Sorrentino F, Tomasino G, Cicchella T, De Bellis L, Giordano C: Treatment of post-traumatic chyluria with sub-cutaneous octreotide administration. Nephrol Dial Transplant 1996;11:365–367.
13.
Saleh AE: Angiotensin-converting-enzyme inhibitors and chyluria. Ann Intern Med 1993;119:1223–1224.
14.
Hashim S, Roholt HB, Babayan VK, van Itallie TB: Treatment of chyluria and chylothorax with medium chain triglyceride. N Engl J Med 1964;270:756–761.
15.
Dhabalia JV, Pujari NR, Kumar V, Punia MS, Gokhale AD, Nelivigi G: Silver nitrate sclerotherapy for chyluria: evaluation of the optimal instillation regimen. Urol Int 2010;85:56–59.
16.
Kulkarni AA, Pathak MS, Sirsat RA: Fatal renal and hepatic failure following silver nitrate instillation for treatment of chyluria. Nephrol Dial Transplant 2005;20:1276–1277.
17.
Su CM, Lee YC, Wu WJ, Ke HL, Chou YH, Huang CH: Acute necrotizing uretritis with obstructive uropathy following instillation of silver nitrate in chyluria: a case report. Kaohsiung J Med Sci 2004;20:512–515.
18.
Lenggenhager C, Warzinek T, Wüthrich RP, Müller J, Schmid HP, Engeler DS: Nonparasitic chyluria treated by laser. Urologe 2007;46:1715–1717.
19.
Zhang X, Zhu QG, Ma X, Zheng T, Li HZ, Zhang J, Fu B, Lang B, Xu K, Pan TJ: Renal pedicle lymphatic disconnection for chyluria via retroperitoneoscopy and open surgery: report of 53 cases with followup. J Urol 2005;174:1828–1831.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.