CHYLURIA is a lymphatic flow disorder which is characterized by abnormal circulation of lymphatic fluid
- It is also known as chylous urine
- The word KYE-UL meaning tiny fat droplets made of lymph
Definition:To define it is a medical disorder involves the presence of chyle in the urine ,which
results in its characteristic milky white appearance
- The chyle is made in bowel or intestines during digestion
In a healthy individual,chyle is taken up by the lymph vessels where it transfers to the blood stream then the lymph and fats are carried where they are required/needed.
When this lymphatic system fails or gets damaged ,the normal carrying up of lymph and fats doesn’t happen instead it gets leaked to surrounding parts such as kidneys or urinary tract.
- Can occur commonly in children but also has its occurrence in adults too
Chyluria is graded into 3 grades
- In mild chyluria ,which comprises of intermittent milky urine with no evidence of symptoms
- In moderate chyluria ,comprises intermittent milky urine with occasional symptoms including clot or coagulum but not any retention/weight loss
- In severe chyluria , intermittent milky urine with urinary retention,hemato chyluria and unintentional weight loss like symptoms are present
- Have associate infectious or non-infectious cause
- Associated mainly with the parasitic infection caused by wuchereria bancrofti
- This Parasite commonly known as ‘tapeworm’ can inhabit in/on humans
- Cancer or tumor in abdomen area
- Swelling or unusual growth in and around lymphatic system
- Surgical difficulty during partial/complete removal of kidney
surgery for any kidney related conditions
- Congenital lymphatic malformations such as lymphangiomatosis & other child birth defects
- Syndromes such as Gorham-stout,Noonan&Turner syndrome
- Lymphatic to vesical fistula
- Can have risk of chyle in urine during pregnancy or childbirth in women
SIGNS & SYMPTOMS
The most possible signs and symptoms include
- Need to urinate more than usual
- Pain and difficulty during urination
- Hematuria/blood in urine
- Back pain usually in lower back region
- Weight loss
- Growth and weight issues
- Fatigue or tiredness
- Characteristic White colored urine
- Decreased proteins/Hypoproteinemia
- Severe malnutrition if chyluria is persistent
- Diagnosis include simple urine/blood test to advance endoscopy,MRI,CT and other radiographic investigation procedures to assess and rule out the condition
- CT scan can be helpful in identifying the fat and dilated vessels in bladder ,lymphatics respectively
- Filarial antigens detection is done by immunochromatography or ELISA
- Lymphangiogram which is an imaging method used to visualize lymphatic structures such as lymph nodes ,ducts capillaries and vessels
- This provides helpful diagnostic features in terms of shape,size,site and no of fistulas
- Laparoscopy,Endoscopy which is a minimally invasive procedure used to diagnose any fistulas or abnormalities
- Lymphangioscintigraphy is used to road map the lymphatic system and its Drainage
Have both conservative and non conservative methods.Mild cases do require non-invasive treatment plan whereas moderate to severe require minimally invasive to invasive procedures
1.To manage symptoms -low fat & high protein diet /with intravenous or parenteral nutrition it is supplied
2.Multivitamins ,green leafy vegetables should be included
3.Severe damage and refractory cases may require surgical approach which unties the chylolymphatic connection or removing entire kidney
4.Sclerotherapy with instillation of 1% silver nitrate or povidone iodine is recommended
(2 ml of 5%+8 ml distilled water)
- To inhibit cholesterol absorption in small intestines –EZETIMIBE
- For symptomatic relief anti inflammatory drugs and analgesics are taken
6.For parasitic infection – DIETHYLCARBAMAZINE,ALBENDAZOLE,BENZATHINE PENICILLIN etc
7.To fix lymph vessels procedures are attempted with the interventional radiologists
8.Endoscopy and laparoscopic procedures helpful as both diagnostic and therapeutic aids
- Depends on the patient’s condition and the level of treatment they are in.But the overall prognosis is good
- Long term medications and treatments can make chyluria curable
- The follow up care should be taken care of without lag or gap
Frequently Asked Questions
1.How serious is chyluria?
Chyluria is often curable and treatable until and unless an underlying kidney condition is present which is non treatable
2.what does protein in urine look like?
Proteins are not visible through eye but a characteristic foamy/bubbly/cloudy appearance is evident
3.what parasite causes chyluria?
Wuchereria bancrofti which known to cause damage to lymphatic vessels can causes chyluria.It is commonly referred as tapeworm
4.what are the first sign of kidney disease
Edema ,nausea,vomiting,tiredness,shortness of breath, frequent urination etc
5.will drinking water reduce protein in urine
No,drinking water does not reduce protein leak into urine until and unless the doctor visits, there is no way to stop .
6.how do i stop leaking protein in urine
Visiting a doctor to know the underlying known or unknown medical conditions related to kidneys and following up according to the doctor’s advice .Sometimes,often rare, but restricted diet,managing weight ,medications can reduce.
7.is protein in urine always serious?
Yes,it’s serious and dangerous because this is a main symptom of any kidney disorder.
8.what food increase protein Leakage
Foods rich in potassium and magnesium can cause increase protein leakage .so limiting the intake can reduce protein Leakage
9.How do you identify chyluria
A urine test is done to measure the level of fat and characteristic white milky fluid is visible
10.Can vitamin cause cloudy urine
Sometimes excessive intake of vitamins will end up with cloudy urine .mostly in case of water soluble vitamins
11.Treatment at home for chyluria
A good rest with restricted diet with low fat and high proteinaceous food with sufficient fluid intake can be done as a conservative part of treatment
12.Is chyluria dangerous?
Usually self limited condition but sometimes can cause life threatening complications .if left untreated can lead to malnutrition and vitamin deficiency
13 .What should I do if I have protein in my urine?
Firstly consult an expert to know the cause through investigations procedures and thorough evaluation and take medication accordingly
14.Is protein Leakage curable ?
Yes,it is curable if the diet ,weight is managed & also with relative medications for the underlying conditions are treated and well maintained