Chyluria is the passage of milky white urine. The urine appears milky white as the chyle comprises albumin, emulsified fat, and fibrin in varying proportions.
It is due to abnormal communication between the lymphatic system and the pyelocaliceal system(kidney).
This condition is seen primarily in Africa and India. It is most common in the age group of 20-30. It affects males more than females, the ratio being (6:1). It mainly affects the left-sided kidney.
Chyluria occurs due to abnormal circulation of lymph fluid. The lymph fluid plays a significant role in immune function and fat and protein transport.
Chyluria’s appearance is intermittent and irregular. It may last several days, weeks, or even months. There can be triggering factors that make it reappear.
Chyluria can be a late manifestation of filariasis in most cases.
Chyluria is more prevalent amongst the rural population and is associated with lower socioeconomic status.
Parasitic causes affect the male mostly around 86%, and non-parasitic causes affect the men and women both in an equal distribution.
Pathophysiology of Chyluria
Chyle enters the urinary tract after the rupture of lymphatic channels into the urinary tract leading to the formation of a lympho-urinary fistula. This begins at the renal pelvis.
This occurs may be due to regurgitation of chyle into the urinary system or obstruction of a lymphatic system near the urinary tract leading to the formation of a fistula.
Types Of Chyluria
There are Three types of Chyluria based on the symptoms –
Mild Chyluria
The patient passes intermittent milky urine.
There is no weight loss or acute retention of urine.
They do not pass chylous clots.
There is the involvement of single calyx only in the affected kidney.
Moderate Chyluria
The patient passes intermittent milky urine.
There is no weight loss or acute retention of urine.
They pass chylous clots.
There is the involvement of 2 or more calyx in the affected kidney.
Severe Chyluria
There is a passage of continuous milky urine.
There is weight loss and acute retention of urine.
They do pass chylous clots.
Most of the calyx is involved with or without the involvement of the ureter.
Causes Of Chyluria
There are primarily two causes of Chyluria –Â
Due to parasites (primary)
Wuchereria bancrofti (90%)
Taenia echinococcus
Taenia nana
Ankylostomiasis
Trichiniasis
Malarial parasites
Due to non-parasites (secondary)
Congenital
Lymphangioma of urinary tract
Mega lymphatics
Urethral/vesical fistulae
Stenosis of the thoracic duct
Retroperitoneal lymphangiectasia
Traumatic lymphangiourinary fistulae
Obstruction of thoracic duct/lymphatics due to tumor, granulomas, aortic aneurysm, etc.
Other causes like pregnancy, diabetes, abscess, etc.
Nephrotic syndrome
Symptoms Of Chyluria
Chyluria is irregular and intermittent. It may last several days, weeks, or even months. Many factors can trigger its recurrence.
If the lymph channels are blocked, it opens into the kidney hilum or ureter
or bladder, and chyle leaks into the urinary tract resulting in milky urine.
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Passage of milky urine is the most common symptom
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Sometimes even chylous clots are passed in the urine. This leads to clot colic.
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Passage of blood along with chyle.
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Dysuria (pain while passing urine), frequency, and urgency are marked.
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Acute urine retention
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Fever, weight loss, back pain.
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Filariasis affects the male private parts
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Lower limb oedema (swelling)
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5% of cases present with cellulitis, abscess, and hematuria.
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Renal colic
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Backache
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Recurrent urinary tract infection
Complications of Chyluria
Usually, the condition is self-limiting, but if left untreated in chronic diseases or prolonged state, it may lead to
Malnutrition
Fat-soluble vitamin deficiency.
Lymphocytopenia
Opportunistic fungal infection
Giving rise to malignant tumors due to suppression of cellular immunity.
Diagnosis of Chyluria
Urine examination:
urine is milky white, and when allowed to stand, it separates into three layers of fat, the middle layer of fibrin, and lower cells.
Urine is also examined for the presence of any bacteria, parasites like wuchereria, etc.
The presence of triglycerides confirms the presence of albuminuria in urine.
Complete blood count
- It shows raised eosinophils.
- Total lymphocyte count is also raised.
- ELISA TEST is done to detect filarial antibodies.
- Liver function test shoes hypo albumin levels.
Other investigations like USG, CT SCAN, MRI are recommended but not very routinely.
Technical procedures are done to know the site of the lesion, where is the backflow, and to find out the other related causes, which includes
- Cystourethroscopy
- RGP
- Lymphangiography
- Lymphangioscintigraphy
Management Of Chyluria
The disease goes into spontaneous remission in 6 months. In mild cases, conservative treatment has been proven to be sufficient. But in cases of severity, conservative management and medications are required to control the progress of the disease.
Conservative line of management
High fluid intake is recommended.
A high protein diet with multivitamins is necessary.
Leafy green vegetables with a fat restriction diet have to be followed.
Bed rest is recommended in case of lymphadenitis.
Some patients are advised to use an abdominal belt.
Medical management of chyluria
Analgesics for inflammation and antipyretics for fever are given to reduce the inflammation.
Ant filarial drugs like DEC, Ivermectin, albendazole are given.
Sclerotherapy is given to those patients where conservative and medical treatment has failed.
Finally, surgery is recommended when three courses of sclerotherapy have failed.
Homeopathic Medicines For Chyluria
Homeopathy can be of great use in the case of Chyluria along with conservative management. It can prove to be of great benefit in patients who want to avoid sclerotherapy or surgery.
Homeopathy helps a great deal by reducing the intensity and frequency of symptoms and slowly helps in establishing a cure.
Duration of treatment would depend upon the intensity of symptoms.
1.CINA: For Chyluria with involuntary urination at night
Symptoms:
It is suited to children who are big, fat, and rosy.
The child is of irritable temperament, ugly, cross, and wants always to be rocked. They desire many things, but when offered, they reject them.
They do not like to be touched or looked at. Their skin is sensitive to touch.
The children are restless and toss about.
The children are always hungry and emaciated. They smell sour.
The children pass urine which is turbid, white, milky, or turn milky on standing.
They tend to bed wet, which worsens every full moon.
The complaints worsen from worms, at night, in sun and summer.
Dosage and potency:
30C, 200C potency can be given to children. Repetition would depend on the susceptibility of the child.
2.COLOCYNTH: For Chyluria with pain all over abdomen on urination
Symptoms:
It is suited to easily angered, irritable, and who has a tendency for obesity.
And also, women who are prone to sedentary habits and are affected with profuse menstruation.
The complaints are brought on due to harmful effects of anger, resentment, chagrin, grief, catching a cold, and excessive sexual indulgence.
The patient is prone to pain all over the abdomen on urination. The urine is gelatinous, sticky, and stringy.
Urine is milky white and coagulates in standing.
They are susceptible to cystospasm after operation at the urethral orifice.
They have pain in the kidney region with excessive passage of urine. And the urethra burns when the patient passes stool.
Dosage and potency:
30C, 200C potency can be used with frequent repetition depending upon the state of the patient.
3.CONIUM: For Chyluria with intermittent urination
Symptoms:
It is suitable for women who are tired of life, broken down, and discouraged.
Their complaints are brought on due to effects of contusions, blow, overstraining, overwork, and grief. They experience progressive debility.
In such patients, there is great difficulty in passing urine. It flows and stops again; there is an interrupted discharge.
They can pass urine only on standing. The urine feels too hot. They have a cutting and burning sensation after urination.
The patient experiences difficulty in passing urine in the beginning; even while standing then it flows freely.
Dosage and potency:
1M and higher potencies are best suitable but in infrequent doses.
4.DULCAMARA: For Chyluria with retention of urine
Symptoms:
This remedy is suitable for those individuals whose complaints are brought about exposure to cold and dampness.
It works wonderfully on people who work in ice-factory and men especially exposed to the constant change of temperature.
The patient is either prone to frequent urination, or there is acute retention of urine from cold or cold drinks.
The urine passed is cloudy, slimy, and smells very foul. The urine has thick, mucous purulent sediment.
The complaints worsen at night, cold, damp, rainy weather. They feel better from moving about and external warmth.
Dosage and potency:
30C, 200C potency can be administered, and repetition would depend upon the state of the patient.
5.IODUM: For Chyluria with frequent and copious urination
Symptoms:
It is suitable for overgrown boys with weak chests and aged people.
The individual is exceedingly thin, dark-complexioned, with enlarged lymphatic glands. They have a voracious appetite, and eating makes them feel better but still appear emaciated.
They are always tired; even the slightest effort brings on perspiration. The individual, when affected with Chyluria, suffers from frequent and copious urination.
The urine is dark, yellow-green, milky, with variegated cuticle on its surface. Milky white fluid runs from the urethra after stool.
Their complaints worsen when quiet, in the warm room, right side. They feel better by walking about in the open air.
Dosage and potency:
200C potency would be the best to be administered and shouldn’t be repeated frequently.
6.LILIUM TIGRINUM: For Chyluria with a constant desire to urinate
Symptoms:
This remedy is most often indicated in unmarried women.
The patient has a constant inclination to weep, and they get anxious about some incurable disease.
They are always aimless in a hurried manner and want to keep themselves busy always.
The patient has constant pressure on the bladder with a constant desire to urinate.
Along with constant desire, they have a sensation as of a ball in the rectum.
They pass urine which is milky, scanty, and hot.
If they do not pass urine, they feel congestion in the chest.
Dosage and potency:
200C, 1M potency acts best, and its action is slow to develop; hence one must not frequently repeat it.
7.PHOSPHORIC ACID: For Chyluria with burning in the kidney region
Symptoms:
This remedy is helpful to those young people who proliferate and are overtaxed physically and mentally.
Their complaints are brought on from acute diseases, sexual excess, grief, loss of vital fluids, grief, chagrin, injuries, shock, terrible news, etc.
The patient experiences burning in the kidney region.
They pass urine frequently, which is profuse, watery, and milky.
Female patients pass whey-like urine shortly before menses.
Before passing urine, the patient is highly anxious, and after passing urine, they have a severe burning sensation.
The patient has to pass urine frequently, mostly at night.
Their complaints worsen from exertion, being talked to, losing vital fluids, sexual excess, and feeling better by keeping themselves warm.
Dosage and potency:
30C, 200C potency can be administered with infrequent repetition.
8.PHOSPHORUS: For Chyluria with weakness
Symptoms:
It is suited to young people who proliferate and are inclined to stoop. They are optimistic people who are very nervous, delicate people and like to be magnetized.
When contract an illness begins, it begins insidiously, then gradually increases debility and then ends in rapid, severe diseases.
The complaints are brought on from anger, fear, grief, worry, drenched in rains, washing clothes, tobacco, iodine, excessive salt, etc.
In Chyluria, the patient passes profuse milky watery urine, which is then followed by weakness. Even when their bladder is complete, they do not get the urging.
Dosage and potency:
200C potency with infrequent repetition.
9.RAPHANUS: For Chyluria with yeast-like sediment
Symptoms:
The urine is copious and thick like milk.
The urine turns turbid with yeast-like sediment.
With nearly all complaints, the patient becomes sad and develops an aversion to children.
Dosage and potency:
30C potency 3-4 pills twice or thrice a day depending upon the state of the patient.
10.STILLINGIA SILVATICA: For Chyluria with white sediment deposits
Symptoms:
Urine is milky and thick, and deposits of white sediments are seen.
Sometimes the patient passes colorless urine.
The patient is gloomy and depressed, and they have a strong feeling that danger or trouble is coming.
The complaints worsen in the afternoon, damp air, motion, and feel better in the morning and dry air.
Dosage and potency:
Mother tincture 5-10 drops in a glass of water twice a day till improvement.
11.UVA URSI: For Chyluria with severe spasm of the bladder
Symptoms:
The patient has frequent urging with severe spasms of the bladder. They have burning and tearing pain in the bladder.
When examined, urine contains blood, pus, mucus with clots in large masses.
The urine is involuntary and green in color and is very painful while passing. Cystitis (inflammation of the bladder) with bloody urine is noted.
There is chronic vesical irritation with pain, tenesmus, and catarrhal discharges.
The patient has to burn after the discharge of slimy urine.
Dosage and potency:
Mother tincture 5-30 drops twice a day till improvement is seen.
12.VIOLA ODORATA: For Chyluria with a pungent smell
Symptoms:
It is suited to tall thin and nervous girls.
The patient experiences great nervous debility.
The patients tend to weep without knowing why.
The patient passes milky urine, which has a strong smell.
And in children, they to bed wet, especially the nervous children.
The complaints get aggravated in cloudy weather, cold air, music, during puberty, and if the discharges are suppressed.
Dosage and potency:
Mother tincture and 30C potency with frequent repetition can be administered.
13. SARSAPARILLA: For Chyluria with scanty urine
Symptoms:
The patients who require this medicine always present with renal colic and weight loss.
They are susceptible people who get easily affected by the slightest emotions.
Renal colic and pain while passing urine are even marked in children. The child screams before and while passing urine.
Renal colic is in the right kidney, and the pain travels downwards.
The urine passed is scanty, slimy, flaky, and sometimes even bloody. The patient experiences severe pain after urination.
They can feel that urine dribbles while sitting. The bladder is distended and tender(painful).
The patient has to cramp pain in the bladder, and they pass urine in a thin, feeble stream. They can also feel pain at meatus.
After urinating, the complaints worsen in dampness at night, when yawning, in spring, and before menses.
Dosage and potency:
Mother tincture and 30C potency with frequent repetition can be administered to the patient.
14. CANTHARIS: For Chyluria with painful tenesmus
Symptoms:
The kidney region is susceptible. Whenever the patient passes urine, there is burning, scalding, and cutting pain.
The patient has intolerable urging and fearful tenesmus or dribbling.
They even give bloody urine drop by drop. They have griping pain in the bladder.
Many complications arise due to Chyluria like acute nephritis, renal colic, cystitis, and swelling all over the body.
The bladder becomes paralyzed due to the retention of urine for a long time. The patient feels better in renal colic by giving pressure to the private part.
The patient passes urine drop by drop, which scalds him. They have a constant desire to urinate.
The urine is jelly-like, shreddy. And also, membranous scales like bran appear in the urine.
The complaints worsen on urinating, drinking cold water, or coffee. They feel better by rubbing.
Dosage and potency:
30C potency bears well with frequent repetition as per the state of the patient.
15. APIS MELLIFICA: For Chyluria in hydrocephalus
Symptoms:
The patient experiences severe burning during urination.
They have stinging pain during urination.
Urine is scanty and smells foul, and the last drop burns. This burning sensation remains for a long time.
Dosage and potency:
Mother tincture, 30C potency, can be administered to the patients. In edematous conditions always give lower potencies.
Sometimes the action is slow and takes several days before its motion is seen, and then the urine flow is increased.