Quiluria

Specialty: Nephrology and urology.

• milky urine
• lymph in the urinary tract

Why it occurs

• Lymphatic filariasis (chronic parasitic infection by Wuchereria bancrofti that obstructs and ruptures the retroperitoneal lymphatic vessels towards the renal pelvis, prevalent in tropical areas)
• Congenital lymphourinary fistula (anomaly of the retroperitoneal lymphatic vessels)
• Neoplastic obstruction of the thoracic duct or abdominal lymphatic vessels (due to lymphomas, sarcomas or retroperitoneal tumors)
• Major retroperitoneal trauma or post-surgical sequelae of retroperitoneal lymphadenectomy or partial nephrectomy

Initial workup

Quantitative determination of triglycerides and cholesterol in a fresh urine sample (high values confirm chyluria); urinary protein electrophoresis; lymphoscintigraphy or magnetic resonance lymphography to identify the course of the lymphoinary fistula; nocturnal peripheral blood smear to detect microfilariae if it comes from an endemic area.

Standard management

• Diethylcarbamazine — 6 mg/kg per day orally divided into three doses for 12 days for the treatment of active filariasis, monitoring for allergic reactions secondary to the lysis of microfilariae
• Octreotide — 100 mcg subcutaneously every 8 to 12 hours to promote the spontaneous closure of the lymphatic fistula by reducing the pressure and inflammation of the chyliferous vessels
• Dietary modification with strict restriction of neutral fats and supplementation with medium chain triglycerides (MCT) that are absorbed directly through the portal venous system without passing through the lymphatic route.