Chyluria: Differential Diagnosis

The passing of intestinal lymph in urine is known as chyluria.In 300 BC, the renowned Indian scholar Charak named it as "Suklameha." Because of obstructive lymphatic stasis, chylomicrons and triglycerides are lost in the urine from an aberrant lymphourinary fistula, most frequently near the renal pelvis. It is an extremely recurring ailment that has several years of remissions and exacerbations.

Chyluria mostly causes dilatation or occlusion of the retroperitoneal lymphatics. Numerous lymphatic trunks that drain the kidneys and intestinal lymphatics that drain the gut, pancreas, and spleen are included in the retroperitoneal lymphatics. The cisterna chyli is the drain for each of these lymphatics. Either the intestinal chyle backflow is caused by varicosities and collaterals resulting from lymphatic hypertension and obliterative lymphangitis caused by the parasitic infections, or occasionally the renal lymphatics rupture into the renal calyces or pelvis due to chyle regurgitation from the cisterna chyli or large intestinal trunks. Chyluria is endemic in parts of Asia and sub Saharan Africa. Chyluria is graded according to the mode of presentation like grade 1 is milky white urine, grade 2 is white clots or episodes of clot retention and grade 3 is haematochyluria. Severe weakness and weight loss too occur in some patients.

The ether test for chylomicrons in urine combined with a visual inspection of milky urine can be used to make the diagnosis. The location of the fistula can be found with intravenous urography, albeit this procedure has a low detection rate. Diethylcarbamazine therapy and a high-protein, low-fat diet are examples of conservative treatment methods. Surgical therapy and endoscopic sclerotherapy—renal pelvic instillation of silver nitrate, povidone iodine, or other substances—are employed when conservative methods prove ineffective.

Given the abundance of available investigative choices, it is necessary to tailor their application to the specifics of each case in order to arrive at a diagnosis and effectively design the therapeutic intervention.