Chyluria With Coexisting Minimal Change Disease: An Uncommon Clinical Association

Chyluria is a rare clinical entity defined by the presence of chyle in the urine, classically presenting as milky or cloudy urine. While typically associated with parasitic infections such as Wuchereria bancrofti in endemic regions, non-parasitic causes are less common and diagnostically challenging. We report the case of a 56-year-old male presenting with milky urine, dysuria, urinary hesitancy, and rectal discomfort. Urine triglyceride level was found to be >525 mg/dL (reference range <10 mg/dL). An extensive infectious and parasitic workup was negative. Renal biopsy revealed minimal change disease (MCD), a highly unusual finding in adult-onset chyluria. Although MCD does not cause chyluria, coexisting disease can contribute to urinary protein loss. This case highlights the importance of maintaining a broad differential diagnosis when evaluating urinary discoloration and emphasizes the rare intersection between glomerular disease and lymphatic-urinary communication. Early recognition of atypical presentations is essential to guide appropriate evaluation and prevent complications associated with chronic chyle loss.