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Angiotensin-Converting Enzyme Inhibitors and Chyluria
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TO THE EDITOR:
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 mol/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.
Alejandro E. C. Saleh
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
