What is Chyle in Urine test? 

Chyle in urine test is performed to check for the presence of chyluria. Chyluria, also known as galacturia, is a condition characterised by a milky appearance of urine. The milky colour is due to the leakage of an odourless lymphatic fluid - Chyle - into the kidneys.

Chyle originally forms in the small intestine during the process of digestion before they are taken up by lymphatic vessels. It comprises proteins, fats and infection-fighting white blood cells and helps in transporting fats and proteins throughout the body. Chyle also plays some role in maintaining normal immune functioning.

Lymphatic vessels are a system of thin blood vessels like tubes that carry lymph - a colourless fluid that carries white blood cells. Together, they make the lymphatic system that works alongside the circulatory system. Normally, lymph vessels carry the lymphatic fluid to the veins where it enters the bloodstream. However, if there is a damage or disruption in the lymphatic flow, chyle will escape into kidneys and will show up in urine.

Chyluria is commonly associated with the parasitic infection caused by Wuchereria bancrofti. However, it can have non-infectious causes too. Chyluria occurs more commonly in men than in women.

The chyle in urine test checks for the level of fats such as triglycerides and cholesterol in the urine that correlates with the occurrence of chyluria.

  1. Why is a Chyle in Urine test performed?
  2. How do you prepare for Chyle in Urine test?
  3. How is Chyle in Urine test performed?
  4. Chyle in Urine test results and normal range

Your healthcare practitioner may order this test if you have the following symptoms:

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Your doctor may ask you to take a fat-rich diet a day or night before the test. This would help increase the levels of chyle in urine and so it is easier to detect. 

Ascorbic acid (vitamin C) can make your cholesterol and triglycerides levels to show up lower than normal in this test, so avoid the intake of vitamin C before the test.

Inform your doctor if you are taking any medications as certain medicines such as acetaminophen, N-acetylcysteine (NAC), and metamizole can give falsely decreased results.

Your healthcare practitioner will give you a special container for collecting a sample of your urine. He/she will explain to you the steps of the test. A clean-catch method is followed to prevent contamination of urine sample with germs from vagina or penis. The following procedure is followed:

  • Wash your hands properly with soap and water. 
  • Using sterile wipes, women should clean the area between the labia (vagina ‘lips’), and men should clean the head of the penis. 
  • Start urinating into the toilet bowl and stop midstream. 
  • Position the container and collect urine until the container it is half-full. 
  • Shut the lid of the container tightly.
  • Finish urinating into the toilet bowl and wash your hands properly. 
  • Label the sample and deliver it to the laboratory for testing.
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Normal results:

Normally, the level of triglycerides and cholesterol in the urine is <10 mg/dL (milligrams per decilitre).

Abnormal results:

A high triglyceride level (>10 mg/dL) indicates chyluria. The following conditions can cause chyluria:

  • Parasitic infections such as:
    • Wuchereria bancrofti (90%)
    • Malarial parasites
    • Ankylostomiasis
    • Trichiniasis
    • Taenia nana
  • Non-parasitic conditions such as:
    • Congenital (from birth)
    • Retroperitoneal lymphangiectasia (a malformation of the lymphatic system surrounding the kidneys)
    • Tumours (lymphangioma/lymphangiomatosis/lymphangioleiomyomatosis)
    • Obstruction of thoracic duct/lymphatics 
    • Urethral/vesical and traumatic lymphangiourinary fistulae (abnormal connection between organs or vessels)
    • Stenosis of thoracic duct (narrowing of the thoracic duct)
    • Other causes (pregnancy, diabetes, abscess)
    • Nephrotic syndrome

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Diamond E, Schapira HE. Chyluria--a review of the literature. Urology. 1985;26(5):427–431. PMID: 4060381.
  2. Children's hospital of Philadelphia [internet]. Philadelphia. PA. US; Chyluria
  3. Parrish CR. When Chyle Leaks: Nutrition Management Options. Practical Gastroenterology. 2004 May: 60-76.
  4. Sharma S, Hemal AK. Chyluria - An Overview. Int J Nephrol Urol. 2009;1(1):14–26.
  5. Germann CA, Holmes JA. Selected urologic disorders. In: Walls RM, Hockberger RS, Gausche-Hill M. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 89.
  6. Nicolle LE, Norrby SR. Approach to the patient with urinary tract infection. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 284.
  7. Kiresi D, Emlik D, Kivrak AS, Odev K. Retroperitoneal lymphangiectasia associated with mediastinal extension: Radiologic findings. European Journal of Radiology Extra. 2007 Aug;63(2):61–63.

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