Abnormal Urine Color

Ryan D. Aycock, MD, MS; Dara A. Kass, MD


South Med J. 2012;105(1):43-47. 

In This Article

Abstract and Introduction


A change in urine color can be distressing for patients and physicians alike. Many of the causes of abnormal urine color are benign effects of medications and foods; however, a change in urine color may be a sign of an underlying pathological condition. The good news is that in many cases the diagnosis can be determined from a thorough history and urinalysis. This article presents many of the conditions physicians may encounter and will help them form a narrow differential diagnosis and treatment plan.


Abnormal urine color can be distressing to patients, their family members, and clinicians alike. Patients expect an explanation for any alterations in the color of their urine, and rightfully so. Unfortunately, little original research exists regarding urine discoloration. Much of the information comes from case reports. Further complicating the issue is that there is no objective, standardized way to describe urine color.[1] One author may use the term "dark" to describe findings without fully defining the term to mean either a bolder shade of yellow, muddy brown, orange, or even a crimson red.[2]

More than 20 years ago, the Southern Medical Journal published a review article on the differential diagnosis of various urine colors.[3] Although useful at that time, clinicians are unlikely to perform benchtop chemistry tests such as adding hypochlorite bleach to urine samples to determine the presence of aminosalicylic acid. The present review attempts to list many of the conditions physicians may encounter and help them form a narrow differential diagnosis and treatment plan. The Fig. lists many of the potential causes of different urine colors that are described in detail in the review.

Figure 1.

Differential diagnosis of disorders and ingestions that can lead to abnormal urine colors.


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