title: Successful treatment of massive proteinuria and severe chyluria by inhibition of cholesterol absorption with ezetimibe in a patient with filariasis.
abstract: We describe a case of filariasis presenting with severe chyluria and nephrotic-range proteinuria. There were no obvious findings of glomerulonephritis in the renal biopsy. Technetium-99m-human serum albumin (Tc-99m-HSA) lymphoscintigraphy revealed the presence of communications between lymphatic channels and the urinary tract. Ezetimibe (10 mg/day) was administered during hospitalization. Chyluria was decreased within a few days following the administration of ezetimibe. Moreover, a remission was obtained from nephrotic-range proteinuria. Tc-99m-HSA lymphoscintigraphy showed a reduction of lymph flow to the urinary tract three months later. In our patient, therapeutic intervention by ezetimibe may have resulted in a reduction of chylous lymph absorption from the intestine and the prevention of mucosal rupture into the renal pelvis and calyx via reduced intralymphatic pressure. Ezetimibe may be an effective and safe treatment for this indication, and should be considered when filarial patients present with chyluria and massive proteinuria before employing invasive surgical procedures.
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan ; Department of Integrated Therapy for Chronic Kidney Disease , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuruya
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tsuchimoto
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Eriguchi
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
keywords: chyluria; ezetimibe; filariasis; proteinuria