Lock D R, Hockenberry D, Cunningham J, Hahm K S, Kantor O, Schonfeld G
Am J Med. 1983 Aug;75(2):360-4. doi: 10.1016/0002-9343(83)91218-4.
The diagnosis and the clinical course of a 17-year-old white male with chyluria are reported. Cloudy, milky urine appeared spontaneously, in the absence of edema or any signs or symptoms of parasitic infection. Pedal lymphangiography demonstrated the presence of a lymphatic renal fistula, and digital subtraction angiography showed aneurysmal dilatation of the aorta at the level of the renal arteries. This case provided an opportunity to ascertain which of the forms of apolipoprotein B were present in lymph chylomicrons. Apolipoprotein B is needed for chylomicron secretion. It exists in several forms--B-100, B-74, B-48, and B-26. After a meal consisting of fat, chylomicrons in which apolipoprotein B-48 was virtually the only apolipoprotein B present appeared in the urine, while apolipoprotein B-100 was the only apolipoprotein B present in the plasma very low-density lipoproteins. Chyluria disappeared two weeks after institution of a low-fat diet. This case illustrates an interesting, rare cause of chyluria. Because of the presence of chyluria, it was also demonstrated that chylomicrons in which apolipoprotein B-48 is virtually the only apolipoprotein B present are a physiologically normal product of the intestine.
本文报告了一名17岁白人男性乳糜尿患者的诊断及临床病程。患者出现浑浊、乳状尿液，无水肿或寄生虫感染的任何体征或症状。足部淋巴管造影显示存在肾淋巴瘘，数字减影血管造影显示肾动脉水平的主动脉呈瘤样扩张。该病例为确定乳糜微粒中存在哪些载脂蛋白B形式提供了契机。乳糜微粒分泌需要载脂蛋白B。它以几种形式存在——B-100、B-74、B-48和B-26。进食含脂肪餐后，尿液中出现几乎仅含载脂蛋白B-48的乳糜微粒，而血浆极低密度脂蛋白中仅含载脂蛋白B-100。低脂饮食两周后乳糜尿消失。该病例说明了乳糜尿一个有趣且罕见的病因。由于存在乳糜尿，还证明了几乎仅含载脂蛋白B-48的乳糜微粒是肠道的一种生理正常产物。
