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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