I read with interest the article by Keilani and colleagues [1], showing improvement of lipid abnormalities associated with proteinuria using the angiotensin-converting-enzyme (ACE) inhibitor fosinopril. It prompted me to describe the following patient. A 60-year-old woman had developed, 15 years earlier in Surinam, a filarial infection of the left leg. She was treated and recovered. In 1990, her urine became milky, and she was diagnosed as having chyluria secondary to the filarial infection. Several kinds of medication had been used unsuccessfully.

She was seen in September 1992 for the same problem. The results of her physical examination were normal except for slight lymphedema of the left leg. Laboratory results included: cholesterol level, 6.8 mmol/L; triglycerides, 1.4 mmol/L; albumin, 38.6 g/L; and creatinine concentration, 120 µmol/L. Her urine was milky (chyluria), with protein levels of 1.2 g/24 h, triglycerides of 28.5 mmol/24 h, and a creatinine concentration of 9.4 mmol/24 h. The urine sedimentation was normal.

She was treated with 5 mg of enalapril twice daily. After 6 weeks, her urine was completely clear with only a trace of protein. Her serum cholesterol level was 5.7 mmol/L, her triglyceride level was 1.1 mmol/L, and her albumin level was 38.2 g/L. Enalapril treatment was stopped, and chyluria appeared within 2 weeks. She was again given enalapril and showed the same response as described above.

It is well known that ACE inhibitors change intrarenal hemodynamics [2, 3]; as a consequence, one can postulate that they also might change the lymph circulation in the kidneys in a way that stops the leakage of lymph.

I could not find any literature on the use of ACE inhibitors in patients with chyluria and report this observation to alert physicians who might have the opportunity to study patients with chyluria to determine whether an ACE inhibitor really works.