Discoloration of urine

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.

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

• 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

Make an appointment with your health care provider if you have:

• Clear, dark-brown urine, particularly if accompanied by pale stools and yellow skin and eyes
• Pink, red, or smoky-brown urine, and the color change was not expected (due to a medication)
• Abnormal urine color that persists without explanation

The doctor will perform a physical exam, which may include a rectal or pelvic exam. You will be asked questions about your medical history and symptoms, including:

• Time pattern
  • When did this begin?
  • Did this begin suddenly?
• Quality
  • What color is the urine?
  • Is it consistently the same color throughout the day?
  • Do you have increased or decreased urination?
  • Can you see blood in the urine?
  • Is there an unusual odor?
• Aggravating factors
  • What medicines do you take?
  • Have you eaten foods such as colored candy, beets, berries, or rhubarb?
• Other
  • What other symptoms do you have? (For example,pain when urinating, abdominal pain,back pain or fever)
  • Are you drinking fewer fluids or have decreased thirst?
  • Do you have a decreased appetite?
  • Have you had any previous urinary problems or kidney problems?
  • Do you have any allergies?

Tests that may be done include:

• Blood tests, including liver function tests, if appropriate
• Clean catch urine sample
• Urinalysis
• Ultrasound of kidneys and bladder

Patel HP. The abnormal urinalysis. Pediatr Clin North Am. Jun 2006; 53(3): 325-37, v.

Wein AJ. Campbell-Walsh Urology. 9th ed. St. Louis, Mo: WB Saunders; 2007.