LYMPHATIC DYNAMICS IN FILARIAL CHYLURIA AND PRECHYLURIC STATE - LYMPHOGRAPHIC ANALYSIS OF 52 CASES

Abstract

Chyluria is an abnormal urinary condition in which intestinal chyle appears in the urine as the result of fistulous communications between the lymphatic pathways (transmitting chyle) and the uriniry tract at, or beyond the level of the renal tubules either within the kidney, the renal pelvis or the urinary bladder.

Lymphatics of the kidney (Fig. 1) fall into three groups - (1) inter-tubular lymphatics - within the substance of the kidney; (2) sub-capsular lymphatics, and (3) perinephric lymphatics. Groups (2) and (3) communicate with each other and join the renal pelvic lymphatics (4) to drain into the superior mesenteric nodes (5). The intertubular lymphatics, coursing along and around the renal vascular pedicle and through the upper para-aortic nodes (viz.), superior mesenteric and coeliac nodes (6), terminate finally into the cisterna chyli (7). Many of the right renal lymphatics and a few from the left drain directly into the cisterna chyli (Fig. 9). Corresponding vessels from the left kidney drain mainly into the descending intercostal trunk (8) which joins the cisterna chyli. The pelvic and para-aortic lymphatics traverse the upper para-aortic nodes before draining into the cisterna chyli as right and left lumbar trunks (9). The intestinal lymphatics carrying chyle also course througb these nodes to terminate in cisterna chyli as gastrointestinal trunk (10). It may thus be noted that the three tributaries of the cisterna chyli (viz.) the right and left lumbar trunks and the gastro-intestinal trunk course through the upper para-aortic nodes prior to their termination into cistcrna chyli and these nodes also act as intermediary stations for the renal and renal pelvic lymphatics. Whenever there is an obstruction to the flow of chyle at the level of the upper para-aortic nodes - (as happens in filarial chyluria, due to fibrotic changes in the lymph nodes) - , the intestinal chyle being unable to course through these nodes takes a deviated retrograde course along the renal and renal pelvic lymphatics which become engorged with chyle and in due course the hydrostatic pressure in them increases to sufficient magnitude as to cause rupture into the renal tubules or into the renal pelvis with resultant escape of intestinal chyle into the urinary tract and its appearance in the urine.