title: Chyluria: a mimicker of nephrotic syndrome.
abstract: OBJECTIVE
  Chyluria can be confused with nephrotic syndrome when massive proteinuria is present on urine examination during evaluation of a milky/white urine. Our objective was to attempt to resolve diagnosis in the case of nephrotic range proteinuria when there is no clear evidence of a significant kidney lesion.
  
  
  METHODS
  Retrospective review of the medical records of all patients referred the nephrology department at a single institution.
  
  
  METHODS
  We identified a subgroup of patients misdiagnosed with nephrotic syndrome and treated aggressively with immunosupression with no benefit and who were later diagnosed as having chyluria.
  
  
  RESULTS
  Twelve patients were identified (8 men, 4 women) with a median age of 34.5 years. Chyle was positive in the urine in eight while chyle was positive on oral ingestion of butterfat in another 4. Six had undergone kidney biopsy and were treated as having minimal change disease. Eight had massive proteinuria and a history of treatment with prednisone, but none of these patients had shown improvement in their clinical presentation. Two patients showed excellent results with diethylcarbamazine with angiotensin-converting enzyme inhibitors in while eight required betadine instillation in the fistulous connection with success in six. Surgical correction was successfully tried in two of these resistant cases.
  
  
  CONCLUSIONS
  In individuals with nephrotic range proteinuria with a normal or low lipid profile status along with normal serum albumin levels, urine color and nature, frequency, and checking the urine for chyle can help identify the large subgroup who unnecessarily have to undergo kidney biopsy and at times are treated with immunosuppression, which is not only life threatening but useless in these patients.
authors: Type IV-40, Sanjay Gandhi, Post Graduate Institute of Medical Sciences Campus, Lucknow, Uttarpradesh, India. anupa@sgpgi.ac.in
authors: Anupama
authors: A
authors: Kaul
authors: Dharmendra
authors: D
authors: Bhadhuria
authors: Sanjay
authors: S
authors: Bhat
authors: R K
authors: RK
authors: Sharma
authors: Ritu
authors: R
authors: Karoli
authors: Amit
authors: A
authors: Gupta
authors: Narayan
authors: N
authors: Prasad
mesh_terms: D000328:Adult; D001706:Biopsy; D002913:Chyle; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000473:pathology / Q000652:urine*; D008297:Male; D009404:Nephrotic Syndrome / Q000175:diagnosis; D012189:Retrospective Studies
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