Chapter 3

Color Indican

The color of urine varies from almost colorless to Methylene blue

black.
Phenol

Table 4-1 Laboratory Correlation of Urine Pink RBCs

Color Cause Clinical/laboratory Red Hemoglobin

correlations
Myoglobin
Colorless Recent fluid
consumption Beets

Pale yellow Polyuria or Rifampin

diabetes
insipidus Menstrual
contamination
Diabetes
mellitus Port wine Porphyrins

Dilute random Red-brown RBCs oxidized to

specimen methemoglobin

Dark yellow Concentrated Myoglobin

specimen
Brown Homogentisic
B complex Black acid
vitamins (alkaptonuria)

Dehydration Malignant
melanoma
Bilirubin
Melanin or
Acriflavine melanogen

Nitrofurantoin Phenol
derivatives
Orange-yellow Phenazopyridin
e (pyridium) Argyrol
(antiseptic)
Phenindione
Methyldopa or
Yellow-green Bilirubin levodopa
oxidized to
biliverdin Metronidazole
(Flagyl)
Green Pseudomonas
infection
Normal Urine Color
Blue-green Amitriptyline
Common descriptions include pale yellow, yellow
Methocarbamol and dark yellow
(Robaxin)
The yellow color of urine is caused by the
Clorets presence of a pigment, which Thuidichum named
Urochrome in 1864.
Urochrome is a product of endogenous
metabolism, and under normal conditions the
body produces it at a constant rate.
Urochrome also increases in urine that stands at
room temperature.
Because urochrome is excreted at a constant rate,
the intensity of the yellow color in a fresh urine
specimen can give a rough estimate of urine
concentration.
A dilute urine will be pale yellow and a
concentrated specimen will be dark yellow.
Two additional pigments:
Uroerythrin
Urobilin
They are present in the urine in much smaller
quantities,and contribute little to the color of
normal, fresh urine.
The presence of uroerythrin, a pink pigment, is
most evident in specimens that have been
refrigerated, resulting in the precipitation of
amorphous urates.
Urobilin, an oxidation product of the normal
urinary constituent urobilinogen, imparts an
orange-brown color to urine that is not fresh.
Abnormal Urine Color
Dark yellow/Amber/Orange
● Dark yellow or amber urine may not
always signify a normal concentrated
urine but can be caused by the presence
of the abnormal pigment bilirubin.
● If bilirubin is present, it will be detected
during the chemical examination;
however, its presence is suspected if
yellow foam appears when the specimen
is shaken.
● A urine specimen that contains bilirubin
may also contain hepatitis virus,
reinforcing the need to follow standard
precautions.
● Photo-oxidation of bilirubin imparts a
yellow-green color to the urine caused by
the presence of biliverdin.
● Yellow-orange specimen caused by the
administration of phenazopyridine (brand
name pyridium) or azo-gantrisin
compounds to people who have urinary
tract infections.
Red/Pink/Brown
● One of the most common causes of
abnormal urine color is the presence of
blood.
● Red is the usual color that blood produces
in urine, but the color may range from
pink to brown, depending on the amount
of blood, the pH of the urine, and the
length of contact.
● RBCs remaining in an acidic urine for
several hours produce brown urine due to
the oxidation of hemoglobin to
methemoglobin.
● Fresh brown urine containing blood may
also indicate glomerular bleeding
resulting from the conversion of
hemoglobin to methemoglobin.
● When RBC is present, the urine is red and
cloudy
● If hemoglobin and myoglobin are present,
the specimen is red and clear.
● Hemoglobinuria resulting from the in vivo
breakdown of RBCs is accompanied by red
plasma.
● Breakdown of skeletal muscle produces
myoglobin.
● Fresh urine containing myoglobin
frequently exhibits more reddish-brown
color than does urine containing
hemoglobin.
● Urine specimens containing porphyrins
also may appear red, resulting from the
oxidation of porphobilinogen to
porphyrins.
● Nonpathogenic causes of red urine:
Menstrual contamination
Ingestion of highly pigmented
food
Medicationsv(that produce red
urine)
■ Rifampin
■ Phenolphthalein
■ Phenindione
■ Phenothiazines
● Black berries can produce a red color in
acidic urine.
Brown/Black
 ● That may contain melanin or ● Freshly avoided normal urine is usually
homogentisic acid. clear
● Melanin is an oxidation product of the ● Precipitation of amorphous phosphates
colorless pigment and carbonates may cause a white
● Melanogen produced in excess when a cloudiness.
malignant melanoma is present.
● Homogentisic acid, a metabolite of
Table 4-2 Urine Clarity
phenylalanine, imparts a black color to
alkaline urine from persons with the Clarity Term
inborn-error of metabolism, called
alkaptonuria. Clear No visible particles, transparent
● Medications producing brown/black urine
Hazy Few particulates, print easily seen through
Levodopa urine
Methyldopa
Cloudy Many particulates, print blurred through
Phenol derivatives
urine
Metronidazole
Blue/Green Turbid Print cannot be seen through urine
● Limited bacterial infections, including
urinary tract infection by pseudomonas Milky May precipitate or be clotted
species and intestinal tract infections
resulting in increased urinary indican.
● Ingestion of breath deodorizers (clorets)
Procedure 4-1
can result in a green urine.
● Medications can cause blue urine Urine Color and Clarity Procedures
Methocarbamol (Robaxin)
1. Evaluate an adequate volume of specimen.
Methylene blue
2. Use a well-mixed specimen.
Amitriptyline (Elavil) 3. View the urine through a clear container.
● Phenol derivatives found in certain 4. View the urine against a white background using
intravenous medications produce green adequate room lighting.
urine on oxidation. 5. Maintain adequate room lightning.
● A purple staining may occur in catheter 6. Evaluate a consistent volume of urine
a. Determine the urine color
bags and is caused by indican in the urine
b. Describe the urine clarity
or bacterial infection, caused by Klebsiella
or Providencia spp.
Nonpathologic Turbidity
● The presence of squamous epithelial cells
Clarity
and mucus, particularly in specimens from
women, can result in a hazy but normal
Is a general term that refers to the transparency or
urine.
turbidity of a urine specimen.
● Refrigerated specimens frequently
Color and clarity are routinely determined at the
develop a thick turbidity caused by the
same time.
precipitation of amorphous phosphates,
Common terminology used to report clarity:
carbonates, and urates.
Clear
● Amorphous phosphates and carbonates
Hazy produce a white precipitate in urine with
Cloudy an alkaline pH
Turbid ● Amorphous urates produce a precipitate
Milky in acidic urine that resembles pink brick
Normal Clarity dust due to the presence of uroerythrin.
 The term isosthenuria is used to describe the urine
with a specific gravity of 1.010.
Specimens below 1.010 are hyposthenuric and
those above 1.010 are hypersthenuric.
Table 4-3 Nonpathologic Causes of Urine Turbidity
Normal random specimens may range from
Squamous epithelial cells approximately 1.002 to 1.035, depending on the
Mucus patient’s amount of hydration.
Amorphous phosphates, carbonates, urates Currently the only method in use in routine
Semen, spermatozoa urinalysis that requires correcting is the
Fecal contamination
refractometer.
Radiographic contrast media
Talcum powder Two other methods in use:
Vaginal creams Chemical reagent strip
Osmolality
Pathologic Turbidity
● Most common encountered pathologic Refractometer
causes of turbidity: ● Refractometry determined the
concentration of dissolved particles in a
RBCs
specimen by measuring refractive index.
White blood cells
● Refractive index is a comparison of the
Bacteria
velocity of light in air with velocity of light
● Bacteria caused by infection or a systemic
in a solution.
organ disorder.
● The refractometer provides the distinct
● Less frequently encountered Causes of
advantage of determining specific gravity
pathologic turbidity include:
using a small volume of specimen (one or
Abnormal amounts of two drops)
nonsquamous epithelial cells ● Temperature corrections are not
Yeast necessary because the light beam passes
Abnormal crystals through a temperature-compensating
Lymph fluid liquid prior to being directed at the
Lipids specific gravity scale.
● Current criteria used to determine the ● Temperature compensated between 15°C
necessity of performing microscopic and 38°C.
examination on all urine specimens ● Corrections for glucose and protein must
include: be calculated by subtracting 0.003 for
Both clarity and chemical tests each gram of protein present and 0.004
for RBCs for each gram of glucose present.
● The refractometer is calibrated using
WBCs
distilled water that should read 1.000.
Bacteria
● The calibration is further checked using
Protein
5% NaC, which as shown in the
refractometer conversion tables should
Specific Gravity read 1.022 +-, 0.001, or 9% sucrose that
should read 1.034 +- 0.001.
Kidney’s ability to concentrate the glomerular
filtrate by selectively reabsorbing essential
Box 4-1 Current Urine Specific Gravity Measurements
chemicals and water from the glomerular filtrate is
one of the kidney’s most important functions. Method Principle
The specific gravity of the plasma filtrate entering
the glomerulus is 1.010. Refractometry Refractive index
 ● The reagent strip reaction is based on the
Osmolality Changes in colligative properties by
particle number change in pKₐ (dissociation constant) of a
polyelectrolyte in an alkaline medium.
Reagent strip pKₐ changes of a polyelectrolyte by ● The higher the concentration of urine, the
ions present more hydrogen ions are released, thereby
lowering the pH.
Urinometry ● indicator = bromthymol blue
● Consists of a weighted float attached to a ● As the specific gravity increases, the
scale that has been calibrated in terms of indicator changes from blue (1.000
urine specific gravity. [alkaline]), through shades of green, to
● The weighted float displaces a volume of yellow (1.030 [acid])
liquid equal to its weight and has been
designed to sink to a level of 1.000 in Table 4-5 Particle Changes to Colligative Properties
distilled water.
● Abnormally high results above 1.040 — Property Normal Pure Effect of 1 Mole of
are seen in patients who have recently Water Point Solute
undergone an intravenous pyelogram.
Freezing Point 0℃ Lowered 1.86℃
● This is caused by the excretion of the
injected radiographic contrast media. Boiling Point 100℃ Raised 0.52℃
Osmolality
● Is affected only by the number of particles Vapor Pressure 2.38 mm/Hg Lowered 0.3
present. at 25℃ mm/Hg at 25℃
● Sodium (molecular weight 23)
Osmotic 0 mm/HG Increased 1.7 x 10⁹
● Chloride (molecular weight 35.5)
Pressure mm/Hg
● Urea (molecular weight 60)
● An osmole is defined as 1 g molecular
weight of a substance divided by the
number of particles into which it Odor
dissociates.
● Glucose (molecular weight, 180) contains Urine odor is a noticeable physical property.
180 g per osmole Freshly voided urine has a faint aromatic odor.
● Sodium chloride (molecular weight 58.5), The breakdown of urea is responsible for the
if completely dissociated, contains 29.25 g characteristic infections, which cause a strong,
per osmole. unpleasant odor similar to ammonia, and diabetic
● Solute dissolved in solvent causes the ketones, which produce a sweet or fruity odor.
following changes in colligative A serious metabolic defect results in urine with a
properties: strong odor of maple syrup and is appropriately
Lower freezing point called maple syrup urine disease.

Higher boiling point

Increased osmotic pressure Table 4-6 Possible Causes of Urine Odor
Lower vapor pressure
Odor Cause
● Harmonic Oscillation Densitometry is
based on the principle that the frequency Aromatic Normal
of a sound wave entering a solution
changes in proportion to the density of Foul, ammonia-like Bacterial decomposition,
the solution. urinary tract infection
Reagent strip specific gravity
Fruity, sweet Ketones (diabetes mellitus,
starvation, vomiting)
Maple syrup Maple syrup urine disease

Mousy Phenylketonuria

Rancid Tyrosinemia

Sweaty feet Isovaleric acidemia

Cabbage Methionine malabsorption

Bleach Contamination

Study questions:

1. The presence of bilirubin in a urine

specimen produces a: Yellow foam when
shaken
2. A urine specimen containing melanin will
appear: Black
3. Specimens that contain hemoglobin can
be visually distinguished from those that
contain RBCs because: hemoglobin
produces a clear, yellow specimen
4. A patient with a viscous orange specimen
may have been: treated for a urinary tract
infection
5. The presence of a pink precipitate in a
refrigerated specimen is caused by:
Uroerythrin
6. A specimen with a specific gravity of
1.001 would be considered: Not urine
7. Which of the following would contribute
the most to a urine osmolality? : one
osmole of sodium chloride
8. Which of the following colligative
properties is not stated correctly?: The
freezing point is raised by solute
9. An osmole contains: One gram molecular
weight of solute dissolved in one kilogram
of solvent
10. The unit of osmolality measured in the
clinical laboratory is the: Osmole
11. In the reagent strip specific gravity
reaction the polyelectrolyte: releases
hydrogen ions in response to ion
concentration
12. Which of the following will react in the
reagent strip specific gravity test? :
Chloride