Introduction: Chyluria is due to the passage of chyle into the urine. Injected sclerosant induces an inflammatory reaction in the lymphatics through pyelolymphatic fistula. This leads to chemical lymphangitis and oedema of the lymphatic channels. Eventually, blockade of the offending lymphatics and communicating lymphatic fistula occurred by fibrosis. With the help of Radionuclide Dimercapto succinic acid (DMSA), we can assess both the relative renal function and renal scars.
Aim: This study is done to look for any parenchymal scaring and renal dysfunction secondary to renal pelvis instillation of sclerosant (RIPS) and the role of DMSA in chyluria.
Material and methods: This is a retrospective study done from July 2017 to June 2020 in the department of Nuclear medicine Dr Ram Manohar Lohia Institute of Medical Sciences. A total of 59 patients, who underwent sclerotherapy for chyluria (from July 2017 to June 2019), were included in this study. Pre and post RPIS DMSA was done. We look for parenchymal scarring and function dysfunction on DMSA as a primary endpoint. Data were analyzed using software SPSS version 20(IBM SPSS Statistics for windows).
Result: The mean split renal function on the normal (unaffected) renal unit was 50.30%± 3.00 %, while that on the affected renal unit (instillation side) was 50.27%± 2.60%before RPIS (p=0.12). After instillation therapy, the mean split renal function of the normal side was 49.69%±3.00% while that of the affected renal unit was 49.07%±3.02% (p = 0.11). Overall, complications were noted in 18 patients (30.51%). Clavien-Dindo Grade-I complications include transient post-operative fever in five, dysuria in three, transient haematuria (managed with hydration) in six (11.8%) and raised serum Creatinine (1.9 mg %) and blood urea (80 mg %) in one patient each (2.9%) were observed. Grade-II complications including flank pain in two and pyelonephritis in one patient were recorded. These patients were followed for 1 year.
Conclusion: Our study showed no parenchymal and functional dysfunction on DMSA. So RPIS is safe and effective in chyluria patients.
Key words: chyluria, sclerotherapy, renal scarring, split renal function
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