Stanzial A M, Menini C, Casaril M, Baggio E, Corrocher R
Istituto di Patologia Medica, Policlinico Borgo Roma, Verona, Italia.
Presse Med. 1996 Feb 3;25(4):157-8.
Chyluria is the passage of chylus into urine resulting in fistulization through the lymphatic system and the urinary system. This rare condition is usually caused by filaria infestation or malformations, neoplasia or trauma. We report a case of a 18-year-old man. The patient presented milky urine which had appeared after angiography following minor leg trauma. Physical examination revealed asymmetry of the face and cutaneous dyschromia. Blood tests revealed hypogammaglobulinemia and altered CD4/CD8 ratio (0.6). Urine tests showed proteinuria (30 mg/dl), lipiduria (triglycerides 750 mg/dl) and density of 1025. Renal function was normal. Abdomen computed tomography and urography were normal. Cystoscopy revealed the presence of milky urine in the bladder and selective catheterization revealed that the origin was the right ureter alone. Ascendent pyelography did not reveal any malformation of the urinary tract; but after this the chyluria spontaneously disappeared. The patient was rehospitalized 3 months later for recurrence. Lymphography was then performed and revealed a dilated lymphatic network with minute lacunar images projecting into the right kidney. Chyluria again disappeared spontaneously and recurred sporadically over the next two years in a patient who remained in good physical condition. The etiology of chyluria in a patient without filaria infestation is problematic, particularly when the most common causes (tuberculosis, neoplasia, trauma) are excluded as in our case. The asymmetry of the face, together with cutaneous dyschromia and the presence of a subarachnoidea cyst in the right temporal region suggested our patient had multiple congenital malformations.
乳糜尿是乳糜液进入尿液，导致通过淋巴系统和泌尿系统形成瘘管。这种罕见病症通常由丝虫感染、畸形、肿瘤或创伤引起。我们报告一例18岁男性病例。该患者在小腿轻微创伤后血管造影后出现乳糜尿。体格检查发现面部不对称和皮肤色素沉着异常。血液检查显示低球蛋白血症和CD4/CD8比值改变（0.6）。尿液检查显示蛋白尿（30mg/dl）、脂尿（甘油三酯750mg/dl），密度为1025。肾功能正常。腹部计算机断层扫描和尿路造影正常。膀胱镜检查显示膀胱内有乳糜尿，选择性插管显示起源仅为右侧输尿管。逆行肾盂造影未发现尿路任何畸形；但此后乳糜尿自行消失。患者3个月后因复发再次住院。随后进行淋巴管造影，显示扩张的淋巴网络，有微小的腔隙影像投射到右肾。乳糜尿再次自行消失，并在接下来的两年中在身体状况良好的患者中偶尔复发。在无丝虫感染的患者中，乳糜尿的病因存在问题，特别是像我们病例中排除了最常见病因（结核、肿瘤、创伤）的情况。面部不对称，连同皮肤色素沉着异常以及右侧颞区蛛网膜下囊肿的存在提示我们的患者有多种先天性畸形。
