Pee Color: What Does It Tell About Your Health?

If a picture is worth a thousand words, the color of your pee also gives you a clue on your state of health.

More than 20 years ago (1988), the Southern Medical Journal published an article on urine color—which may vary from transparent to yellow to orange to red to brown—and the corresponding conditions that it indicates. 

The shade that varies from blood red to a tinge of pink could be the result of taking  certain medications such as: 
  •         Chloroquine (anti-malaria drug)
  •         Deferoxamine (antidote to iron poisoning, especially in children)
  •         Hydroxycobalamine (vitamin B12)
  •         Ibuprofen (pain reliever)
  •         Phenazopyridine (local analgesic for urinary tract infection)
  •         Rifampicin (treament for TB, leprosy or meningitis)
  •         Warfarin (anticoagulant or blood thinner)

Diseases related to reddish urine are:
  •         Hemolytic anemia (anemia due to destruction of red blood cells)
  •         G6PD deficiency (lacks the enzyme for red cell metabolism)
  •         Sickle cell anemia (abnormally shaped red cells)
  •         Thalassemia (deficiency of one component of red cells)
  •         Thrombocytopenic purpura (bleeding disorder with bruising and blood spots)
  •         Transfusion reaction
  •         Nephrolithiasis (kidney stones)
  •         Nutcracker syndrome (compression of left renal vein)
  •         Porphyria (enzyme abnormalities in blood production)

Foods which may cause harmless red urine:
  •         Beets
  •         Blackberries
  •         Carrots

From bright yellow-orange or dark yellow, this color may be the result of a urinary tract infection (UTI), lack of fluid intake or dehydration.

Often indistinguishable or difficult to tell apart from dark red urine, brownish pee may even be caused by the same diseases as red urine due to the presence of blood in the urine. There are, however, some medications which specifically cause pee to turn brown, including:
  •         Acetaminophen overdose (pain reliever)
  •         Metronidazole (antibiotic for vaginal infections and amoebiasis)
  •         Niridazole (treatment against flatworms)
  •         Nitrofurantoin (treatment for urinary tract infection)

Foods that produce brown urine are:
  •         Fava beans
  •         Rhubarb

An alarming color but don't rush to the emergency room just yet. Common medications responsible for black urine are:
  •         Methyldopa (antihypertensive)
  •         Cresol (food additive in ketchup, cheese, bacon, smoked foods)
  •         Iron (included in multivitamins)
  •         Laxative (stool softener)
  •         L-dopa (anti-Parkinson's drug)
  •         Methocarbamol (muscle relaxant)
  •         Sorbitol (sugar alcohol found in apples, pears, peaches, prunes)

Black urine disease or alkaptonuria is a genetic disorder of phenylalanine and tyrosine metabolism. The toxic byproduct of this disease causes osteoarthritis, damage to heart valves and kidney stones.

Albinuria or white urine may appear milky white to thinly white. Diseases related to this urine color are:
  •         Chyluria (leakage of lymphatic fluid in urine)
  •         Filariasis (roundworm infestation)
  •         Lymphatic fistula (abnormal connection between urinary tract and lymphatics)
  •         Schistosomiasis (parasitic infection with liver fluke)
  •         Lipiduria (presence of fat cells in urine due to nephrotic syndrome)
  •         Propofol infusion (injection with the anesthetic Propofol)
  •         Proteinuria (excessive protein in urine in kidney disease)
  •         Pyuria (pus cells in urine)
  •         Urinary tuberculosis (TB of the urinary tract)
  •         Hypercalciuria (elevated calcium in urine)
  •         Hyperoxaluria (excess oxalate, a component of kidney stones)
  •         Phosphaturia (phosphate in urine, a component of bone and teeth)

Blue or green
When you see that the toilet water has turned blue, don’t blame it on Toilet Duck. Several medications may cause your pee to turn into this unusual color:
  •         Methylene blue (anti-malarial drug, dye, component of urinary analgesic)
  •         Amitriptyline (anti-depressant)
  •         Clorets breath mints
  •         Cimetidine (anti-ulcer)
  •         Flupirtine (analgesic)
  •         Indomethacin (anti-inflammatory)
  •         Metoclopromide (antiemetic for nausea and vomiting)
  •         Promethazine (antihistamine for allergy)
  •         Tetrahydronaphthalene (used in dyes, fat solvents, resins)
  •         Zaleplon (sedative)

Medical conditions which may cause blue or green urine are:
  •         Biliverdin (liver disease)
  •         Blue diaper syndrome or Hartnup disease (defect in tryptophan absorption)
  •         Herbicide ingestion
  •         Pseudomonas UTI (antibiotic resistant UTI)

The next time you see your urine turn an unusual color, rule out the blue food coloring in the cupcake you ate, or the lack of fluids that’s causing the dark yellow tinge in your pee, or the medications you’re taking.

You need to make a thorough investigation whenever the color of your urine changes.  If you can’t rule out the causes listed above,  see your doctor for your peace of mind.

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