Chyluria.
Definition:—A condition of milky urine, due to the presence of chyle or fat in the urine.
Etiology:—The condition is more common in tropical climates, and is due usually to parasitic origin. However, it is often caused by other conditions. That which obstructs the larger branches of the thoracic duct or injures the lymphatics, or results in a rupture of the renal lymph vessels, may act as the cause. It may occur during pregnancy. It is caused by the presence of the filaria sanguinis hominis.
Symptomatology:—The appearance of the urine is the first symptom. The urine is turbid and of a milky hue. Upon standing, a layer of fat particles rises to the surface, while a sediment usually forms which contains fibrin. This usually coagulates.
Diagnosis:—An analysis of the urine will show the presence of a small quantity of albumin, and in parasitic cases there may be some blood. If the urine be thoroughly shaken with a small quantity of ether, the fat particles dissolve and the urine becomes clear. Microscopically examined, the appearance is that of milk, and there are innumerable granules and fat cells. Careful examination must be made of the blood for the filariae, which may be also found in the urine when hematuria co-exists.
Prognosis:—If the patient can be put into a normal condition of health, the chyle may disappear from the urine, but usually while the condition does not threaten the life of the patient, a prognosis as to a permanent cure is unfavorable.
Treatment:—The condition of the gastrointestinal tract must receive first attention. The stomach must digest and readily appropriate the food, which should be taken at first in rather limited quantity. Hydrastis, nux vomica, iron and quinin are among the available measures. Derangements of the liver must be met with small doses of iris or leptandra. Any evidence of a depraved condition of the blood must be met with the most direct alteratives, such as echinacea, berberis, stillingia, and occasionally with the potassium iodid.
