ABSTRACT
UNLABELLED: Chyluria is an inappropriate urinary excretion of chyle that turns the urine milky. A nutritional approach based on low-fat/high-protein content diet associated or not with medium-chain triglyceride (MCT) showed to be an efficient conservative treatment to improve the milky urine appearance in a patient with chyluria. CASE REPORT: A 30-year-old female patient was admitted with chyluria of unknown etiology. An ureteropyeloscopy revealed a single lesion in each kidney, both with linear aspect and measuring 5 mm in extension. These lesions were located close to the renal papillae and were leaking a cloudy and milky fluid. Both lesions were laser cauterized followed by improvement of the milky urine. However, the chyluria relapsed after few months and a low-fat/high-protein content diet with 10 g of soybean oil to meet the requirements essential fatty acids (EFA) and with MCT from coconut oil as alternative to prepare foods was started. Few weeks later the patient returned reporting consistent improvement of the milky urine appearance related with the use of the diet. However since the diet was tasteless and time consuming to prepare, she reported low compliance to diet with MCT and the milky urine relapsed. The MCT was discontinued and the diet with EFA source was maintained with better compliance. Since then the chyluria remains in remission. In conclusion, the dramatic improvement of the milky urine with low-fat/high-protein diet with EFA source observed in our patient demonstrates that this nutritional approach is efficient with fast results to treat chyluria during long term.
Subject(s)
Chyle , Dietary Fats/administration & dosage , Dietary Proteins/administration & dosage , Adult , Coconut Oil , Diagnosis, Differential , Female , Glomerulonephritis/diagnosis , Humans , Plant Oils/administration & dosage , Proteinuria/etiology , Soybean Oil/administration & dosage , UrineABSTRACT
O hiperparatireoidismo secundário é uma complicação comum nos pacientes com doença renal crônica(DRC), influenciando a morbidade e a mortalidade desses pacientes. Estratégias clínicas de tratamento nem sempre alcançam o resultado esperado, e freqüentemente recorre-se ao tratamento cirúrgico, aparatireoidectomia. Os avanços no conhecimento da fisiopatologia do hiperparatireoidismo secundário influenciam as condutas clinicas e cirúrgicas. O número de pacientes necessitando de tratamento cirúrgico tem aumentado assustadoramente. A paratireoidectomia cirúrgica tem sido utilizada amplamente, entretanto, é necessário definir o melhor tratamento baseando-se em evidências. A paratireoidectomia farmacológica representa uma novapossibilidade terapêutica, porém, com resultados ainda bastante controversos. Este trabalho apresenta um panorama histórico da literatura vigente, visandomelhor padronização das condutas e do seguimento dos pacientes, além de estimular novos centros e grupos de estudo a se lançarem no tratamentocirúrgico.
The secondary hyperparathyroidism is a common complication of chronic kidney disease, having an influence on mortality and quality-of life of patients. Clinical strategies of treatment not always reach the expected results, and the surgical treatment, parathyroidectomy, is frequently necessary. The progress inknowledge of pathogenesis, histopathology and pathophysiology of secondary hyperparathyroidism in chronic kidney disease has substantially influenced the decisions regarding the surgical procedures. The number of patients demanding surgical treatment increased considerably. The surgical parathyroidectomy has been broadly described, however, an evidence based best way of treatment is still missing. Nowadays, the pharmacological parathyroidectomy appears as a new possibility of treatment, but data are still very inconsistent. This paper presents a brief historical report with a focus on the best way to treat patients based on the literature suggesting a better standardization of follow-up and treatment. It also encourages new centers to assemble groupsdevoted to study the subject and to accomplish the surgical procedures.
