Chyluria is caused by the reflux of celiac fluid into the urine and has a varying degree of milky appearance. A urine chyluria test may be positive. If it contains more blood, it is called chyluria. Celiac disease is characterized by cloudy urine like milk, or like slop or soy milk, hence the name. The age of onset of celiac disease is highest between 30 and 60 years old. The cause of celiac disease is thought to be obstruction of the thoracic duct and inflammatory damage to the local lymphatic vessels, which leads to changes in lymphatic dynamics and the entry of lymphatic fluid into the urinary tract, resulting in celiac disease.
Causes
The cause of celiac disease is thought to be obstruction of the thoracic duct and inflammatory damage to the local lymphatic vessels, which leads to changes in lymphokinetics and the entry of lymphatic fluid into the urinary tract. In addition, some patients are associated with an epidemic of Haematochezia zoster, which causes damage to the lymphatic vessels due to the entry of filarial worms into the lymphatic vessels.
There are two major categories of celiac disease etiology.
(i) non-parasitic, such as tuberculosis and malignant tumors that extensively invade the retroperitoneal lymphatic vessels and lymph nodes, causing destruction or obstruction, which is relatively rare.
(2) Parasitic, most of which are due to filariasis. Nowadays, it is believed that celiac disease is a common complication of B. bancrofti, which can occur in both acute and chronic stages; domestic data prove that celiac disease can also have intra-scrotal complications such as celiac disease, syringomyelia and spermatorrhea, but the number is very small.
Symptoms
Patients often have a history of living in a filariasis endemic area or a history of filarial infection. The urine is milky or soy sauce colored, or interspersed with celiac clots that float upward in lipid droplets after resting. Mostly intermittent episodes, but in severe cases may be persistent, lasting several days or weeks at a time. It is often triggered or aggravated by high-fat diet, exertion, and cold. Unilateral or bilateral low back pain or dull pain may occur. Sometimes renal colic may occur due to obstruction of the ureter by celiac masses and blood clots; if the urethra is obstructed, difficulty urinating or urinary retention may also occur. Long-term recurrent episodes of celiac disease may present with symptoms of malnutrition such as weakness, wasting, edema, and anemia.
Differential diagnosis of common diseases
1, filariasis celiac disease caused by filariasis is one of the main symptoms of chronic filarial infection is the most common cause of celiac disease filariasis in the lymphatic system repeatedly cause lymphangitis a large number of fibrous tissue proliferation so that the abdomen extensive lymphatic tract thoracic duct obstruction caused by filariasis caused celiac disease often intermittently appear overwork pregnancy and childbirth is often the trigger can also persist.
2, celiac tuberculosis extensive celiac tuberculosis can involve the peritoneal cavity retroperitoneal lymphatic tract reflux into the urinary tract lymphatics cause celiac disease often combined with renal tuberculosis and celiac tuberculosis and renal tuberculosis often secondary to pulmonary lymph node tuberculosis.
Malignant tumors that originate or metastasize to the retroperitoneal mediastinum and other parts of the abdominal cavity can compress and obstruct the abdominal lymphatic tract or thoracic duct causing celiac disease.
4, Thoracic and abdominal trauma or major surgery is due to damage to the abdominal lymphatic tract or thoracic duct history can often provide a diagnosis.
5.Primary lymphatic duct disease is rare in early childhood due to congenital malformation of the thoracic duct or congenital hypoplasia of the extensive lymphatic vessels.
6, Other causes such as pyelonephritis glomerulonephritis pregnancy compression malaria etc. can occasionally cause celiac disease only a few cases have been reported in the literature.
Diagnosis
1.Inquire in detail whether there is a history of living in a filariasis endemic area, or a history of tumor, tuberculosis, chest and abdominal trauma, recurrent episodes of milky urine with hematuria, whether it is induced or aggravated after a high-fat meal or exertion, whether there are other symptoms of filariasis, what kind of treatment has been given, and how effective it is.
2, urine examination urine can be divided into 3 layers after resting in a glass container: white lipid in the upper layer, celiac lump in the middle layer, and red and white blood cells in the bottom layer. Positive urine protein. Celiac disease test: turbid urine by centrifugal sedimentation turbidity does not disappear, after adding ether turbidity disappears, by Sudan III staining microscopic see yellow fat particles, called celiac disease test positive. If it is celiac disease caused by filariasis, microfilariae may be detected in the urine.
3. Blood tests can detect microfilariae in blood drawn at night. In the acute phase, the blood leukocyte count increases and the eosinophils also increase significantly.
4.Cystoscopy ask the patient to eat high-fat food, such as fried eggs and fried rice with heavy oil, 2-3 hours before the examination, and strengthen the activity. When you see the urine is milky white, immediately carry out the examination to observe the celiac disease from the ureteral orifice on which side of the spray. In addition, retrograde ureteral cannulation is also feasible to collect pelvic urine for microscopy and celiac test. Lymphatic reflux of the renal pelvis is evident on retrograde pyelogram.
5. Lymphography can show the location, number and extent of pathological traffic between the lymphatic system and the urinary tract. Transdorsal pedicle lymphography is usually used. In normal lymphography, there is no contrast in the kidney area. In celiac disease, the affected side may show tortuous and dilated renal lymphatic vessels and the outline of the pelvis and calyces; the retroperitoneal lymphatic vessels may be uneven in thickness or even bamboo-like; the lymph nodes may have filling defects.
Treatment
Conventional treatment
1. If blood tests prove filariasis, medication should be given.
2.During the attack, bed rest should be taken in a head-low, foot-high position, and a low-fat, high-protein, high-vitamin diet should be given.
3.If celiac block causes urethral obstruction, it can be flushed via cystoscopy.
4, 1% to 2% silver nitrate solution 5m1 irrigation of the renal pelvis, retained for 2 to 3min and then flushed with saline, interval 1 to 2 weeks to implement once.
5.Chinese herbal medicine treatment is often based on Capsicum, with the addition of red peony, chapters, yellow essence, dioscorea, fenugreek, jasmine, which can be infused or decocted.
6, recurrent severe disease, and the above treatment is ineffective, surgical treatment can be performed, including lymphatic duct stripping ligation around the kidney, lumbar stem lymphatic duct – internal spermatic vein (or ovarian vein) anastomosis.
Western medical treatment
In the past, 10% silver nitrate solution was used for intrarenal pelvic perfusion, which has certain effect, but it is easy to recur. Surgical treatment is to cut off and separate the lymphatic vessels of the kidney, or to anastomose the lumbar lymphatic vessels with the lumbar lymphatic trunk, or to anastomose the saphenous vein with the inguinal lymph nodes, etc. After surgery, there are also recurrences, and the surgery is more complicated.
Health care
1.Avoid excessive fatigue, take more rest and do not exert yourself.
2, avoid over-eating spicy (fishy), greasy and soy products, and many fruits are not suitable for those with spleen Yang deficiency, kidney Yang deficiency and cold dampness.
3, the diet should be light, such as: rice porridge, red date glutinous rice porridge, noodles, bread, etc.
4, other: vegetables, mushrooms, lotus seeds, fungus, yam, etc., fruits such as cantaloupe, watermelon, pear, apple, coconut, pineapple, etc. can be eaten in moderation, only orange can still be eaten, with ginger and dates of the agent drink better.