Clinical Presentation And Evaluation

Chyluria has an unpredictable course associated with remission and exacerbation. The disease usually affects young adults presenting with complaints of passage of whitish urine, white clots, or hematuria (hematochyluria). Sometimes chylous clots can lead to obstruction in the urinary tract, leading to clot colic (flank pain), retention of urine, or even anuria. Although not life threatening, the disease can be debilitating.

Chyluria can lead to considerable weakness and weight loss secondary to loss of proteins, cholesterol, and triglycerides (11,12,16).

Patient, usually come from an endemic area and give a long history of the disease. Urinary chemistry reveals proteiuria and lipiduria with high triglycerides along with a layer of chylomicrons. Serum proteins may be low in cases of intractable chy-luria. Renal functions are usually normal. Intravenous urography is usually not helpful in delineating the pyelolymphatic leak but is required to know the function and anatomy of upper tracts. Cystoscopy may show the chylous efflux from the ureteral orifice from one or both the sides. In cases of clear efflux, ureters should be catheter-ized, and selective sampling should be tested for the chyle to know the exact side of the involved renoureteral unit.

Retrograde ureteropyelogram helps in establishing the connection between the lymphatics and urinary system. It is useful not only to identify the affected side but also to assess the severity of the pyelolymphatic communications (Fig. 2).

Ultrasonography or computed tomography of the abdomen may be required in cases of nonfilarial etiology, e.g., malignant tumors (7).

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