Chyluria: a scourge of our region

Chyluria, commonly seen in south Asian countries, is mainly a manifestation of lymphatic filariasis as a result of infestation with Wuchereria bancrofti, although many other causes can contribute. Many patients can be effectively treated with dietary modifications and drug therapy. The most widely used drug is diethyl carbamazine. The recurrences are common after such treatment. Such patients would benefit from sclerotherapy to obliterate the lympatico-renal fistulae located mainly in the renal pelvicalyceal system. The commonly used sclerosing agent is a combination of 5% povidone-iodine and 50% dextrose instilled through a ureteric catheter. A small percentage of patients who recur after sclerotherapy and those with systemic complications, such as hypoproteinemia and edema, might require surgery in the form of renal hilar lymphatic disconnection. Although it is a major operation, the success rates are >90%. Laparoscopic and robotic techniques have minimized the morbidity related to such surgery. With the advent of the global program for eradication of filariasis initiated by the World Health Organization, the incidence of the disease is decreasing. Mass chemotherapy with diethyl carbamazine is the mainstay of this global program. Many years after eliminating filariasis, chyluria continue to occur in such populations, though in dwindling numbers. Future research should aim at finding more efficacious sclerosing agents with minimal recurrences.

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“…It is an ancient disease described by Hippocrates in 400 bc . The Indian philosopher Charak described it as “suklameha” in 300 bc …”

Section: Introductionmentioning

confidence: 99%

New developments in chyluria after global programs to eliminate lymphatic filariasis

2017

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“…The most conservative measures include fat-restricted diets (since fat absorption results in chyle formation), supportive treatment, and prescribing diethylcarbamazine [13]. Administering povidone iodine or silver nitrate has also been shown to be effective for managing chyluria patients [24]. If the chyluria is more severe or persistent, then more radical measures can be taken such as a lympho-venous disconnection with surgery, or in severe cases nephrectomy and renal autotransplantation [4].…”

Section: Discussionmentioning

confidence: 99%

Robotic surgery for treatment of chyluria

Barman

Palese

2016

J Robotic Surg

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Chyle is a milky lymphatic fluid that is normally formed in the small intestine to aid in the absorption of dietary fats. Occasionally, chyle leaks into the kidney, ureter, or bladder, which results in chyluria. Chyluria is most commonly caused by the parasite Wuchereria bancrofti and is therefore extremely rare in the USA. The use of robotic surgery for treatment has been suggested as a viable option, but has not been thoroughly reported in the literature. This article reviews the literature on the various treatment options for chyluria and presents the case of a 75-year-old Indian female from the USA who was diagnosed with non-parasitic, persistent chyluria and treated with right robotic ureterolysis, renal hilar dissection and intraperitonealization of the ureter.

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“…Hydrocele and lymphedema are the main clinical manifestations, whereas chyluria is a less common presentation [24] that manifests itself through milky-color urine associated with flank pain, similar to ureteric cramps [25] and may be triggered by meals with high lipid contents. More severe cases may result in malnutrition, hypoproteinemia, immune dysfunction and hypercoagulability states [26, 27]. Chyluria may present an unpredictable clinical course, including spontaneous remission in up to half of the individuals [28].…”

Section: Discussionmentioning

confidence: 99%

Chiluria in a lymphatic filariasis endemic area

Araújo

Souza

et al. 2018

BMC Res Notes

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ObjectiveTo establish clinical and laboratory data of individuals presenting chyluria in endemic areas.Results75 individuals were studied. The majority were females with an average age of 45 years residing in the Metropolitan Region of Recife. The mean time between the beginning of the presentation of chyluria and the first care service in the Serviço de Referencia Nacional em Filarioses was approximately 5 years. The most frequent urinalysis changes were hematuria (27.6%), leukocytes (21.9%) and proteinuria (10.5%). The Addis test showed mean values of 155.43 E/min/mL of cylinders, 52,892 E/min/mL of erythrocytes and 291,660 E/min/mL of leukocytes. Among recorded cases, proteinuria had a mean value of 1372.80 mg/dL in 24 h, and the presence of lymphocytes in the urine was positive in 68.3%. Among lymphatic filariasis tests, immunochromatography was positive in 16.7%, there was circulating filarial antigen determined by detection of OG4C3 antibodies in 7.7% and microfilaremia in only 1/55.

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Chyluria: a scourge of our region

Cited by 16 publications

References 21 publications

New developments in chyluria after global programs to eliminate lymphatic filariasis

New developments in chyluria after global programs to eliminate lymphatic filariasis

Robotic surgery for treatment of chyluria

Chiluria in a lymphatic filariasis endemic area

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