Urine (Pee) Color and Diseases, Disorders, and Conditions
Urine: What is it, really?
We all know what urine is…but few of us know any in-depth details. For instance: What are normal color variations and what colors could signal disease? What is its ideal pH and what creates dips or spikes in acidity? Is it sterile and is bacterial presence a cause for alarm?
And, most importantly, what can this information tell us about ourselves and our overall health?
It is time to pause before flushing thousands of unique chemicals down the drain and instead look closely at the fluid to learn its secrets. Are we healthy, or is there an indication of a serious medical condition lurking unnoticed within our toilet bowls?
Urinalysis: Not a New Idea
The Greeks understood the value of analyzing the urine of sick individuals as far back as 500BC and European physicians performed it routinely on their patients in the Middle Ages.
The Compounds in Urine
Urine contains much more than a few metabolic waste products.
In fact, it took a group of scientists seven years to identify the over 3000 different compounds commonly present within it. Of these, 72 are produced by bacteria, as many as 1,453 originate from the body and an impressive 2,282 are linked to external influencers such as diet, drugs, cosmetics, and environment.
In other words, it is most affected by our deliberate, conscious actions—what we put in our mouths, on our bodies, and through our noses—than by anything else.
Overall, urine has more chemicals than either saliva or cerebrospinal fluid—and, therefore, the potential to provide countless details about the body: its microbial balance, organ and systemic function, and even its level of pollutant exposure…if an individual knows what to look for.
What to Look For?
The urine specimen of a healthy, disease-free individual has a few expected qualities:
A very mild if not nonexistent smell
A pH reading between 4.8 and 7.5
At most, trace amounts of protein and glucose
NO ketones, hemoglobin (from blood), bilirubin (from liver bile), or oxidized products of bilirubin such as biliverdin
NO white blood cells or nitrites
And how do we know if the urine of an individual meets these expectations?
Urine color does a fantastic job of alerting us to any deviations from the norm.
This hub focuses on urine color; because, when a strange color is accompanied by an usual pH or odor, or is because of the presence of something unusual (hemoglobin or bilirubin), this information helps us realize that something is wrong and what that something could be.
With this knowledge we are one step closer to catching potentially disastrous health complications before it is too late.
The Normal Yellow
Urine gets its yellow color from a pigmented substance known as urochrome.
The body produces this substance at a constant rate; however, the quantity of liquids an individual consumes alters the intensity of yellow by changing the amount of fluid with which the urochrome is excreted. If an individual consumes twice as many beverages one day as the day before, urine volume will double and its color will be only half as vivid.
Pigment mixed in a very small amount of fluid is highly concentrated and turns urine a dark, almost orange color. This often indicates dehydration.
Virtually translucent pee is a diluted mixture of urochrome in large amounts of fluid and is usually the product of a well-hydrated individual.
Pee varies daily from a pale straw-colored yellow to a dark orange under normal circumstances in perfectly healthy individuals. But sometimes light or dark urine can be symptoms of serious medical conditions.
As previously mentioned, orange urine is not necessarily indicative of more than a need to consume more fluids; for example, the first urination of the day is usually a concentrated yellow-orange as one does not often drink while sleeping during the night. However, orange pee can be problematic.
Sometimes it is not urochrome that is coloring urine, but bilirubin, a similarly tinted pigment present in the digestive bile of the liver that also appears orangey yellow in high concentrations. Abnormally elevated urinary bilirubin is the result of elevated bilirubin levels in the body which may be caused by a blockage of the liver bile duct, liver disease, or an accelerated rate of red blood cell destruction—and may be linked to jaundice. Shaking urine can determine which pigment is present: bilirubin will produce yellow foam.
If urine is an opaque orange with a pink tint it may be due to crystalized uric acid. Three kidney diseases are known to elevate levels of uric acid: acute and chronic uric acid nephropathy and uric acid nephrolithiasis (30).
Fever or sweating often lead to dehydration and darker pee.
Many drugs, such as painkillers or antibiotics, turn pee a vibrant neon tangerine. Phenazopyridine or ethoxazene (prescribed to reduce urinary tract irritation) and nitrofurantoin (a urinary tract infection treatment) are examples.
Excessive carrot, sweet potato, or pumpkin consumption turns urine, and even skin, a shade of orange due to their high carotene content.
Riboflavin (vitamin B2) supplements may color urine yellow-orange.
Supplemental vitamin C can have the same effect.
When fluid ingestion is very high urine appears almost colorless.
The consumption of a high volume of diuretics (alcohol, caffeine, etc.) can also result in translucent pee.
Unfortunately, color-free urine is also a by-product of diabetes. In fact, the term “diabetes” means a medical condition that produces abnormally large quantities of urine.
In diabetes insipidus impaired production or recognition of the hormone regulating fluid retention (antidiuretic hormone) prevents the kidneys from conserving water, leading to the elimination of copious amounts of dilute urine. Individuals with this disease run the risk of developing extreme dehydration and a possible electrolyte imbalance. The response of kidneys after administration of antidiuretic hormone (checking for a reduction in urine output) is one method of disease diagnosis.
Diabetes mellitus occurs when insulin is inadequately produced or is unrecognized by the body. Glucose levels rise and the excess sugar is eliminated in urine. Because urine does not normally contain more than trace amounts of glucose, a significant sugar presence is a likely indicator of diabetes. Blood samples screening for glucose level abnormalities confirm this condition.
More on Red Blood Cells in Urine
Normal, intact red blood cells may be present because of several serious medical conditions such as cancers, infections, tumors, or stones within the urinary tract.
Abnormally shaped red blood cells accompanied by a high urine protein content suggests kidney disease.
Rigid and c-shaped cells indicate sickle cell anemia.
When excretory fluid takes on a red hue, it is often due to the presence of red blood cells, hemoglobin (from the breakdown of red blood cells), or myoglobin (from the breakdown of muscle cells).
Hemoglobin from lysed blood cells can indicate conditions such as Nutcracker Syndrome where veins of the kidney are compressed, a glucose-6-phosphate dehydrogenase deficiency where blood cells are destroyed by drugs, stress, or infection, or a condition known as thalassemia--often accompanied by severe anemia.
Injuries, such as those resulting from high impact exercise when muscle has been considerably damaged, create elevated myoglobin levels.
In the absence of red blood cells, hemoglobin, or myoglobin and when pee is also acidic, a red coloration may be the result of a dye like phenolphthalein in ExLax medication. In this case the hue will vanish when acidity is reduced.
Acid urine (a low pH value) can also turn red upon blackberry or beet ingestion. Alkaline urine (with a high pH value) is required for rhubarb to have a similar effect.
Red urine is also a symptom of lead or mercury poisoning.
Rare diseases (Porphyria) linked to malfunctioning enzymes in heme (a component of blood) production increase porphyrin levels of the body and in the urine and this turns pee pink to red.
Medication such as warfarin, phenazopyridine, rifampin (also capable of turning sweat and tears red), ibuprofen, and deferoxamine all darken urine a reddish color and the cyanide poisoning treatment Hydroxocobalamin temporarily tints skin and urine red.
Propofol, a sleep-inducing drug administered intravenously, sometimes tints urine pink (this is most common in alcoholics).
Eating large amounts of beets, blackberries, or other dark red anthocyanin-pigment-containing produce can create pink pee.
If rosey urine is accompanied by a little less than rosey urine odor and fever, chills, or pain in the lower abdomen and back, it likely indicates a urinary tract infection.
This uncommon urine shade is often a side effect of drugs like methylene blue—a carbon monoxide poisoning treatment and surgical dye—as well as Viagra, indomethacin, or propofol. Any of these can also cause green urine as their blue color when mixed with yellow urochrome becomes green.
Individuals with blue diaper syndrome and Hartnup disease have an impaired ability to break down and digest the amino acid tryptophan which leads to its mass elimination via the urine, coloring it blue.
The consumption of food treated with blue dye may also affect urine color.
The orange/yellow substance bilirubin (sometimes responsible for orange urine) converts to a greenish/brownish yellow pigment called biliverdin upon reacting with oxygen. This pigment is in liver bile and when in urine is a likely indicator of organ malfunction. To confirm biliverdin presence, shake urine and look for green foam.
A pseudomonal bacterial infection or an infection of the urinary tract can create green pee.
If urine becomes a dark green and is accompanied by symptoms of a urinary tract infection and contains particles, a fistula may exist between the intestines and urinary tract causing a leakage of bile.
Dietary supplementation with chlorophyll has been known to temporarily color pee--and feces--green.
The medications promethazine, thymol, and cimetidine as well as metoclopramide and amitriptyline harmlessly color urine green.
Deep purple pee indicates kidney failure, and a high concentration of wastes and blood.
Violet urine can also result from urinary tract infections and basic, non-acidic urine.
Porphyria, a term encompassing as many as 8 different conditions that all result in the abnormal build-up of porphyrins or porphyrin precursors in the body, results in red pee that darkens to purple upon contact with light.
Did You Eat Beans?
High levels of L-Dopa (found in Parkinson’s medications and in velvet and broad beans) will tint urine dark brown to black.
Eating a large quantity of rhubarb, fava beans, or aloe may also darken pee brown to black.
Brown to Black
Dark brown urine may be caused by excess amounts of the substance bilirubin that has been converted to biliverdin upon reacting with oxygen (biliverdin can range from green to brown). This pigment originating from the liver indicates functional abnormalities.
Brownish black pee can also result from oxidized red blood cells or myoglobin and indicates several potentially harmful conditions (see red urine).
Individuals with elevated levels of copper due to biliary cirrhosis, hepatitis, or Wilson’s disease will have the metal into their urine, turning it a shade of brown.
Phenol poisoning also colors pee green to brown.
Melanin and melanogen are produced by cancerous melanomas of the skin, and when spread to other areas of the body such as the liver, enter into urine. Melanin/melanogen containing pee will show brownish black darkening that begins at the surface.
The disease Alkaptonuria, which colors cartilage and skin bluish black, also causes urine to blacken upon air exposure. Unfortunately there are more serious symptoms that accompany this condition: impaired heart function, arthritis, and kidney and prostate stones.
Porphyria cutanea tarda is a disorder where individuals lack a key enzyme causing porphyrin build-up in the liver. Darkening and blistering skin and a reddish brown tint to urine are symptoms of this disease.
Those with the disease Tyrosinosis release certain metabolites into their urine, coloring their pee black.
Metronidazole is a medication prescribed to treat reproductive system infections and has the side effect of causing reddish-brown urine. The antibiotic nitrofurantoin, the muscle relaxant methocarbamol, and certain laxatives do the same.
Black urine is not uncommon after receiving intramuscular iron injections.
Cloudy to White
When urine is cloudy or white with a strong smell pyuria, or an elevated white blood cell count, is indicated. Often, this is a symptom of a urinary tract or kidney infection but can also indicate acute glomerulonephritis, vaginal or cervical infections, or external urethral meatus.
An opaque or milky color is also due to the presence of red blood cells or mucus. Mucus can signal a urinary tract infection, sexually transmitted disease, stones, or tumor.
Chyluria is characterized by leakage of lymph fluid into the kidneys. This releases chyle into urine and turns it milky.
Globules of fat can turn pee a milky color as well.
Calcium, phosphorus, or oxalate crystals can color pee cloudy or white. These may be caused by a medication or a large intake of certain foods. For example, phosphaturia, or a buildup of phosphate crystals in urine, may follow a large ingestion of milk.
Tuberculosis of the urinary tract also turns urine white.
Color Is Only the Beginning
Clearly urine’s color is important to alerting an individual that something is wrong; however, more information is needed before the exact problem can be identified. Is urine pink because of that beet salad you had for lunch or because of a urinary tract infection? Further analysis is likely necessary.
Unless you want to sample your clear urine to see if it tastes sweet, labs testing for the presence of glucose will need to be performed to rule out diabetes. As far as red colored pee—if blood cells are present, and if they are intact, abnormally shaped, or broken into pieces—only a view through a microscope will tell.
Color is just a part of the puzzle but it is a good starting point. If urine color changes unexpectedly it is always better to err on the side of caution and consult a health professional to rule out these possible causes.