Urine Appearance

Aka: Urine Appearance, Urine Color, Urine Discoloration, Chromaturia, Dark Urine, Black Urine, Green Urine, Brown Urine, Urine Fluorescence under Woods Lamp

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II. Background

  1. Urochrome (Hemoglobin breakdown product) gives urine its typical yellow appearance

III. Causes: Cloudy Urine

  1. Urinary Tract Infection with increased Urine White Blood Cells (LR+ 3)
  2. Alkaline urine (precipitated phosphate crystals)
  3. High Purine food intake (increased Uric Acid with Hyperuricosuria)
  4. Urine lipids or Chyle (lymph fluid including Fatty Acids)
  5. Urine with high oxalate concentration
  6. Propofol

IV. Causes: Brown or Black Urine

  1. Gross Hematuria with renal source
  2. Bile pigment
  3. Myoglobinuria (e.g. Rhabdomyolysis)
    1. Myoglobin is rapidly filtered by Kidney and discolors the urine red or brown
    2. Myoglobin is not Protein bound (serum is a normal coloration)
  4. Hemolysis
    1. Excretion of Hemoglobin in urine which discolors it red or brown
    2. However, unlike myoglobin, Hemoglobin is Protein bound to Haptoglobin, and also discolors the serum brown
  5. Fava beans (broad beans)
  6. Melanin
  7. Methemoglobinuria
  8. Medications
    1. Levodopa
    2. Metronidazole (Flagyl)
    3. Nitrofurantoin
    4. Antimalarial Medications
    5. Methydopa
    6. Sorbitol
    7. Cascara or senna (bitterbark)
  9. Feces
    1. Enterovesical fistula

V. Causes: Purple Urine

  1. See Brown or Black Urine as above
  2. Purple Urine Bag Syndrome (PUBS)
    1. Rare variant of UTI in catheterized patients with alkaline urine
    2. Depends on phosphatase and sulfatase producing Gram Negative Bacterial strains

VI. Causes: Blue or Green Urine

  1. Urinary Tract Infection due to Pseudomonas
  2. Bilverdin
  3. Medications
    1. Amitriptyline
    2. Cimetidine
    3. Indomethacin
    4. Prochlorperazine (Compazine)
    5. Promethazine (Phenergan)
    6. Propofol
    7. Triamterene
  4. Dyes
    1. Methylene blue
    2. Indigo carmine or indigo blue

VII. Causes: Orange to yellow urine

  1. Increased urine concentration
  2. Bile pigments
  3. Uric Acid (newborns)
  4. Medications
    1. Phenothiazines
    2. Phenazopyridine (Pyridium)
    3. Pyridium
    4. Carrots
    5. Tetracycline
    6. Rifampin
    7. Rhubarb (red in alkaline urine)
    8. Senna (red in alkaline urine)
    9. Sulfasalazine

VIII. Causes: Red Urine

  1. See Red Urine
  2. Gross Hematuria
  3. Pseudohematuria

IX. Causes: Foamy Urine

  1. Dehydration
  2. Significant Proteinuria (e.g. Nephrotic Syndrome)

X. Causes: Urine Fluorescence under Woods Lamp

  1. Fluorescein
    1. Fluorescein is added to antifreeze to aid detection of antifreeze Poisoning
  2. Porphyrins (red)
    1. Increased urine concentrations in Porphyria
    2. Zeligman (1950) Arch Derm Syphilol 61(5): 853-4 [PubMed]
  3. Pteridine
    1. Increased concentrations in Ovarian Cancer
    2. Zvarik (2013) Neoplasma 60(5):533-7 +PMID: 23790172 [PubMed]

XI. References

  1. Hitzeman (2022) Am Fam Physician 106(1): 27-35 [PubMed]
  2. Simerville (2005) Am Fam Physician 71(6): 1153-62 [PubMed]

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Related Studies

Ontology: Color of urine (C0278030)

Concepts Finding (T033)
SnomedCT 86192007, 430327009
English Urine color, urine color, urine color (lab test), Color of urine (observable entity), Colour of urine, Color of urine, colour of urine, color of urine, urine colour, Finding of urine color, Finding of urine colour, Observation of urine color, Finding of urine color (observable entity), Observation of urine colour, Urine color, NOS
Spanish color de la orina (entidad observable), color de la orina, color de la orina - hallazgo (entidad observable), color de la orina - hallazgo, color de la orina - observación
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Black urine (C0278033)

Concepts Finding (T033)
SnomedCT 88746009
English black urine, urine black, Black urine, Black urine (finding)
Spanish orina negra (hallazgo), orina negra
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Urine looks dark (C0426396)

Concepts Sign or Symptom (T184)
SnomedCT 39575007, 139413009
English Dark urine, dark urine, Urine;dark, urine dark, Urine looks dark, Urine looks dark (finding), dark; urine, urine; dark
Dutch donker; urine, urine; donker
Spanish orina oscura (hallazgo), orina oscura
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Urine color abnormal (C0522153)

Definition (NCI_CTCAE) A disorder characterized by a change in the color of the urine.
Definition (NCI) Change in the color of the urine. Causes include medications, vitamins, urinary tract infection, liver disease, hemolysis, and kidney cancer.
Concepts Finding (T033)
SnomedCT 102867009, 144476005, 167239007
English URINE DISCOLORATION, URINE DISCOLOURATION, Abnormal urine color, Discoloration urine, Urine discoloration, Urine discolouration, Urine Discoloration, urine discoloration, abnormal urine color, discolouration urine, urine discolor, urine discolour, discolor urine, abnormal color urine, discolored urine, discolour urine, discoloured urine, urine abnormal color, discoloration urine, Discolouration urine, Urine colour abnormal (situation), Discolored urine, Discoloured urine, Urine color abnormal, Urine colour abnormal, Discolored urine (finding), Urine color abnormal (finding), Abnormal urine color, NOS
Dutch verkleurde urine, urine verkleurd, verkleuring urine, urine kleur abnormaal
French Couleur anormale de l'urine, Coloration des urines, Décoloration de l'urine, COULEUR ANORMALE DE L'URINE, Couleur d'urine anormale
German Urinverfaerbung, Verfaerbung des Urins, URINVERFAERBUNG, Urinfarbe anomal, Farbe des Urins anomal
Portuguese Alteração da cor da urina, DESCOLORACAO DA URINA, Cor da urina anormal
Spanish Cambio de color de la orina, ORINA, CAMBIO DE COLOR, alteración del color de la orina (hallazgo), alteración del color de la orina, color anormal de la orina (hallazgo), color anormal de la orina, Coloración de la orina anormal, orina de color anormal (hallazgo), orina de color anormal
Japanese 尿変色, ﾆｮｳﾍﾝｼｮｸ, 尿色調異常, ﾆｮｳｼｷﾁｮｳｲｼﾞｮｳ
Czech Změna barvy moči, Barva moči abnormální
Italian Alterazione del colore delle urine, Colore dell'urina anormale
Hungarian Vizelet elszíneződés, Vizelet elszíneződése, Vizelet szín kóros, Vizeletszín kóros
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Chromaturia (C0541832)

Concepts Laboratory or Test Result (T034)
Italian Cromaturia
Japanese 着色尿, ﾁｬｸｼｮｸﾆｮｳ
Czech Pigmenturie
English Chromaturia
Hungarian chromaturia
Portuguese Cromatúria
Spanish Cromaturia
Dutch chromaturie
French Chromaturie
German Chromurie
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Urine appearance (observable entity) (C0578511)

Concepts Clinical Attribute (T201)
SnomedCT 139411006, 162133005, 162137006, 139417005, 267065001
English Urine appearance NOS, Urine appearance (observable entity), appearance urine, urine appearance, Urine appearance (& symptom) (finding), Urine appearance sympt., Urine appearance NOS (observable entity), Urine appearance (& symptom), Urine appearance symptom, Urine appearance
Spanish aspecto de la orina, SAI, Urine appearance NOS, aspecto de la orina, SAI (entidad observable), aspecto de la orina (entidad observable), aspecto de la orina
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Brown urine (C1142277)

Concepts Finding (T033)
Dutch bruine urine
French Urine marron
German brauner Urin
Italian Urine scure
Portuguese Urina acastanhada
Spanish Orina parda
Japanese 褐色尿, ｶｯｼｮｸﾆｮｳ
Czech Hnědá moč
English urine brown, brown urine, Brown urine
Hungarian Barna vizelet
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Discoloration urine green (C2939085)

Concepts Finding (T033)
English Discoloration urine green, Discolouration urine green
Dutch groene verkleuring van de urine
Spanish Cambio de color de la orina a verde<, Cambio de color de la orina a verde
Portuguese Descoloração esverdeada da urina
Italian Colorazione verde dell'urina
German gruene Verfaerbung des Urins
French Décoloration verte de l'urine
Japanese ﾆｮｳﾉﾘｮｸｼｮｸﾍﾝｶ, 尿の緑色変化
Czech Zelené zabarvení moči, Zelené zbarvení moči
Hungarian Vizelet zöld elszíneződése
Derived from the NIH UMLS (Unified Medical Language System)

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