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Pathology of Urine Color

 

Dr Sampurna Roy MD    

 

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Urine specimen has been referred to as a liquid tissue biopsy of the urinary tract which is painlessly obtained.

It gives a great deal of information quickly and economically.

Like any other laboratory procedure, urine tests should be carefully performed and properly controlled.

Gross appearance of the urine can provide useful diagnostic information and should not be overlooked.

 

 

      (1)   (2)   

The transparent yellow color of normal urine (1) is mainly due to pigment urochrome and  small amounts of urobilins and uroerythrin.

Urochrome excretion is thought to be proportional to the metabolic rate and is increased during fever, thyrotoxicosis and starvation.

Pale urine (2) in a normal person follows high fluid intake.

Colourless or very dilute urine is a sign of diabetes insipidus.

 

     

Cloudy urine is most often normal.

It may be due to phosphates, carbonates, urates, uric acid, leukocytes, bacteria, yeasts, spermatozoa, mucin, mucous thread, prostatic fluid, fecal contamination or due to radiographic dye.

 

        (1)  (2)  

Milky urine:

(1) Chyluria is rare. The urine contains lymph.

It is associated with obstruction to lymph flow and rupture of lymphatic vessels into renal pelvis, ureters, bladder or urethra.

Filariasis (late in the disease), abdominal lymphnode enlargement  and tumours have been associated with chyluria.

Pseudochyluria occurs with the the use of paraffin-based vaginal creams for treatment of Candida infection.

(2) Lipiduria is characterised by fat globules which appear in urine in nephrotic syndrome. These are neutral fats (triglycerides) and cholesterol.

Lipiduria is also present in many patients who have major skeletal trauma and fractures to major long bones or pelvis.

 

        

Red urine :

The most common abnormal color is red or red-brown.

When seen in the female, contamination with mentrual blood flow should be considered.

Urine in hematuria (presence of red blood cells) may appear pink, red or brown.

In Hemoglobinuria urine may appear clear red, clear red brown.

Myoglobin is another reason for red urine.

In porphyrias urine may be red or purple. 

Beeturia is passing of red urine after eating beets.

Drugs and dyes can also cause red  urine like - Anthraquinone laxative (senna), Chlorzoxazone, Chlorpromazine, Deferoxamine mesylate.

 

      

Yellow Urine:

Concentrated urine has a yellow colour.

Acriflavin is another cause of yellow urine.

Yellow brown urine is often associated with with bile pigment-bilirubin.

On shaking the urine specimen, a yellow foam may be seen which distinguishes bilirubin from a normal, dark, concentrated urine which will have white foam.

Drugs like Fluorescein sodium and mepacrine can also cause yellow urine.

 

       

Green Urine: In severe obstructive jaundice the urine may be dark green.

Some drugs and bacterial infection can cause green urine.

 

         

Blue Urine: Blue diaper syndrome, Hartnup disease and Methylene blue used to delineate fistula can cause blue urine.

 

       

Orange Urine:

Urine containing large amount of urobilin may appear orange red.

Excreted urobilinogen is colorless but is converted in the presence of light and acid pH to urobilin which is dark yellow or orange.

Drugs like isoniazid rifampin, riboflavin and phenazopyridines can also cause orange urine.

 

         

Purple Urine: Purple Urine Bag Syndrome is associated with purple colored urine. It is a rare disorder where the plastic urinary catheter bag and tubing turn purple.

 

         

Brown Urine :

Hemoglobin on standing, Methemoglobin, Myoglobin and drugs like Furazolidone, Iron-sorbitol, Nitrofurantoin can cause brown urine.

Brown urine is also noted in Phenol poisoning.

 

           

Dark Brown or Black Urine :

Urine containing homogentisic acid will darken rapidly when alkaline.

Melanin pigment in patients with melanoma can rarely cause brown urine.

Dark brown or cola colored urine is seen in the urine of some patients taking levodopa.

 

Pretty things in wrong places can cause serious problems.

Rainbow looks beautiful in the sky and that is where it should stay.

If you see rainbow colors in your "pee" please contact your doctor. 

 

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Dr  Sampurna Roy  MD

Consultant Histopathologist (Kolkata - India)

 

 


 

 

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