URINE COLOR CHANGES

Apart from hematuria, red urine may signify hemoglobinuria or myoglobinuria, suggesting the various hemolytic anemias, the march hemoglobinuria, paroxysmal “cold” hemoglobinuria and nocturnal hemoglobinuria, and the Crush syndrome. Red urine is also found in acute porphyria, especially the erythropoietic type. Ingestion of beets and purple cabbage may cause red urine. Phenazopyridine hydrochloride (Pyridium), a urinary tract anesthetic, will turn the urine a reddish orange color. A dark, yellow–brown urine usually signifies jaundice , but the chartreuse yellow from riboflavin ingestion should be remembered. Urobilinogen may make the urine yellow. A brown or smoky urine may be found in nephritis and is usually due to hemoglobinuria or red cells discolored by an acidic pH. A malignant melanoma may present with a brown urine. Black urine is characteristic of alkaptonuria but this usually occurs on standing (as the urine turns from acid to alkaline). Melanuria will also turn black on standing but may even be voided black. The green urine of Pseudomonas infections and the blue–green urine of methylene blue dye should be remembered. How can these causes of urine discoloration be remembered? One method is to group them into endogenous and exogenous causes (e.g., beets, phenazopyridine hydrochloride [Pyridium], and methylene blue). The endogenous causes are invariably related to the metabolism of a body pigment. Hemoglobin metabolism will suggest porphyria and hemoglobinuria, whereas melanin metabolism will suggest melanuria and alkaptonuria. The other method is to apply the mnemonic VINDICATE. I suggest that the reader use this as an exercise.

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Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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