Devastating complication of silver nitrate instillation for the treatment of chyluria

The passage of milky white urine (chyluria) is an alarming sign. Safety and efficacy of silver nitrate instillation therapy for chyluria has been demonstrated in various studies in literature. Inspite of these, various serious complications following silver nitrate therapy have been reported from the regions where the pathology is prevalent. Even today, no protocol has been standardised for instillation therapy for chyluria about the ideal agent used, exact concentration or amount to be instilled, total number of instillations and doses per instillation to be administered. We presented a devastating complication of silver nitrate instillation therapy resulted in acute renal failure followed by later formation of long ureteric stricture in a patient resulting in long-term morbidity to the patient. There is a need for more vigilant approach and standardisation of protocol for silver nitrate instillation for treatment of chyluria.