Hiluria

Hiluria (Greek chylos - juice, uron - urine) - secretion of lymph (tissue fluid) with urine. Synonyms: galacturia, lactaciduria, lymph.

Freshly extracted urine with hiluria ad oculus resembles concentrated milk or milky juice. Over time, the clot retraction occurs in the vessel, and the urine is stratified into three immiscible layers. The top layer is the formed clot, the middle one is of milk color, the lower layer is small in volume, contains epithelial and fat cells, salts. Unlike other conditions characterized by a similar clouding of urine (for example, with pionefroze), with hiluria there is no massive leukocyturia, bacteriuria in a significant titer and the symptoms of an acute destructive process in the kidneys.

Causes of the hilurii

Hiluria is a symptom of a serious illness, manifested by the presence of lymph in the urine. The origin of the definition of "hiluria" has Greek roots: chylus denotes milky, milky juice, and ouron is urine. There is a characteristic feature of urine containing lymph: if urine is collected for laboratory testing, it is distributed fairly quickly in three layers - the thickest part of it is at the top, the middle is urine with lymph, that is milk-white liquid, at the bottom - a sediment containing salts, epithelial cells, lipids and leukocytes. Also characteristic of hiluria is the paradoxical course, when it can independently disappear or decrease significantly in terms of the intensity of urine filling with lymph, provided that strict bed rest is observed. If a person gets up, especially sharply, not only pain appears due to obstruction of the kidney and urinary ducts, but also the consistency and composition of urine changes dramatically - it almost instantly becomes lymphatic.

Hiluria can be the result of a message (fistula) between the lymphatic and urinary tracts. Most often, lymphobacillus fistula occurs between large lymphatic vessels and the renal pelvis (cups), less often involve involvement in the pathological process of the bladder. Most often, hiluria is found in filariasis - a parasitic disease caused by nematodes of the Filariata class. Filariatosis is characterized by endemic distribution. The disease is transmitted through bloodsucking insects (mainly through mosquitoes) and manifests as a simultaneous lesion of the urinary and lymphatic tract. Hiluria can be a consequence of post-traumatic, inflammatory, post-tubercular and neoplastic processes leading to compression of the abdominal and thoracic lymphatic collector, act as a monosymptom.

She is accompanied, and often preceded by signs of lymphostasis of the lower half of the trunk: swelling of the skin of the abdomen, penis, scrotum, lower limbs. Observations that indicate the onset of renal colic due to obturation of the VMP with lymphatic clots are described. A correlation of the degree of intensity of the hiluria from the position of the patient's body and the intake of food was noted. With orthostasis (standing) and after eating hiluria higher than after the patient's stay in the position of the clenostasis (lying down) and on an empty stomach.

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Symptoms of the hilurii

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

However, the hiluria caused by Filaria nematodes, in the initial stage, can be unnoticed by a person, since the primary attack is by the parasite immune system. Only when the lymphatic system and kidneys are damaged, the filariotosis is accompanied by typical symptoms of tropical diseases - chills, fever. Specific signs of filariotosis are inflammatory processes in the lymphatic system, leading to swelling and "elephantiasis" of the limbs, eye damage, giant swelling of the scrotum.

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

In addition to obvious puffiness, hiluria can provoke dysuria (violation of urination), often associated with infections of the urinary tract. Also, hiluria in the acute stage is accompanied by renal colic, when lymphatic clots try to find a way out, pain in the lumbar region. Common symptoms in the form of milky white urine and pain can be repeated for several months, alternating between remission and relapses.

Hiluria is detected by laboratory tests of blood and urine, X-ray contrast lymphography, urography, percutaneous and contrast pyelography. Confirmation of the diagnosis is the detection in the blood and urine of eggs and adult specimens of filarias.

Treatment of the hilurii

If the hiluria is caused by filarias, the therapeutic measures are determined by the doctor on the basis of anamnesis, the severity of the patient's condition, and also on the basis of their own knowledge and practical experience, since there is no single effective treatment regimen to date. Filarious hiluria treatment involves a variety - from conservative, antiparasitic to minimally invasive surgical. As a rule, the patient is treated under stationary conditions with the help of anthelmintic drugs - ditrazine, albendazole, ivermectin.

Hiluria, whose treatment is based on dithrazine, requires constant monitoring by the doctor, since the ejection of nematodes can be accompanied by various complications, in addition, the drug itself is very toxic. Ditrazine acts on the nerve impulses of ganglion parasites, provoking their paralysis. Nematotsidnoe action of the drug is directed to both adults and preimaginal forms (larvae, embryos). Simultaneously with nematocides, the appointment of desensitizers to reduce the risk of allergic reactions - antihistamines of the latest generation, not causing drowsiness and obvious complications. If allergies can not be avoided, and this is often combined with hiluria, glucocorticosteroids and hepatoprotectors are used to reduce the load on the liver. Also strong is the strong drug - diethylcarbamazine citrate, which is used in combination with antihistamines, hepatoprotectors and enzyme preparations. Nematocide drugs affect only those filaries and larvae that are in the bloodstream, all parasites in the urine, as a rule, go there already unsustainable.

If hiluria is not treated for a long time, more precisely, the filariotosis is not treated, the patient can develop irreversible consequences in the form of elephantiasis - elephantiasis of legs, pathological lesions of the retina of the eyes, up to blindness. Therefore, in the diagnosis of complicated cases of filariotosis, endoscopic coagulation (excision of lymph), as well as resection of the affected parts of the bladder wall, surgical intervention for the purification of the renal pelvis, and sometimes nephrectomy. Hiluria with repeated analyzes is not detected, as soon as the source of the underlying disease is eliminated, that is, the filarias die and the lymph drainage recovers.

Parasitic hiluria, whose treatment can be quite lengthy, is by now a poorly understood symptom, despite its apparent manifestation in the form of milk-white urine.

Hiluria, which develops against the background of lymphangioma or malignant tumors, does not require a separate treatment, since therapy should be aimed at arresting the main symptomatology of the disease.

Forecast

The prognosis, which involves hiluria, with timely diagnosis and treatment is favorable, in the presence of persistent lymphostasis and elephantiasis, disability is possible, the lethal outcome is extremely rare with a purulent-septic complication developing rapidly in conditions where it is not possible to provide proper medical care.