Discoloration of urine

Alternative names
Urine - abnormal color

Definition
Urine of an abnormal color appears different from the usual straw-yellow color. Abnormally-colored urine may also be cloudy, dark, or blood-tinged. See also - urine, bloody or dark.

Considerations
Any changes in urine color, or the presence of an abnormal urine color that cannot be linked to the consumption of a food or drug, should be reported to the doctor. This is particularly important if it happens for longer than a day or two, or if there are repeated episodes.

Some dyes used in candy may be excreted in the urine, and a wide variety of drugs can discolor the urine.

Cloudy, murky, or turbid (muddy) urine is characteristic of a urinary tract infection, which may also have an offensive smell. Murky urine may also be caused by the presence of bacteria, mucus, white blood cells or red blood cells, epithelial cells, fat, or phosphates.

Dark brown or clear urine is characteristic of a liver disorder such as acute viral hepatitis or cirrhosis.

Pink, red, or smoky brown urine can be a side effect of a medication or may be caused by the recent consumption of beets, blackberries or certain food colorings. It is also characteristic of a urinary tract disorder in which bleeding occurs such as cystitis, enlarged prostate, kidney cancer, bladder tumor, tuberculosis, bladder stones, kidney infection, Wilms’ tumor (in children), or hypernephroma. Hemolytic anemia and porphyria can also cause urine to take on these colors. It may also occur after trauma to the kidneys or urinary tract.

Dark yellow or orange urine can be caused by recent use of laxatives or consumption of B complex vitamins or carotene. Orange urine is often caused by Pyridium (used in the treatment of urinary tract infections), rifampin, and warfarin.

Green or blue urine is due to the effect of artificial color in food or drug. It may also result from medications including amitriptyline, indomethacin, and doxorubicin.

Common Causes

     
  • Food (beets, blackberries or other naturally red foods)  
  • Food dyes  
  • Certain drugs  
  • Urinary tract infection  
  • Liver diseases such as acute viral hepatitis or cirrhosis

Other diseases (not presented in order of likelihood - some are extremely unlikely):

     
  • Acute tubular necrosis  
  • Acute unilateral obstructive uropathy  
  • Alport syndrome  
  • Carcinoma of the urinary bladder  
  • Chronic or recurrent urinary tract infection  
  • Chronic prostatitis  
  • Endocarditis  
  • Acute cystitis  
  • Acute glomerulonephritis  
  • Chronic glomerulonephritis  
  • Hepatitis  
  • Nephrolithiasis (kidney stones)  
  • Prostate cancer  
  • Renal cell carcinoma  
  • Rhabdomyolysis

Call your health care provider if

     
  • There is clear, dark-brown urine, particularly if accompanied by pale stools and yellow skin and eyes.  
  • There is pink, red, or smoky-brown urine, and the color change was not expected (due to a medication).  
  • Abnormal urine color is persistent and unexplained or accompanied by other unexplained symptoms.

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting abnormal urine color in detail may include:

     
  • Time pattern       o When did this begin?       o Did this begin suddenly?  
  • Quality       o Is there any pain associated with urination?       o What color is the urine?       o Is it consistently the same color throughout the day?       o Is the quantity of urine per day decreased? Increased?       o Is any blood visible?       o Is there an odor?  
  • Aggravating factors       o Are medications being taken that could cause this change in color?       o Have foods been eaten that could account for this change in color (such as colored candy, beets, berries, rhubarb)?  
  • Relieving factors:       o Does a change in diet change the color of the urine?       o Does a change in medication change the color of the urine? (Note: NEVER change medications without first consulting your health care provider.)  
  • Other       o What other symptoms are also present?           + Pain when urinating?           + Pain in the abdomen?           + Back pain?           + Fever?       o Has there been a decreased fluid intake or decreased thirst?       o Has there been a decreased appetite?       o What medications are being taken?       o Have there been any previous urinary problems or kidney problems?       o Are there any allergies?

A history will be obtained and a physical examination performed (possibly including a rectal or pelvic exam). Take a clean catch urine sample to your health care provider’s office.

Diagnostic tests that may be performed include:

     
  • Blood tests, including liver function tests if appropriate  
  • Urinalysis  
  • Urine culture and sensitivity studies  
  • Ultrasound of kidneys and bladder

After seeing your health care provider:
If a diagnosis was made by your health care provider related to abnormal urine color, you may want to note that diagnosis in your personal medical record.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.