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Pharmacotherapy for chyluria by subcutaneous injection with a somatostatin analogue

A 53-year-old Japanese women presented after having a milky urinary discharge for 6 months. Laboratory data showed slightly low serum protein and white blood cell counts. Cystoscopy showed a chylous urine jet from the left ureteric orifice and a retrograde pyelogram revealed a multiple pyelolymphatic fistulae (Fig. 1a). The cause of the chyluria was unknown, but parasitic and neoplastic causes were excluded by the patient’s history, negative Giemsa stain for microfilaria, a normal distribution on a lympho-scintigram and other clinical images. A somatostatin analogue (octreotide acetate, 100 μ g) was injected subcutaneously every 12 h (200 μ g/day) with no dietary restriction for 10 days, to evaluate the effect of the drug alone, and then with a low-fat diet for 10 days. This trial was undertaken after obtaining informed consent from the patient and permission from the ethics committee of our institution. The significant protein and triglyceride loss in the urine was reduced with no dietary restriction, and as efficiently when on the diet (protein loss 4.8 g/day to 0.5 g/day; triglyceride loss 1.2 g/day to an undetectable level; Fig. 2). A retrograde pyelogram after treatment showed regression of the pyelolymphatic fistulae (Fig. 1b). The gastric fullness, nausea, headache and transient sinus bradycardia (45–50/min), treated effectively by a simple remedy, were noted as minor side-effects, but no serious complications occurred. The nutrient loss continued to some degree at the 2-month follow-up.