‫‪CHANGE IN URINE COLOR‬‬

‫‪Supervised by:‬‬
‫‪Prof. Dr. Nariman Fahmi Ahmed‬‬
‫‪Done by :‬‬
‫ﻋﻤﺎر ﺳﻌﺪ ﻋﻠﻲ رﺷﯿﺪ‬
‫ﻋﺒﺪ اﻟﺮﺣﻤﻦ وﻋﺪ ﻋﺒﺪ اﻟﺴﺘﺎر‬
‫ﺳﺎرة ﻣﺤﻤﺪ ﺟﺎﺳﻢ‬
‫ﺳﺎرة ﻋﺪﻧﺎن ﺣﺴﻦ‬
‫رﻧﺪ ھﯿﺜﻢ ﺣﺴﻦ‬
 Case Scenario 1
An 8 months old male infant was admitted to the ER for sings of respiratory
distress, after rapid assessment and evaluation, with history provided by the
mother, he was diagnosed with methemoglobinemia.

Treatment with methylene blue, however no clinical improvement was

observed after the initial dose, after noticing the response, a trial of high dose
vitamin C was initiated, within an hour, clinical signs and labs showed
improvement, within 24h, blood levels of methemoglobin returned to normal.

The following day, the infant’s urine was abnormal in color and hemoglobin
levels were down to 9.3 g/dl.
 I will ask you..

1. What color you think the urine of the infant changed to? And
why?

2. What is the diagnosis of this infant following the course of his

condition?
 Case Scenario 2

A 1 year old girl was admitted to the Hospital, for diarrhea. The onset of the disease
was five days prior to the admission with anorexia and diarrhea. On the second day
of illness, a stool culture was performed, which was positive for enter pathogenic
Escherichia coli. On the fourth day of illness, the patient presented with dark
colored stools.

Laboratory work up showed:

Anemia ( Hb =6.1 dL ),
thrombocytopenia (platelet count 40 000/ uL ), slightly
increased serum urea 65 mg/ dL , and normal serum
creatinine of 0.4 mg/ dL
Physical examination revealed :

Alert but irritable and ill appearing child with a normal body temperature

Heart rate of 130 beats/min, Blood pressure of 90 60 mm Hg, oxygen

saturation by pulse oximetry of 95

The child’s weight at admission into hospital was 8700 g. The skin was pale,
slightly decreased skin turgor pale buccal mucosa, soft fontanelle and capillary
refill time of three seconds

Urine output was normal

Heart and lung examination were normal, except for tachycardia the abdomen
was distended, no hepatosplenomegaly There were no signs of meningeal
irritation no peripheral edema either
Q/ What is the most likely diagnosis?
 INTRODUCTION
• Regular urine color ranges from clear to yellow color.
• Urobilin or urochrome, which is a product of bilirubin
degradation, is the chemical primarily responsible for the yellow
color of urine.
• Urine colors can vary depending on what you eat.

But, Is it always pathological to have another

urine color?
THIS DIFFERENCE IS DUE TO CHANGE IN GLOMERULAR FILTRATION AND
URINE DILUTION OR URINARY CONCENTRATION CAPACITY ( AMOUNT OF
UROCHROME PIGMENT ).
Abnormal urine color can be caused by a
variety of issues. For example, it can result
from taking certain medications, eating certain
foods, having certain medical conditions, or
being dehydrated.
 Dark yellow urine
If urine appears darker than normal, its mostly due dehydration.
Others causes: Diabetes mellitus, hypothyroidism Rifampin.
• Orange color urine
• Orange urine is commonly caused by medications, such as:
• • Rifampin.
• • Laxatives.
• • warfarin
• • some chemotherapy drugs.
• Foods
• Carrots
• Vitamins include:
• • Vitamin C.
• • Vitamin B12.
• • Beta-carotene.
• Brown urine

• Causes include:
• haemolytic disease like G6pd , liver disorders like hepatitis C or post
hepatic obstruction , some urinary tract infections, sever muscle injury
• Or certain medications like acetaminophen, methyldopa, chloroquine

•
 Green urine
Causes include:
Pseudomonas infection.
Vitamin B supplements.
Fluorescein used in tests
Methyl blue dye
familial benign hypercalcemia
Drugs such as cimetidine and phenol
 Cloudy urine
Also referred as turbid or foamy urine
Causes include
Urinary tract infection
Kidney stones
Dehydration
Diabetes
Pregnancy
STDs
 Red or pink urine
caused by:
certain foods, such as blackberries.
certain medications, such as rifampin and laxatives that contain
senna.
poisoning from lead or mercury, severe muscle injury and hematuria
 Hematuria

which means blood in urine. It could be macroscopic or

microscopic hematuria.
Macroscopic hematuria: Visible to the naked eyes.
Microscopic hematuria: is presences of 3-5 red blood cells
per high power eld in sediment of 10 ml freshly voided
urine.
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Causes of hematuria

Glomerular origin:
● Postinfectious glomerulonephritis
● (IgA) nephropathy
● Lupus nephritis
● Thin basement membrane disease
● Alport syndrome
● Hemolytic-uremic syndrome
Non-Glomerular origin:
● UTI
● Trauma
● Kidney stones
● Sickle cell disease
● Coagulopathy
● Tumors
● Anatomic abnormalities
WHOA!
APPROACH TO RED COLOR
URINE
HISTORY
Age:
• 2-5 years Wilms tumor.
• 5- 12 years PSGN.
Sex:
• Female > male as UTI > 1 year and SLE nephritis
• Male > female in infant < 1 year (especially if
uncircumcised).
• X linked as Alport syndrome.
Race:
• White as in idiopathic hypercalcemia.
• Black as in SCD.
 CHARACTER OF URINE DISCOLORATION
Color of urine:
❑ Red or pink (lower UT origin), drugs as rifampicin, deferoxamine, foods , food dyes,..
❑ Tea- or cola-colored (renal or glomerular)
❑ Black as bile pigments
Amount of urine: Reduced in AGN, ARF
Clots in urine: Extraglomerular
Frequency: Dysuria, recent enuresis: UTI
Frothy urine: Suggests Proteinuria seen in Glomerular diseases
Timing of color change:
✓ Initial (urethral source)
✓ Constant (glomerular or renal source)
✓ Terminal (hemorrhagic cystitis)
Persistent or intermittent
 ASSOCIATED SYMPTOMS
• Fever (suggests infectious or systemic illness)
• Loin pain (renal colic suggests a stone)
• Voiding symptoms: incontinence, dysuria, frequency, urgency,(suggest
hemorrhagic cystitis)
• Facial puffiness, Oedema of legs, weight gain, Shortness of breath: AGN
• Hypertension (Headache, visual changes, epistaxis, seizures): AGN, ARF
• Abdominal pain: Urolithiasis (Loin to groin), UTI, clots, Nutcracker syndrome
• Painless: Glomerular
• Abdominal mass: Hydronephrosis, PKD, Wilms tumor
• Joint pain (HSP, SLE)
• Rashes (HSP, SLE)
• Neurologic: SLE, HUS (seizures, irritability)
• Jaundice: Hemolysis, Obstructive jaundice
 PAST HISTORY:

•Previous similar attack of gross hematuria.

•Medical history: recent streptococcal infection or impetigo or chronic hemolysis.
•Concurrent upper respiratory infection or GE: (suggests IgA nephropathy)
•Historv of trauma, catheterization or vigorous exercise
Drug history: anticoagulants, aspirin, nitrofurantoin, rifampicin, metronidazole.
Dietary history: type of feeding, ingestion of beetroot, fava beans, berries.
 FAMILY AND SOCIAL HISTORY:

Family history:
• Hematuria, renal diseases, renal failure (may suggest hereditary nephritis)
• Renal stone, SLE, coagulation disorders.
• Premature deafness (Alports syndrome).
Social history:
• Child abuse
• Exposure to hepatitis b or c.
• Occupational exposure to toxins.
EXAMINATION
 GENERAL APPEARANCE:
• Check for the level of consciousness
• Orthopneic position if there is renal impairment
• Pallor
Vitals:
• Vital measurement especially HR and blood pressure as in AGN
• Temperature for UTI and AGN
HEAD TO TOE EXAMINATION:
• Eye and ear problem for Alport syndrome
• Aniridia for Wilms tumor
• Check for periorbital and leg edema
HEAD TO TOE EXAMINATION:
• Joint for arthritis as in HSP and SLE
• Skin lesion for: Purpura (HSP), Butter fly rash (SLE)
 ABDOMINAL EXAMINATION
• Renal mass as in hydronephrosis, PSK, or Wilms
tumor
• Examination for bladder distension
 Investigations

1. Blood test
2. General urine examination
3. Dipstick test
4. Microscopic examination
 LINES OF TREATMENT

1. Infection: Antibiotics are typically prescribed to treat urinary

tract infections (UTIs) or other bacterial infections that might
be causing hematuria in children.
2. PIGN: Blood pressure management and diuretics
3. Trauma: Rest and monitoring for healing if the hematuria is
due to recent injury. Further evaluation may be needed (case
by case)
4. Hemorrhagic Cystitis: If the hematuria is caused by viral
infections or medications, managing the underlying condition
and discontinuing the o ending drugs may be necessary.
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5. Hypercalciuria and associated Kidney Stones: Treatment depends
on the size and location of the stones. Small stones may pass
naturally, while larger ones might require intervention such as
lithotripsy or surgery. Thiazide diuretics may also be needed
6. Glomerulonephritis: Treatment varies depending on the speci c
type and cause. It may include medications, dietary changes, or other
interventions.
7. Structural Abnormalities: Surgical correction may be needed for
congenital or acquired structural issues a ecting the urinary system.
8. Hematuria Evaluation: Additional tests and imaging may be
required to determine the cause of hematuria in children.

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THANK YOU