CHYLURIA.
BY JAMES TYSON, A.M., M.D.
The term chyluria is applied to a condition of urine in which the secretion is admixed with fat in a minute state of subdivision, whence the urine acquires a milky or chylous appearance. The proportion of fat varies greatly between such as gives a mere opalescence to the secretion and that which makes it absolutely indistinguishable, in appearance, from milk, while even the characteristic odor and taste of urine are often wanting. The further resemblance of such urines to milk is found in the fact that, on standing, a cream-like substance rises to the surface. On the other hand, a spontaneous coagulation into a jelly-like substance containing fibrin proves an unmistakable relation to blood.
The chemical composition of such a urine, having a specific gravity of 1013 and neutral in reaction, is given by Beale,1 as follows:
| Water | 947.4 | ||
| Solid matter | 52.6 | ||
| Urea | 7.73 | ||
| Albumen | 13.00 | ||
| Uric acid | 0.00 | ||
| Extractive matter with uric acid | 11.66 | ||
| Fat insoluble in hot and cold alcohol, but soluble in ether Fat insoluble in cold alcohol Fat soluble in cold alcohol | 9.20 2.70 2.00 | 13.90 | |
| Alkaline sulphates and chlorides | 1.65 | ||
| Alkaline phosphates Earthy phosphates | 4.66 | ||
1 Urinary and Renal Derangements and Calculous Disorders, Philada., 1885, p. 73.
Such urines are of course albuminous, as will have been seen from the table. They therefore coagulate when boiled or on the addition of an acid. They also exhibit a tendency to spontaneous coagulation more or less complete, which is apt to be followed by later disintegration of the clot. The proportion of solids is larger than in ordinary urines.
Microscopically, the urine is found to contain, in addition to its usual elements, immense numbers of molecular particles easily soluble in ether, and therefore fatty in their composition. It may be rendered perfectly clear by the addition of ether, and again approximately milky after evaporating the ether and shaking the residue; but now the microscope shows the oil in the shape of oil-drops and not molecules. Oil-drops are also sometimes sparsely present in the fresh fluid, but the fatty particle is commonly molecular. Indeed, the molecules are commonly so small that an aggregated mass of them appears like a delicate cloud under the microscope, rather than a collection of individual particles. Blood-corpuscles may also be present, sometimes in sufficient quantity to produce a distinct pink coloration, but no unusual proportion of leucocytes is common. The pink tinge, and even an almost bloody appearance, is very apt to precede the chyluria. This bloody character sometimes gradually increases until the chyluria has become a hæmaturia, so that we have sometimes a chyluria spoken of as a first stage of hæmaturia. Tube-casts do not occur. Chyluria is seldom constant, and a specimen of urine passed a couple of hours after one white as milk may be, again, perfectly clear and in all respects natural. Thus, a second specimen, passed by the same patient as that of which the analysis is given above, was almost clear. It had a specific gravity of 1010 and a slightly acid reaction, and contained a mere trace of deposit, consisting of a little epithelium, a few cells larger than lymph-corpuscles, and a few small cells, probably minute fungi. Not the slightest precipitate was produced by the application of heat or addition of nitric acid. The following is Beale's analysis:
| Water | 978.8 | |
| Solid matter | 21.2 | |
| Urea | 6.95 | |
| Albumen | 0.00 | |
| Uric acid | .15 | |
| Extractive matter with uric acid | 7.31 | |
| Fat insoluble in hot and cold alcohol, but soluble in ether Fat insoluble in cold alcohol Fat soluble in cold alcohol | .00 | |
| Alkaline sulphates and chlorides | 1.45 | |
| Earthy phosphates | .15 | |