Chyluria is the presence of an admixture of lymph in the urine. In appearance, urine resembles diluted milk, sometimes with a pinkish tint. A laboratory symptom occurs when there is an abnormal communication between the urinary and lymphatic tracts. It is detected with filariasis, compression of the lymphatic ducts by tumors, post-traumatic and post-tuberculosis scars, inflammatory infiltrates. Chyluria is determined by the results of a general urine test. To determine the cause of the violation, microscopy of a blood smear for filariae is prescribed, imaging techniques for examining the condition of the kidneys and urinary tract.
Hiluria (galacturia, lymphuria, lactaciduria, milky urine) does not normally occur, it is always caused by pathological conditions. When it appears, urine loses its transparency, acquires a milky white color. After settling, it is divided into three layers. Above is a clot, below is a sediment of salts, epithelial cells and fat droplets, determined during microscopy. The middle part of the vessel is occupied by a liquid similar to diluted milk.
The occurrence of chyluria during compression of the thoracic duct, as a rule, is preceded by lymphostasis, accompanied by persistent dense swelling of the lower body. The tendency to form clots from the components of the lymph causes the appearance of obstructions to the outflow of urine at the level of the pelvis, ureter or bladder. Aching pains, renal colic are possible. Prolonged loss of a significant amount of lymph can cause exhaustion.
A distinctive feature of chyluria is considered to be a paradoxical course, in which the severity of the symptom directly depends on the position of the patient's body. When staying in a horizontal position, especially following strict bed rest, chyluria decreases or disappears on its own. When moving to a vertical position, it resumes almost instantly again.
Left - normal urine, right - chyluria
Filariasis is a transmissible helminthiasis caused by roundworms of the filaria genus that parasitize in body tissues outside the intestine. They are common in countries with a tropical and subtropical climate, in Russia they are diagnosed only in travelers who have visited endemic zones. The defeat of the lymphatic system with the possible development of chyluria is observed in two varieties of filariasis - brugiasis and wuchereriosis.
The first symptoms in visitors appear after 3-6 months. Initially, urticaria, fever, edema, lymphangitis, lymphadenitis, hepatosplenomegaly are detected. Chiluria is detected several years after infection, combined with elephantiasis of the lower extremities and genital organs. Perhaps the occurrence of chylous ascites, the formation of parasitic abscesses.
Occlusion of the thoracic duct with the development of chyluria can be caused by tumors of the lymphatic system and other organs. Lymph enters the urine when the underlying ducts rupture and the subsequent formation of lymphourinary fistulas. Benign neoplasms of the lymphatic system include chylangiomas and lymphangiomas. Slow growth is typical, chyluria occurs with a significant amount of mass formation, is not prone to rapid growth.
Lymphangioendothelioma is one of the primary malignant neoplasias. Due to the aggressive growth of the tumor, chyluria progresses rapidly, accompanied by chylous pleurisy and ascites caused by the germination of neighboring organs and the formation of metastases. There is lymphostasis of the lower half of the body. Cancer cachexia develops.
Metastases to the thoracic duct can be found in cancers of the ovaries, uterus, stomach, and colon. Chiluria and elephantiasis are formed against the background of characteristic symptoms, depending on the localization of the primary neoplasm, combined with common manifestations: weakness, weight loss, lack of appetite. In addition, chyluria can be observed with the germination of the thoracic duct in patients with lung cancer.
Violation of lymph circulation with the subsequent development of chyluria is noted with closed injuries of the chest and lumbar region, inflammatory infiltrates, scarring after tuberculosis. Sometimes the cause of damage to the duct, followed by scarring and narrowing of the lumen, is penetrating wounds and surgical interventions on the organs of the chest cavity. Chyluria is also detected in some patients with aortic aneurysm.
Lymphoscintigraphy
Determining the causes of chyluria is the responsibility of lymphologists. In small settlements where there are no such specialists, the examination is carried out by phlebologists. Patients may need to consult an infectious disease specialist, oncologist or phthisiatrician. The laboratory symptom is confirmed according to the clinical analysis of urine. The presence of chyluria is often recognized with the naked eye, for an accurate determination, the liquid is settled and the sediment is microscopy.
If filariasis is suspected, a swab or thick drop of blood is examined for microfilariae. According to the indications, a biopsy of the lymph nodes and skin is carried out, followed by a morphological analysis. Perform immunological tests (ELISA, RSK, RPGA). The list of imaging techniques may include ultrasound of the kidneys and bladder, ultrasound of the abdominal cavity and small pelvis, X-ray of the chest. To assess the state of the lymphatic system, lymphoscintigraphy, X-ray lymphography, CT, MRI are performed.
With lymphostasis, an elevated position of the limb, compression bandaging, and lymphatic drainage massage are recommended. Patients with filariasis are hospitalized, ditrazine is prescribed for deworming, the effect is assessed by repeated laboratory tests of smears for helminths. In the presence of an allergic component, corticosteroids and antihistamines are included in the treatment regimen.
Patients with malignant tumors are prescribed radiation therapy, chemotherapy. Depending on the localization and prevalence of the oncological process, conservative methods are used separately or in combination with surgical operations. If the cause of compression of the lymphatic tract is an inflammatory infiltrate, anti-inflammatory drugs are used.
With lymphedema, tunneling is performed, the imposition of lymphovenous anastomoses. With dropsy of the scrotum against the background of filariasis or compression of the lymphatic ducts, a puncture, Bergman or Winkelman operation is performed. Benign tumors are removed within healthy tissues. Patients with malignant neoplasms undergo extended interventions.