乳び尿、乳糜尿

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/21 16:36:50」(JST)

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Chyluria, also called chylous urine, is a medical condition involving the presence of chyle in the urine stream,^[1] which results in urine appearing milky white.^[2] It is a condition that is more prevalent among people of Africa and the Indian subcontinent.

Chyluria appearance is irregular and intermittent.It may last several days, weeks or even months. There are several factors that trigger Chyluria recurrence.

Causes

Chyluria is often caused by filariasis due to the parasite Wuchereria bancrofti, a thready nematode which lodges the lymph channels.^[3] Another cause is pregnancy or childbirth. Patients claimed that Chyluria occurred after overwork. Mental tension, sadness, annoyance, anger etc. could also produce an attack of Chyluria.

In the United States, one of the most common causes is partial nephrectomy or thermal ablation of a kidney lesion.

Symptoms

Once the lymph channels are blocked, one may open into the kidney hilum or ureter or sometimes into the bladder and chyle can leak into the urinary tract resulting in milky white urine. Blood sometimes mixes with the urine resulting in haemato-chyluria.

Usually the condition is self-limiting and can sometimes lead to complications. If left untreated, chronic chyluria can lead to malnutrition and vitamin deficiency.

Treatment

An anti-filarial drug, such as diethylcarbamazine, may be prescribed. Severe damage to lymph channels may require surgery. Sclerotherapy with instillation of 1% of silver nitrate or povidone iodine (2ml of 5% + 8ml distilled water )

References

^ Chronic filariasis
^ 490012696 at GPnotebook
^ Dunavan, Claire Panosian (2008-05-22). "The white urine that held the key". Discover Magazine.

Campbell, Meredith Fairfax (1954). Urology 1.
Parasitology by das

UpToDate Contents

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1. リンパ管フィラリア症の診断、治療、および予防 diagnosis treatment and prevention of lymphatic filariasis
2. 腎疾患の診断における尿検査 urinalysis in the diagnosis of kidney disease
3. リンパ管フィラリア症の疫学、病因、および臨床症状 epidemiology pathogenesis and clinical manifestations of lymphatic filariasis
4. 肺リンパ脈管筋腫症 pulmonary lymphangioleiomyomatosis
5. リンパ管炎 lymphangitis

English Journal

Refractory chyluria due to filariasis.

Hagiya H1, Otsuka F2.
Infection.Infection.2015 Dec;43(6):785-6. doi: 10.1007/s15010-015-0804-8. Epub 2015 Jun 6.
PMID 26048257

Intranodal Lymphangiography in Chyluria.

Pua U1, Png KS2, Tan TS3.
Journal of vascular and interventional radiology : JVIR.J Vasc Interv Radiol.2015 Dec;26(12):1839. doi: 10.1016/j.jvir.2015.06.026.
PMID 26596177

A child with white urine: Answers.

Maji B1, Akhtar S1, Poddar S2, Sinha R3.
Pediatric nephrology (Berlin, Germany).Pediatr Nephrol.2015 Nov 24. [Epub ahead of print]
PMID 26604086

Japanese Journal

Pathogenesis and Treatment of Chronic Symptoms with Emphasis on Chyluria and Elephantiasis

TADA Isao
Tropical medicine and health 39(1), 47-50, 2011-03-01
NAID 10028116827

胆嚢癌術後に乳び尿を来し治療に難渋した1例

樋口亮太,太田岳洋,竹下信啓,梶山英樹,谷澤武久,小貫建一郎,矢川陽介,濱野美枝,新井田達雄,山本雅一
日本消化器外科学会雑誌 43(10), 1031-1036, 2010-10-01
症例は58歳の女性で,右肝動脈,門脈と胆管浸潤を伴う胆嚢癌に対し経皮経肝的門脈塞栓術後に肝右葉切除兼肝外胆道切除,門脈合併切除再建術を行った.大きな合併症なく術後26日目に退院したが,術後50日目頃より白濁尿が出現し,脱水,電解質異常のため再入院した.対症療法にて1度退院したが息切れと食思不振のため再々入院した.分腎機能検査にて左腎盂尿は正常であったが,右腎盂尿は蛋白2+/糖2+で,膀胱鏡で右尿管 …
NAID 110007730447