Are there any factors affecting the outcome of endoscopic sclerotherapy in filarial chyluria? A prospective study

Abstract

Introduction:Filarial chyluria is a frequent problem in India. While endoscopic therapy is the mainstay of treatment, it is not always successful. We aimed to determine parameters that affect outcomes of endoscopic sclerotherapy for filarial chyluria (FC).Methods:Prospectively maintained data of FC patients who received endoscopic sclerotherapy between June 2011 and March 2015 were analyzed. Sclerotherapy included either povidone-iodine (0.1%) or silver nitrate (1%). The parameters recorded included clinical evaluation, urinary triglyceride (TG)/cholesterol, sclerotherapy treatment, and follow-up.Results:One hundred and fifty-seven patients (male: female, 104:53) with a mean age (± standard deviation [SD]) 41.12 ± 13.68 years underwent endoscopic sclerotherapy. Grade II (68.88%) chyluria was a most common presentation followed by Grade III (25.69%). One hundred and forty-four patients responded whereas six patients failed to respond; another seven were lost to follow up, and twenty patients had recurrence. Overall success rate was 86.11%. Baseline urinary TG (mean ± SD) between success and recurrence group was 195.51 ± 164.73 mg/dl and 652.65 ± 62.55 mg/dl and cholesterol (mean ± SD) was 16.99 ± 10.08 mg/dl and 89.07 ± 39.87 mg/dl, respectively. Patient with urinary TGs >300 mg/dl and urinary cholesterol >30 mg/dl had 3.2 and 1.3 times higher chance to have recurrence after endoscopic sclerotherapy, respectively. Choice of sclerosing agent (silver nitrate 1% versus povidone-iodine 0.1%) had no difference in success rate, but silver nitrate had slightly higher complications rate (25% vs. 20%). A higher number of instillations (>3) was associated with better success rate. Majority of the complications were either Clavien Grade 1 or 2.Conclusions:The factors predicting recurrence were higher clinical grade, higher number of pretreatment courses, and high urinary TG and cholesterol.

Duplication mutation in CHIT1 gene is associated with poor response to medical therapy in patients affected with filarial chyluria

“…Approximately 10% of filariasis patients develop chyluria About 30%-40% of patients do not respond or respond partially to medical therapy or recur after the initial response [ 3 , 4 ]. Most recurrences are treated by repeat course of conservative medical treatment [ 16 ]. However, some of these patients need endoscopic sclerotherapy.…”

Genetic association of MBL-2 gene polymorphisms with Filarial chyluria

“…However, as recruiting consenting controls is difficult, we occasionally included other healthy volunteers. Parameters obtained consist of demographics of subjects (age, sex, and ethnicity), details of chyluria like duration, grading of severity of current episode, [12] number of previous episodes, chylous clot retention, and details of investigations like hemoglobin, urinary parameters like urinary triglycerides and cholesterol levels. After collecting the above details, 5-ml blood sample was collected from each participant to perform diagnostic tests and genotyping.…”

Single-dose instillation of povidone iodine for chyluria: A safe and effective therapy

“…The factors predicting recurrence were higher clinical grade, higher number of pretreatment courses, and high urinary TG and cholesterol. [ 18 ]…”