Analysis of case series of milky urine: A single center and departmental clinical experience with emphasis on management perspectives: A prospective observational study

Abstract

Background:Milky urine can be due to chyluria or lipiduria due to nephrotic syndrome. Filarial chyluria usually responds to medical management while non-filarial cases may require surgical intervention.Aim:To perform a prospective observational study in patients presenting with milky urine in our centre over a period of one year from July 2011 to June 2012, a complete biochemical work up and imaging to find out the site of leakage of lymph if it is a case of chyluria, its response to medical management and the requirement of surgical intervention.Materials and Methods:Routine blood and urine investigations, 24 hour urine protein excretion, USG abdomen, serum lipid profile and rapid filarial antigen test were done in all. MRI abdomen was done in affordable patients. Renal biopsy was done in some chyluria patients for academic purpose and in milky urine with negative urine ether test. Sclerotherapy was done with 50% dextrose and 0.2% povidone iodine. Patients were followed up with 24 hour urine protein and triglyceride estimation.Results:18 cases of milky urine were encountered. 8 were filarial chyluria, 9 non- filarial and 1 MCD. Mean urine TG level and median 24 hour urinary protein excretion were 37.2 ± 24.6 mg% and 4.96 g respectively. The mean age for filariasis (22.9 ± 4.5 years) was significantly different from that of non-filarial etiology (31.5 ± 4.8 years) (P = 0.005). The mean 24 hour urinary protein for normal MRI cases (4.64 ± 0.70 g) was significantly different from those with dilated lymphatics (8.15 ± 2.55 g) (P = 0.02). All the non- filarial and 4 filarial cases required sclerotherapy. One patient required a second sitting.Conclusion:Milky urine is most commonly due to chyluria and occasionally due to nephrotic syndrome. Nephrotic syndrome is managed in its own way while chyluria not amenable to pharmacological intervention is managed with sclerotherapy.

Parasitic chyluria in a 72-year-old Sierra Leonean woman: A case report

“…In converse to the male preponderance in most studies, the index case was a female 2,3,4,5 and her age of 72 years is at variance with the age bracket of the majority of affected patients, which falls between 15 and 30 years. 2,4,6…”

Chiluria in a lymphatic filariasis endemic area

“…Individuals complained of chyluria. There was a slight predominance of women in the sample, while the majority of studies had a higher proportion of men [14, 21–23]. However, this may be related to the fact that women seek more medical care.…”

A Patient with Milky Urine: Nonparasitic Chyluria and Silver Nitrate Sclerotherapy

“…Magnetic resonance imaging might show clusters of dilated lymphatic channels ( 1 ), and the necessity of such investigation should be individualized at the discretion of the attending clinician. Lymphangiography and Lymphoscintigraphy using 99 m Tc-nano colloid are capable of demonstrating the site of fistula, caliber, and the number of fistulous communications ( 6 ), hence can be described as important second-line investigations, while taking in to account its clinical value, cost and the availability ( 1 , 6 ). Rigid cystoscopy examination helps in lateralizing chyluria by demonstrating chyle efflux from the ureteric orifice.…”

“…Endoscopic sclerotherapy is a minimally invasive treatment option for chyluria. Various types of sclerosant agents such as 0.1-1% silver nitrate, 0.2-5% povidone-iodine, 50% dextrose, 3% hypertonic saline and contrast media can be used for this purpose ( 1 , 6 ). Initially, sclerosant induced chemical lymphangitis and oedema temporarily block the channels with eventual fibrosis to permanently occlude and close them ( 4 , 5 ).…”

“…Sclerosant therapy has its drawbacks about side effects, out of which nausea, vomiting, flank pain, and haematuria are by far the commonest but transient ( 4 , 5 ). However, high concentration silver nitrate therapy is known to cause dangerous and possibly fatal acute necrotizing ureteritis with obstructive uropathy ( 6 ).…”