Chyluria

　　It is currently considered that the cause of chyle urine is the obstruction of the thoracic duct, local lymphatic inflammation and damage, leading to changes in lymphodynamics, lymph fluid entering the urinary tract, and the occurrence of chyle urine. In addition, a portion of patients are related to the epidemic of Bancroftian filariasis, due to the entry of filaria into the lymphatic vessels, causing lymphatic vessel damage.

　　The causes of chyle urine can be divided into two major categories: 1. Non-parasitic causes such as tuberculosis, malignant tumors, etc., which widely invade the retroperitoneal lymphatic vessels and lymph nodes, causing destruction or obstruction, and are relatively rare. 2. Parasitic causes, the vast majority of which are due to filariasis. It is currently believed that chyle urine is a common complication of Bancroftian filariasis, which can occur in both the acute and chronic stages; Chinese data prove that malay filariasis can also have chyle urine and scrotal complications such as hydrocele and orchitis, but they are very rare.

　　Patients with this disease may experience recurrent lymphangitis, lymphadenitis, and fever due to an increase in the content of chyle microparticles in the urine, manifested as enlargement, tenderness, and redness of the lymph nodes, and the appearance of a reticular red line during lymphangitis. The chronic stage is lymphedema and elephantiasis. In severe cases, due to increased cardiac load, myocarditis, lower limb or scrotal edema, psychiatric symptoms, and even exhaustion may occur.

　　Patients often have a history of residence in an area with filariasis or a history of filariasis infection. The urine is milky white, soy sauce-colored, or mixed with chyle clots, with floating fat droplets after standing. It usually presents as intermittent attacks, and severe cases can be persistent, lasting for several days or weeks. It is often triggered or exacerbated by high-fat diet, fatigue, and catching a cold. There may be unilateral or bilateral lumbar back soreness or dull pain, and sometimes renal colic may occur due to the blockage of the ureter by chyle clots and blood clots. If the urethra is blocked, it can also cause difficulty in urination or urinary retention. Chronic recurrent chyle urine can lead to symptoms of malnutrition such as fatigue, weight loss, edema, and anemia.

　　Chyle urine is a chyle formed by the absorption of nutrients by the intestines, which reverses to the lymphatic vessels of the urinary system due to the blockage of the lymphatic vessels, causing an increase in pressure, varicose rupture, and the chyle flowing into the urine. It contains protein, fat, and lymphocytes. How can chyle urine be prevented? The following experts introduce the preventive measures for chyle urine:

　　1. Prevention and elimination of mosquitoes

　　Cut off the routes of transmission and eliminate the breeding places of mosquitoes. It is best to use mosquito nets during the season with many mosquitoes; when working outdoors, pay attention to apply mosquito repellent oil, mosquito repellent, and other repellents to the exposed skin, and the head can be covered with a mosquito net made by soaking cotton thread in 701 mosquito repellent oil.

　　2. General survey and treatment

　　A general survey of the population over 1 year old in the epidemic area during summer is conducted, with a requirement for more than 95% of the residents to accept blood collection. Early detection of patients and carriers, timely treatment, ensures people's health and reduces and eliminates the source of infection. In winter, general treatment is carried out for those with positive microfilaria or negative microfilaria but with a history and signs of filariasis.

　　3. Epidemiological monitoring

　　Strengthen the epidemiological monitoring of areas that have reached the basic elimination criteria for filariasis.

　　4. Protect susceptible populations

　　In the epidemic area, the dipterex salt therapy is adopted, with 3g dipterex added to each kilogram of salt, an average of 16.7g of salt per person per day, containing 50mg of dipterex, used for half a year, which can reduce the positive rate of microfilariae in the population.

　　The pathogenesis of chyle urine is currently believed to be obstruction of the thoracic duct, local lymphatic vessel inflammation and damage, leading to changes in lymphodynamics, lymph fluid entering the urinary tract, and causing chyle urine. Then, what kind of laboratory tests are needed for patients with chyle urine disease? The following experts introduce the laboratory tests required for chyle urine:

　　1. Urine test:After the urine is placed in a glass container and allowed to stand, it can be divided into three layers: the upper layer is white lipid, the middle layer is chyle lumps, and the lower layer is red. The urine protein is positive, and the chyle test is positive (the turbidity disappears after adding ether to the urine sample and centrifugation, and a fat ring is formed on top), and the microfilaria examination in the urine can be positive.

　　2. Blood test:Blood drawn at night can detect microfilariae, and the white blood cell count increases during the acute stage, with a significant increase in eosinophils.

　　3. Cystoscopy:Instruct the patient to consume high-fat foods such as fried eggs and heavy oil fried rice 2-3 hours before the examination, and increase activity, check immediately when the urine turns milky white to observe from which side the chyle is ejected from the ureteral orifice. In addition, retrograde ureteral catheterization can be performed to collect renal pelvis urine for microscopic examination and chyle test, and obvious renal pelvis lymph reflux can be seen during retrograde pyelography.

　　4. Lymphography:It can show the location, number, and extent of pathological communication between the lymphatic system and the urinary tract, usually using retrograde lymphography through the lower limb lymphatic vessels; during normal lymphography, there is no contrast agent in the renal area, and the ipsilateral renal hilum lymphatic vessels in patients with chyle urine can show tortuous expansion, and the outline of the renal pelvis and calyces can be seen; retroperitoneal lymphatic vessels are uneven in thickness, even呈 bamboo joint-like, and lymph nodes may have defects in filling.

　　Patients with chyle urine should have a light and nutritious diet, pay attention to dietary balance, and avoid spicy and刺激性 food to prevent the recurrence of the disease. For example, seafood, chicken, dog meat, and other foods. At the same time, do not avoid spicy foods. Eat more fresh vegetables and fruits; fresh vegetables and fruits contain a large number of nutrients required by the human body. Eat more foods that enhance immunity to improve the body's resistance to diseases.

　　Chyle urine refers to the liquid fat saponified after the chyle absorbed from the intestines cannot be drained into the blood through the normal lymphatic channel, but reverses into the lymphatic vessels of the urinary system, causing increased pressure, varicose veins, and rupture of the lymphatic vessels. The chyle leaks into the urine, causing the urine to appear milky white. Depending on the amount of chyle, the urine can be milky white with a thick curd-like consistency or slightly turbid. Then, how to treat chyle urine? The following experts introduce the treatment methods for chyle urine:

　　1. Conservative Treatment

　　Since chyluria has a high natural remission rate, some patients do not need special treatment and can stop spontaneously. During the attack, patients should rest in bed, avoid fatty and oily foods and vigorous activities, drink plenty of water; they can also take medium-chain triglycerides such as medium-chain triglycerides (MCT) instead of ordinary edible oils and fats. The dosage of MCT for adults is: 4-5g, 3 times a day, 1 month as a course, and can be taken for 2-3 courses consecutively.

　　2. Treatment for the Pathogen

　　For those found to have microfilariae in peripheral blood or urine, the first step should be to perform insecticidal therapy, with diethylcarbamazine citrate (Hetrazan) as the effective drug, generally using a medium-term therapy; those with blood positivity can take 3 courses consecutively, and most patients will turn negative.

　　3. Renal Pelvis Perfusion Therapy

　　Apply 10ml of 0.1% to 0.5% silver nitrate or 12.5% sodium iodide solution slowly into the renal pelvis, use刺激性药液 to promote the closure of the chylous fistula, infuse once every 2 to 3 days to 1 week, the method is relatively simple, but it is prone to recurrence after a certain period of time; another is that if the pressure is too high during the infusion under local anesthesia, the patient may experience severe pain in the lateral腰部 or even shock. Renal pelvis perfusion therapy has risks, as Lu Gongcheng et al. found in rabbit renal pelvis perfusion experiments that the perfusion fluid (hydrogen peroxide, methylene blue) was too much and perfused too quickly into the veins, even into the right heart.

　　4. Extracorporeal Shock Wave Therapy

　　When using extracorporeal shock wave therapy to treat patients with kidney stones, some people accidentally found that the patient's chyluria, which had lasted for nearly 20 years, was cured. Inspired by this, they treated 113 patients with chyluria with extracorporeal shock wave therapy, followed up for 5 to 9 years and 5 months, and 107 cases were cured (94.7%). The mechanism is unknown and requires further study.

　　5. Surgical Treatment

　　Early adoption of nephrectomy, renal capsule stripping, thoracic duct-hemiazygos vein anastomosis, and other operations has been abandoned due to the lack of theoretical basis or irrationality in surgical design, as well as the large damage and poor efficacy. At the same time, it must be noted that when evaluating the effectiveness of a surgical technique, the characteristics of intermittent发作 of chyluria and a high natural remission rate should be considered. Without long-term follow-up, it is difficult to judge the exact efficacy of a surgical technique.