What disease is chyluria seen in?

Many people in life do not care much about some diseases until the condition worsens and they need to go to the hospital for treatment. Then they start to worry. Now there is a very common disease called chyluria. The existence of this disease is mainly due to many factors. For example, you may feel that there is some turbid stuff in the urine, which does not look clear at all. This is mostly related to inflammatory infection, lymphatic system, bladder and kidney function.

Chyle (liquid after fat saponification) absorbed from the intestine cannot be drained into the blood through the normal lymphatic channels, but flows back into the lymphatic vessels of the urinary system, increasing the pressure in the lymphatic vessels and causing varicose veins to rupture. Chyle overflows into the urine, making the urine milky white. Clinically, this is called chyluria. Depending on the amount of chyle contained, the urine color may be milky white, thick cheese-like, or slightly turbid. If the chyle contains a lot of blood, it may appear pink, which is clinically called chyle hematuria. If there is a combined infection, it is called chyle pyuria. Chyleuria is divided into three layers after being still in vitro. The upper layer is fat; the middle layer is milky white with small particles and clots suspended in it; the lower layer is red or pink and contains red blood cells or pus cells. When ether is added to chyleuria and the urine is fully mixed, it becomes clear and is called true chyluria. Otherwise, it is called pseudochyluria, which occurs when the urine contains too much inorganic salts or combined fat droplets or a large number of pus balls.

Causes of chyluria:

A. Etiology Classification

It can be roughly divided into two categories: parasitic and non-parasitic. The former is mostly caused by Bancroftian filariasis; a few can be caused by abdominal tuberculosis, tumors, chest and abdominal trauma or major surgery.

Primary lymphatic system diseases are mainly seen in congenital malformations. They are rare in clinical practice. Pyelonephritis and nephrotic syndrome in pregnancy can also be seen occasionally.

Second mechanism

Chylous urine is caused by various reasons, including obstruction of the cisterna chyli or thoracic duct, rupture of high-pressure varicose veins in the distal lymphatic vessels and urinary tract communication. Varicose lymphatic vessels can penetrate the human renal calyces, ureters and bladder. There are two major types of chyluria. One type is caused by extensive obstruction of the abdominal lymphatic vessels. The chyle fluid normally absorbed from the intestine reaches the pre-aortic lymph nodes to the cisterna chyli through the intestinal trunk lymphatic vessels. When the pre-aortic lymph nodes or intestinal trunk lymph nodes are blocked, the chyle cannot enter the chylous cisterna chyli, but flows into the lumbar lymphatic vessels through the pathway between the pre-aortic lymph nodes and the para-aortic lymph nodes to the chylous cisterna chyli. If the lumbar lymphatic vessels are also blocked, the chyle will flow back into the urinary lymphatic vessels, increasing their internal pressure and causing varicose veins to rupture and produce chyluria. Another type of thoracic duct obstruction is when the lower end of the thoracic duct is blocked, and the internal pressure of the cistern chyli increases. The chyle will flow back through the lumbar lymph nodes to the urinary system lymphatic vessels, increasing their internal pressure and causing them to rupture and form chyluria. The most common site of rupture of the urinary system lymphatic vessels is the renal pelvis, followed by the ureter, and sometimes in the bladder and posterior urethra.

Chylous urine diagnosis:

Chylous urine caused by filarial worms should be investigated in epidemic areas. Microfilaments can be diagnosed by finding microfilaments in blood and urine. Microfilaments can be easily found in the blood at night. For patients with tuberculosis, attention should be paid to finding tuberculosis lesions. Acid-fast bacilli can be found in pleural and abdominal fluids to confirm the diagnosis. Malignant tumors originating from the abdominal cavity, retroperitoneum, mediastinum, etc. are serious and progress quickly. Tumor cells can be found in the serous cavity to confirm the diagnosis. During physical examination, attention should be paid to superficial lymphadenopathy and hepatosplenomegaly. Patients with filariasis have a long course of disease and even elephantiasis of the lower limbs.

Laboratory examination: First, identify true chyluria from false chyluria. Sudan dish staining method: Take 0.5 ml of urine and add 1 drop of Sudan III solution, mix well and observe under a microscope. If the fat droplets in the urine are stained red, it is positive, which is true chyluria. Ether extraction method: Take 10 ml of urine and add 2-3 ml of ether. Add a stopper and shake repeatedly. Then stand for a while. After the ether is separated, the urine becomes clear. Then take out the ether layer and place it in an evaporating dish to evaporate it. If an oily residue appears, the Sudan dish is stained red, which is positive.