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Patient was given symptomatic treatment in addition to di-ethyl carbamazine but chyluria was still persisting. To knowwhether it was due to lymphourinary stula of larial originor there were other causes, urine and blood were again sentfor presence of microlaria on 10
day of diethyl carbam-azine therapy. Centrifuged urine revealed microlaria (
). Blood examination also showed presence of microlaria(
Figure 4 & 5
)As there was no improvement of chyluria, the patient wassent to urology department and they had operated andclosed the communication. Patient became symptomaticallybetter with control of chyluria and was discharged with al-bendazole for 2 weeks.
In the endemic areas, up to 10% may be aficted by la-riasis .Chyluria is a state of chronic lymphourinary reuxvia stulous communications secondary to lymphatic stasiscaused by obstruction of the lymphatic ow. Chyluria occursonly in 2% of larial aficted patients in the larial belt. Ifthe obstruction is between the intestinal lacteals and thoracicduct, the resulting cavernous malformation opens into theurinary system forming a lymphourinary stula. Once such astula is formed, intermittent or continuous chyluria occurs.Milky urine is also produced by urates, which clear on heatingor phosphates, which clear on adding 10% acetic acid .Other causes of chyluria may be parasitic (Filariasis, Echinococ-cosis,
, malarial parasites,
) ornonparasitic (congenital lymphangiomas of the urinary tract,tuberculosis, reteroperitioneal abscess and neoplastic inltra-tion of retroperitional lymphatics, trauma and pregnancy).The most useful roentgenographic procedure in delineatinglymphatic channels in patients of chyluria is lymphangiogra-phy, which is diagnostic to visualize the lymphourinary stula,particularly when surgical intervention is planned. Radionu-clide lymphoscintigraphy has been claimed to be a noninva-sive technique in the diagnosis and management of chyluria.In our patient, chyluria was the chief complaint and hema-turia due to rupture of minute blood vessels at the stuloussite, weight loss, malnutrition cachexia (
) were alsopresent. Loss of proteins in urine may add to the malnutrition.Microlaria positivity in urine has been variously reported as40- 75%  & could not be demonstrated in our patientat rst but DEC provocation test is 80% as efcacious indemonstrating microlaremia and that’s why it was detectedafter DEC therapy.The lipid contents of chyluria are mainly chylomicrons, 90%content of which is in the form of triglycerides as in ourpatient.The whole blood immunochromatographic card test (ICT cardtest) to detect larial antigen has shown several advantageswhen compared to thick blood lm. The sensitivity of theICT card test is 94.7% and in the endemic area, the pos-sible range of the specicity is from 72.4% to 100% .Our patient was a case of antigen negative lariasis. Morestudies evaluating the performance of the whole blood cardtest are necessary to verify indices of accuracy under differ-ent diagnostic criteria, for instance, considering faint lineseither as a positive or negative result. It would be useful ifthe manufacturers could give more specic details about themethod and antigen applied in the test, as well as furtherinformation related to the correct interpretation of the testsin the case of extremely faint lines. The management of cases of chyluria includes bed rest, highprotein diet, drug treatment (diethycarbamazine) and useof abdominal binders, which is claimed to prevent the lym-phourinary reux by increasing the intra-abdominal pressure.Clearance of microlara by DEC therapy did not appear toreverse the type of lymphatic pathology observed in micro-laraemic subject 
Surgical management is indicated incases of recurrent clot-colic, retention of urine and progres-sive weight loss despite conservative treatment, especially inchildren. The cornerstone of management of chyluria is renalpelvic instillation sclerotherapy. Surgical alternatives includeopen or laparocopic chylolymphatic disconnection.
The authors declare that there is no competing interests exist.