Hiluria

Chyluria (Greek chylos - juice; urоn - urine) - the release of lymph (tissue fluid) with urine. Synonyms: galacturia, lactaciduria, lymphuria.

Freshly excreted urine in chyluria ad oculus resembles concentrated milk or milky juice. Over time, the clot retracts in the vessel, and the urine separates into three immiscible layers. The upper layer is the formed clot, the middle layer is milky, the lower layer is small in volume, contains epithelial and fat cells, salts. Unlike other conditions characterized by similar turbidity of urine (for example, in pyonephrosis), in chyluria there is no massive leukocyturia, bacteriuria in significant titer and symptoms of an acute destructive process in the kidneys.

Causes hiluria

Chyluria is a symptom of a serious disease, expressed by the presence of lymph in the urine. The origin of the definition "chyluria" has Greek roots: chylus means milky, milky juice, and ouron - urine. There is a characteristic feature of urine containing lymph: if urine is collected for laboratory testing, it is distributed quite quickly in three layers - the thickest part is on top, the middle is urine with lymph, that is, a milky-white liquid, at the bottom is sediment containing salts, epithelial cells, lipids and leukocytes. Also characteristic of chyluria is a paradoxical course, when it can disappear on its own or significantly decrease in terms of the intensity of filling urine with lymph, subject to strict bed rest. If a person gets up, especially abruptly, not only pain appears due to blockage of the renal and urinary ducts, but the consistency and composition of urine also changes dramatically - it is almost instantly filled with lymph.

Chyluria may be a consequence of communication (fistula) between the lymphatic and urinary tracts. Most often, a lymphurinary fistula occurs between large lymphatic vessels and the renal pelvis (cups), less often, the urinary bladder is involved in the pathological process. Chyluria is most often detected in filariasis - a parasitic disease caused by nematodes of the Filariata class. Filariasis is characterized by endemic distribution. The disease is transmitted through blood-sucking insects (mainly through mosquitoes) and manifests itself with simultaneous damage to the urinary and lymphatic tract. Chyluria may be a consequence of post-traumatic, inflammatory, post-tuberculous and neoplastic processes leading to compression of the abdominal and thoracic lymphatic collector, and act as a monosymptom.

It is accompanied and often preceded by signs of lymphostasis of the lower half of the body: edema of the skin of the abdomen, penis, scrotum, lower extremities. Observations are described indicating the occurrence of renal colic due to obstruction of the upper urinary tract by clots of lymphatic contents. A correlation is noted between the intensity of chyluria and the patient's body position and food intake. With orthostasis (standing) and after eating, chyluria is higher than after the patient is in the position of clinostasis (lying down) and on an empty stomach.

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Symptoms hiluria

The signs of chyluria are obvious, as they quickly manifest themselves in an uncharacteristic appearance and composition of urine.

However, chyluria caused by Filaria nematodes may go unnoticed by humans in the initial stage, since the immune system is the primary target of the parasites. Only when the lymphatic system and kidneys are damaged, filariasis is accompanied by typical symptoms of tropical diseases - chills, fever. Specific signs of filariasis are inflammatory processes in the lymphatic system, leading to swelling and "elephantiasis" of the limbs, eye damage, and giant swelling of the scrotum.

Lymphostasis (lymphedema, lymphatic edema) is a congenital or acquired disease that manifests symptoms in the form of persistent edema. Edema is accompanied by thickening of the skin, noticeable thickening of the limbs, which subsequently leads to the formation of ulcers and the development of "elephantiasis" of the limbs. Lymphostasis occurs due to an imbalance between the formation of lymph and its outflow from the capillaries and peripheral lymphatic vessels, as a rule, this phenomenon develops in the tissues of the limbs and organs where the main lymphatic collectors are located (thoracic region).

In addition to obvious swelling, chyluria can provoke dysuria (impaired urination), often accompanying urinary tract infections. Also, chyluria in the acute stage is accompanied by renal colic, when lymph clots try to find a way out, pain in the lumbar region. General symptoms in the form of milky-white urine and pain can recur for several months, alternating remission and relapses.

Chyluria is detected using laboratory tests of blood and urine, X-ray contrast lymphography, urography, transcutaneous and contrast pyelography. The diagnosis is confirmed by detection of eggs and adult filariae in the blood and urine.

Treatment hiluria

If chyluria is caused by filariae, then the therapeutic measures are determined by the doctor based on the anamnesis, the severity of the patient's condition, as well as on his own knowledge and practical experience, since there is no single effective treatment regimen to date. Filariasis chyluria treatment involves a variety of treatments - from conservative, antiparasitic to minimally invasive surgery. As a rule, the patient is treated in a hospital setting with anthelmintic drugs - ditrazine, albendazole, ivermectin.

Chyluria, the treatment of which is based on ditrazine, requires constant monitoring by a doctor, since the expulsion of nematodes can be accompanied by various complications, in addition, the drug itself is very toxic. Ditrazine acts on the nerve impulses of the parasite ganglia, causing their paralysis. The nematicidal effect of the drug is aimed at both adult individuals and preimaginal forms (larvae, embryos). Along with nematicides, it is recommended to prescribe desensitizers to reduce the risk of allergic reactions - antihistamines of the latest generation that do not cause drowsiness and obvious complications. If allergies cannot be avoided, and this is often combined with chyluria, glucocorticosteroids and hepatoprotectors are used to reduce the load on the liver. Also effective is a strong drug - diethylcarbamazine citrate, which is used in combination with antihistamines, hepatoprotectors and enzyme preparations. Nematicidal drugs only affect those filariae and larvae that are in the bloodstream; all parasites found in the urine usually arrive there already non-viable.

If chyluria is left untreated for a long time, or more precisely, filariasis is left untreated, the patient may develop irreversible consequences in the form of elephantiasis - elephantiasis of the legs, pathological damage to the retina, and even blindness. Therefore, when diagnosing complicated cases of filariasis, endoscopic coagulation (lymph excision) is possible, as well as resection of the affected areas of the bladder wall, surgical intervention to clean the renal pelvis, and sometimes nephrectomy. Chyluria is not detected during repeated tests as soon as the source of the underlying disease is eliminated, that is, the filariae die and the lymph flow is restored.

Parasitic chyluria, the treatment of which can be quite lengthy, is currently a poorly understood symptom, despite its obvious manifestation in the form of milky-white urine.

Chyluria that develops against the background of lymphangioma or malignant tumors does not require separate treatment, since therapy should be aimed at relieving the main symptoms of the disease.

Forecast

The prognosis that chyluria suggests, with timely diagnosis and treatment, is favorable; in the presence of persistent lymphostasis and "elephantiasis" disability is possible; a fatal outcome is extremely rare with purulent-septic complications that develop rapidly in conditions where there is no possibility of providing proper medical care.