Urine discoloration

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Urine discoloration

Dark / Brown
Cascara	Chloroquine
ferrous salts/ iron dextran	Levodopa
methocarbamol	methyldopa
metronidazole	nitrates
nitrofurantoin	quinine
Senna	sulfonamides
Yellow-brown
Bismuth	Chloroquine
Cascara	Metronidazole
Nitrofurantoin	Primaquine
Senna	Sulfonamides
Blue or blue green
amitriptyline	methylene blue
triamterene	Methocarbamol
Orange/yellow
Chlorzoxazone	Dihydroergotamine
heparin	phenazopyridine
rifampin	sulfasalazine
warfarin
Red / Pink
daunorubicin or doxorubicin	heparin
ibuprofen	methyldopa
phenothiazines	phenytoin
phenylbutazone	rifampin
Salicylates	senna

Urinalysis

Normal urine output (minimum): 0.5 to 1 ml/kg/hr daily
Oliguria: < 500 ml urine/ 24 hours
Anuria: < 100 ml urine/ 24 hours.

Low urine output: potential causes
Prerenal:	heart failure, shock, volume depletion, third spacing fluids, renal artery compromise
Renal:	acute tubular necrosis, end-stage renal disease, interstitial disease, glomerular disease, drug induced: (Aminoglycosides, amphotericin B, cisplatin, colistin, cyclosporin, dextran, gallium, hydroxyurea, lithium, methicillin, methotrexate, methoxyflurane, nitrofurantoin, pentamidime, plicamycin, streptozocin, and vancomycin.), bilateral cortical necrosis
Post-renal:	neurogenic bladder, obstruction of ureter, bladder neck, or urethra.
Differential diagnosis
Lab	pre-renal	renal
Urine/serum creatinine	>40	<20
fractional excreted sodium: [UNa/serum Na] / [Ucr/ serum creatinine] x 100	<1	>1
Urine osmolality	>500	<350
Urinary sodium	<20	>40

Normal values:
Appearance	straw or yellow colored / clear
Specific gravity:	infant: 1.002 - 1.006 child and adult: 1.001 - 1.035
pH	Child and adult: 4.6 - 8
Following substances should be negative:	acetone, bilirubin, blood, glucose, nitrite, protein, leukocyte esterase.
WBC	0 - 4/HPF
RBC	Male: 0 - 3/HPF female: 0 - 5/HPF
Epithelial	Occasional
Hyaline casts	Occasional
Bacteria	None

Differential diagnosis:
Bilirubin
Positive	hepatitis, obstructive jaundice
Blood
Positive	tumors, infection, trauma, hemolytic anemia, coagulopathy, interstitial nephritis, polycystic kidneys, kidney stones, burns, cystitis, prostatitis, pyelonephritis
Epithelial cells
Positive	acute tubular necrosis, necrotizing papillitis
Glucose
Positive	diabetes, cushing's disease, burns, steroids, hyperthyroidism, pancreatitis, pancreatic carcinoma, shock
Ketones
Positive	diarrhea, vomiting, DKA, starvation, high fat diet, hyperthyroidism, pregnancy, febrile states.
Leukocyte esterase (detects 5 or > WBC). Used along with test for nitrites to detect UTI (predictive capacity: approximately 74 %). If both nitrites and leukocyte esterase are negative, there is a 97% chance that a UTI is not present.
Positive	Infection
Nitrite
Positive	Infection present. Nitrates are converted to nitrites by many strains of bacteria.
Protein
Positive	glomerulonephritis, pyelonephritis, nephrotic syndrome, pre-eclampsia, malignancies, heavy exercise, stress, CHF, malignant hypertension

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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