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"code": "R82.0",
"name": "Хилурия",
"icd_name": "Хилурия",
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"lead": "наличие примеси лимфы в моче",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хилурия может быть следствием сообщения (свищ) между лимфатическими и мочевыводящими путями. Чаще всего лимфомочевая фистула возникает между крупными лимфатическими сосудами и почечной лоханкой (чашечками), реже отмечают вовлечение в патологический процесс мочевого пузыря. Чаще всего хилурия обнаруживается при филяриатозе - паразитарном заболевании, вызываемом нематодами класса Filariata. Филяриатозу свойственно эндемическое распространение. Заболевание передается через кровососущих насекомых (главным образом через комаров) и манифестирует одновременным поражением мочевых и лимфатических путей. Хилурия может быть следствием посттравматических, воспалительных, посттуберкулёзных и неопластических процессов, ведущих к сдавлению брюшного и грудного лимфатического коллектора, выступать в качестве моносимптома.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Её сопровождают, а зачастую ей предшествуют признаки лимфостаза нижней половины туловища: отёк кожи живота, полового члена, мошонки, нижних конечностей. Описаны наблюдения, свидетельствующие о возникновении почечной колики вследствие обтурации ВМП сгустками лимфатического содержимого. Отмечена корреляция степени интенсивности хилурии от положения тела пациента и приёма пищи. При ортостазе (стоя) и после приёма пищи хилурия выше, чем после пребывания пациента в положении клиностаза (лежа) и натощак.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Определение причин хилурии находится в ведении врачей-лимфологов. В небольших населенных пунктах, где такие специалисты отсутствуют, обследование проводят флебологи. Пациентам может потребоваться консультация инфекциониста, онколога или фтизиатра. Лабораторный симптом подтверждается по данным клинического анализа мочи. Наличие хилурии нередко распознается невооруженным глазом, для точного определения производится отстаивание жидкости и микроскопия осадка.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При подозрении на филяриатоз мазок или толстую каплю крови исследуют на микрофилярии. По показаниям осуществляют биопсию лимфатических узлов и кожных покровов с последующим морфологическим анализом. Выполняют иммунологические тесты (ИФА, РСК, РПГА). Перечень визуализационных методик может включать УЗИ почек и мочевого пузыря, УЗИ органов брюшной полости и малого таза, рентгенографию ОГК. Для оценки состояния лимфатической системы проводят лимфосцинтиграфию, рентгеновскую лимфографию, КТ, МРТ.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативная терапия</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При лимфостазе рекомендуют возвышенное положение конечности, компрессионное бандажирование, лимфодренажный массаж. Пациентов с филяриатозом госпитализируют, для дегельминтизации назначают дитразин, эффект оценивают с помощью повторных лабораторных исследований мазков на гельминты. При наличии аллергического компонента в схему лечения включают кортикостероиды и антигистаминные препараты.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациентам со злокачественными опухолями назначают лучевую терапию, химиотерапию. В зависимости от локализации и распространенности онкологического процесса консервативные методики применяются отдельно либо в комплексе с хирургическими операциями. Если причиной сдавления лимфатических путей является воспалительный инфильтрат, используют противовоспалительные средства.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При лимфедеме выполняют туннелирование, наложение лимфовенозных анастомозов. При водянке мошонки на фоне филяриатоза или сдавления лимфатических протоков производят пункцию, операцию Бергмана либо Винкельмана. Доброкачественные опухоли удаляют в пределах здоровых тканей. Больным со злокачественными новообразованиями проводят расширенные вмешательства.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "",
"clinical_picture": "<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Отеки кожных покровов брюшной полости, мошонки, члена, ног.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Моча принимает белый мутный цвет, через время в емкости она распределяется на три слоя.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При атаке организма паразитами симптомы на начальном этапе никак не выражены. После поражения лифмосистемы, иммунитета и почек, возникает лихорадка, озноб, быстрая утомляемость, увеличение до гигантских размеров мошонки, нижних конечностей, поражаются глаза.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение мочеиспускания, острые боли в поясничном отделе, почках, колики.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наследственный фактор у ребенка сопровождается постоянными отеками кожи, слоновости ног. В результате нарушения лимфотока возникают язвы.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Болезнь имеет стадии ремиссии и рецидивов на протяжении нескольких месяцев.</span></p>",
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