# Chyluria
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> Source: https://en.wikipedia.org/wiki/Chyluria
> Source revision: 1267217005
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{{Infobox medical condition (new)
| name = Chyluria
| synonyms = Chylous urine
| image = Chyluria urine.jpg
| caption = Urine from a patient with filarial chyluria.
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| field = [Infectious disease](/source/Infectious_disease_(medical_speciality))
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'''Chyluria''', also called '''chylous urine''', is a medical condition involving the presence of [chyle](/source/chyle) in the [urine](/source/urine) stream,[{{Cite web |url=http://www.pon.nic.in/fil-free/chronic.html#chyluria |title=Chronic filariasis |access-date=2007-04-13 |archive-url=https://web.archive.org/web/20120207023747/http://www.pon.nic.in/fil-free/chronic.html#chyluria |archive-date=2012-02-07 |url-status=dead }}] which results in urine appearing milky white.[{{cite journal |vauthors=Saha M, Ray S, Goswami M, Kundu S, Saha P, Saha A, Maitra S, Talukdar A |title=An occult filarial infection presenting as chyluria with proteinuria: a case report and review of literature. |journal=BMJ Case Reports |volume= 2012|year=2012 |page= bcr0120125635|pmc=4542962 |pmid=22669920 |doi=10.1136/bcr.01.2012.5635}}] The condition is usually classified as being either parasitic or non parasitic. It is a condition that is more prevalent among people of [Africa](/source/African_continent) and the [Indian subcontinent](/source/Indian_subcontinent).
Chyluria appearance is irregular and intermittent. It may last several days, weeks or even months. There are several factors that trigger Chyluria recurrence.
==Signs and symptoms==
thumb|Chyluria flow during cystoscopy and ureteral catheterization.
Once the lymph channels are blocked, one may open into the kidney [hilum](/source/hilum_of_kidney) or [ureter](/source/ureter) or sometimes into the [bladder](/source/Urinary_bladder) and chyle can leak into the urinary tract resulting in milky white urine. Blood sometimes mixes with the urine resulting in haemato-chyluria.
Usually the condition is self-limiting and can sometimes lead to complications. Symptoms of chyluria can include dysuria (pain when urinating), hematuria (blood in urine), urinary tract infections; and, in more severe cases, weight loss, hypoproteinemia, and immunosuppression.[pubmed.ncbi.nlm.nih.gov/28362041] If left untreated, chronic chyluria can lead to [malnutrition](/source/malnutrition) and fat-soluble [vitamin deficiency](/source/vitamin_deficiency).[{{Cite journal|last1=Guttilla|first1=Andrea|last2=Beltrami|first2=Paolo|last3=Bettin|first3=Laura|last4=Galantini|first4=Andrea|last5=Moro|first5=Fabrizio Dal|last6=Ficarra|first6=Vincenzo|last7=Zattoni|first7=Filiberto|date=2016-09-01|title=Non-Parasitic Chyluria: Our Experience With Sclerotherapy With Solution of Povidone-Iodine and Destrose and A Review of the Literature|journal=Urology Case Reports|language=en|volume=8|pages=28–30|doi=10.1016/j.eucr.2016.05.010|issn=2214-4420|pmc=4925792|pmid=27413693}}]
==Causes==
Chyluria is often caused by [filariasis](/source/filariasis) due to the parasite ''[Wuchereria bancrofti](/source/Wuchereria_bancrofti)'', a thready [nematode](/source/nematode) which lodges the [lymph](/source/lymph) channels.[{{cite journal|last=Dunavan|first=Claire Panosian |author-link1=Claire Panosian |date=2008-05-22|title=The white urine that held the key|url=http://discovermagazine.com/2008/jun/22-the-white-urine-that-held-the-key/|journal=Discover Magazine}}] The parasitic infection can lead to obstruction of peripheral lymphatic vessels and increased pressure within the vessels causing collateral flow of the lymph, redirecting the lymph flow from the intestinal lymphatic vessels into the lymphatic vessels of the kidney and ureter.[{{Cite journal|last1=Paul|first1=Sagorika|last2=Kumar|first2=Manoj|last3=Singh|first3=Viswajeet|last4=Sankhwar|first4=Satyanarayan|date=2014-01-06|title=Chyluria: is retrograde pyelogram mandatory prior to endoscopic sclerotherapy?|url= |journal=BMJ Case Reports|language=en|volume=2014|pages=bcr2013200550|doi=10.1136/bcr-2013-200550|issn=1757-790X|pmc=3902324|pmid=24395870}}] Because of obstruction, subsequent local inflammation of the area leads to dilation of the lymph vessels and the development of a urinary [fistula](/source/fistula)e due to rupture of the lymphatic vessel, which allows for the passage of white blood cells, fat, and fat-soluble vitamins into the urine.[{{cite journal | pmc=10322811 | date=2023 | last1=Sabbah | first1=A. | last2=Koumako | first2=C. | last3=El Mouhadi | first3=S. | last4=Ali | first4=A. | last5=Minssen | first5=L. | last6=Vanderbecq | first6=Q. | last7=Arrivé | first7=L. | title=Chyluria: Non-enhanced MR lymphography | journal=Insights into Imaging | volume=14 | issue=1 | page=119 | doi=10.1186/s13244-023-01461-2 | doi-access=free | pmid=37405513 }}]
==Treatment==
In order to diagnose this condition, urinalysis, triglyceride tests, ultrasonography, lymphangiography, and/or endoscopy may be performed to identify the presence of fats in the patient’s urine. [pmc.ncbi.nlm.nih.gov/articles/PMC7366404] Following a low fat and high fluid diet is recommend for managing symptoms.[{{Cite journal|last1=Tanaka|first1=Shigeru|last2=Tsuruya|first2=Kazuhiko|last3=Tsuchimoto|first3=Akihiro|last4=Eriguchi|first4=Masahiro|last5=Kitazono|first5=Takanari|date=2012-10-01|title=Successful treatment of massive proteinuria and severe chyluria by inhibition of cholesterol absorption with ezetimibe in a patient with filariasis|url= |journal=Clinical Kidney Journal|volume=5|issue=5|pages=449–452|doi=10.1093/ckj/sfs110|issn=2048-8505|pmc=4432420|pmid=26019826}}]
Medicines that inhibit [cholesterol](/source/cholesterol) absorption in the small intestine, such as [Ezetimibe](/source/Ezetimibe), may be effective treatments in some patients.