Abstract: TH-PO0827
Milky Urine: A Rare Case of Nephrotic-Range Proteinuria from Chyluria
Session Information
- Glomerular Case Reports: Potpourri
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Correa, Simon, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Mount, David B., Brigham and Women's Hospital, Boston, Massachusetts, United States
Introduction
Chyluria—chyle in the urine—is a rare cause of post-renal proteinuria. Chyle contains triglycerides, chylomicrons, and various proteins (including albumin), giving urine a milky-white appearance. We present a case of AKI, nephrotic range proteinuria and milky urine.
Case Description
A 67-year-old male with APLS, lymphedema, diabetes, a prior perinephric hematoma, and recent proctocolitis admission presented with 4–6 weeks of right flank pain, dysuria, and foul-smelling, turbid white urine (Fig 1A). Labs showed AKI (creatinine 1.47 mg/dL from baseline 0.8–1.1), nephrotic-range proteinuria (UPCR 13.4 g/g), albuminuria (UACR 5.8 g/g), and hypoalbuminemia (3 g/dL). Lipids were normal on atorvastatin 40 mg daily. He reported frequency (10–20x/day), urgency, urinary hesitancy, and expulsion of gelatinous/bloody material (Fig 1B). Serologic workup showed ANA 1:320, negative dsDNA, ANCA, anti-GBM, anti-PLA2R, SSA/B, normal C’, SPEP with an M-spike (0.28 g/dL) on a background of polyclonal immunoglobulins, IgG kappa monoclonal gammopathy, but normal κ/λ ratio (1.49). He had no travel history; Strongyloides IgG and T-spot were negative. Urine triglycerides were elevated (391 mg/dL). Lymphangiography showed contrast pooling in the right kidney (Fig 1C); cone beam CT demonstrated a lymphatic channel entering the right renal hilum near the upper pole with contrast in the collecting system (Fig 1D). AKI resolved after intravenous fluid administration. Lymphatic embolization was performed twice, resolving the chyluria.
Discussion
Chyluria is most often caused by Wuchereria bancrofti in endemic regions. Non-parasitic causes include trauma, surgery, malignancy, congenital malformations, or radiation. This case was idiopathic. His history of lymphedema, APLS (LA+), and a prothrombin II mutation raises questions about lymphatic thrombosis. Though chyle contains von Willebrand factor, fibrinogen and other coagulation factors, including FVIIa, the role of coagulation in lymphatic fistula formation is unclear and warrants further study.