The Color of Urine

Urinalysis begins with a macroscopic examination for color and clarity of the urine. In healthy individuals, urine color ranges from pale yellow to amber, depending on the state of hydration. Many factors can affect urine color including fluid balance, diet, medications and disease. The following table summarizes the most common causes of abnormal urine coloration.

Color Pathologic Causes Food & Drug Causes
Cloudy white Phosphorus, pyuria, chyluria, lipiduria, hyperoxaluria, uricosuria Diet high in purine-rich foods causing uricosuria, propofol, hypercalciuria, phosphaturia
Brown Bile pigments, myoglobin, hemolytic anemia, porphyria Fava beans, rhubarb, Levodopa, metronidazole (Flagyl), nitrofurantoin, anti-malarial drugs, acetaminophen overdose
Brownish-Black Bile pigments, melanin, methemoglobin, alcaptonuria, porphyria levodopa, methyldopa, Senna, Cascara, iron, methocarbamol, metronidazole, nitrofurantoin, sorbitol
Green or Blue Pseudomonas UTI, biliverdin, Hartnup disease, herbicide poisoning Amitriptyline, indigo, carmine, IV cimetidine (Tagamet), IV promethazine (Phenergan), methylene blue, triamterene (Dyrenium), indomethacin, methocarbamol, metoclopramide, propofol, Zaleplon
Orange Bile pigments, urinary tract infection Phenothiazines, phenazopyridine (Pyridium), isoniazid, sulfasalazine, riboflavin
Red Hematuria, hemoglobinuria, myoglobinuria, porphyria Beets, blackberries, rhubarb, Phenolphthalein, phenoazopyridine, rifampin, chloroquine, deferoxamine, hydroxycobalamin, warfarin
Yellow Concentrated urine Carrots, Cascara
Purple Urine bag syndrome due to gram negative bacteruria  

 

Aycock RD and Kass DA, Abnormal Urine Color. Southern Med J. 2012;105:43-37.

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