Urine of an abnormal color appears different from the usual straw-yellow color. Abnormally colored urine may be cloudy, dark, or blood-colored.

See also: Urine, bloody or dark

Discoloration of urine

Tell your health care provider about any changes in urine color that do not go away, or that do not seem to be caused by a food or drug. This is very important if the urine changes color for longer than a day or two, or you have repeated episodes.

Some dyes used in food may be released in the urine. A wide variety of drugs can change the urine color.

Diseases that can change the urine color include:

• Acute cystitis
• Acute glomerulonephritis
• Acute tubular necrosis
• Acute unilateral obstructive uropathy
• Alport syndrome
• Carcinoma of the urinary bladder
• Chronic glomerulonephritis
• Chronic prostatitis
• Endocarditis
• Hepatitis
• Nephrolithiasis (kidney stones)
• Prostate cancer
• Renal cell carcinoma
• Rhabdomyolysis

Cloudy or milky urine is a sign of a urinary tract infection, which may also cause a bad smell. Milky urine may also be caused by bacteria, crystals, fat, white or red blood cells, or mucus in the urine.

Dark brown but clear urine is a sign of a liver disorder such as acute viral hepatitis or cirrhosis, which causes excess bilirubin in the urine.

Pink, red, or lighter brown urine can be caused by:

• Beets, blackberries, or certain food colorings
• Hemolytic anemia
• Injury to the kidneys or urinary tract
• Medication
• Porphyria
• Urinary tract disorders that cause bleeding, such as cystitis, an enlarged prostate, a kidney or bladder tumor, tuberculosis, bladder stones, kidney infection, or kidney cancer such as Wilms' tumor (in children) or hypernephroma

Dark yellow or orange urine can be caused by:

• B complex vitamins or carotene
• Medications such as phenazopyridine (used to treat urinary tract infections), rifampin, and warfarin
• Recent laxative use

Green or blue urine is due to:

• Artificial colors in foods or drugs
• Bilirubin
• Medications including methylene blue
• Urinary tract infections

Make an appointment with your health care provider if you have:

• Abnormal urine color that cannot be explained and does not go away
• Blood in your urine, even once
• Clear, dark-brown urine, especially if you also have pale stools and yellow skin and eyes
• Pink, red, or smoky-brown urine that is not due to a food or medication

The health care provider will perform a physical exam, which may include a rectal or pelvic exam. You will be asked questions about your medical history and symptoms, including:

• Time pattern
  • When did this color change begin?
  • Did this begin suddenly?
• Quality
  • What color is your urine?
  • Is it always the same color throughout the day?
  • Do you urinate more or less often than usual?
  • Can you see blood in the urine?
  • Is the urine an unusual odor?
• Factors that make it worse
  • What medicines do you take?
  • Have you eaten foods such as colored candy, beets, berries, or rhubarb?
• Other
  • What other symptoms do you have? (For example, pain when urinating, abdominal pain, back pain, or fever)
  • Are you drinking fewer fluids or are less thirsty?
  • Do you have a decreased appetite?
  • Have you had any urinary problems or kidney problems?
  • Do you have any allergies?

Tests that may be done include:

• Blood tests, including liver function tests
• Ultrasound of kidneys and bladder
• Urinalysis
• Urine culture for infection

Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 3.

Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116.