Factors affecting response to medical management in patients of filarial chyluria: A prospective study

Abstract

Introduction:Filarial chyluria is a common problem in filarial endemic countries. Its management begins with medical therapy but some patients progress to require surgery. The present study aimed to determine factors affecting response to medical management in patients of filarial chyluria.Materials and Methods:This prospective study conducted between August 2008 and November 2012, included conservatively managed patients of chyluria. Demographic profile, clinical presentation, treatment history and urinary triglycerides (TGs) and cholesterol levels at baseline were compared between the responders and non-responders. Apart from the clinical grade of chyluria, hematuria was evaluated as an independent risk factor.Results:Out of the 222 patients (mean age, 37.99 ± 13.29 years, 129 males), 31 patients failed to respond while 35 had a recurrence after initial response; the overall success rate being 70.3% at a mean follow-up of 25 months. No difference was observed in demographics, clinical presentation, presence of hematuria, disease duration and mean urinary TGs loss between responders and non-responders. On multivariate analysis, patients with treatment failure were found to have a higher-grade disease (14.3% Grade-I, 36.6% Grades-II and 60% Grade-III), higher number of pretreatment courses (1.59 ± 1.08 vs. 1.02 ± 0.79) and heavier cholesterol (26.54 ± 23.46 vs. 8.81 ± 8.55 mg/dl) loss at baseline compared with responders (P < 0.05).Conclusion:Conservative management has a success rate in excess of 70%, not affected by the disease chronicity, previous episodes and recurrent nature. However, higher-grade disease, extensive pre-treatment with drugs and higher urinary cholesterol loss at baseline are the predictors of poor response. Hematuria is not an independent poor risk factor for conservative management.

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

“…[ 12 ] About 30%–40% of patients do not respond or respond partially to medical therapy or recur after the initial response. [ 3 5 13 ] Most recurrences are treated by repeat course of conservative medical treatment. [ 5 ] However, some of these patients need endoscopic sclerotherapy or chlylolymphatic disconnection.…”

“…In the postinstillation therapy, we advised all patients to continue fat-restricted diet and to use cooking oil containing medium chain TGs (MCT, <12 carbon atom) fat. [ 3 ] MCT oil is commercially available and can be started 5 ml three times a day (TDS) and can be increased to 15 ml TDS; however, it is costly. Some authors recommend using coconut oil (rich source of MCT), but it is not advisable because it contains other fatty acids also.…”

“…All patients were advised fat-restricted diet in the postinstillation period and were asked to avoid further exposure to mosquito bite. [ 3 ] Follow-up was done at 2 weeks, 3 months, 9 months, and thereafter if needed or if the patient developed recurrence. At each follow-up visit, patients were enquired about episodes of milky urine, and urine examination was done for evidence of chyle or TGs.…”

“…Medical therapy has a success rate of about 50%–65%. [ 2 3 4 5 ] Patients who fail or do not respond to conservative medical treatment are managed by endoscopic sclerotherapy. Instillation therapy has variable success rates ranging between 65% and 80%.…”

“…Previously, we reported factors that predict successful medical therapy in patients with chyluria. [ 3 ] In the present study, we determined different parameters that affect outcomes of endoscopic sclerotherapy for FC.…”