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Discolored Urine Client Education
Sheet

BASIC INFORMATION ○ Weakness DIAGNOSIS
○ ± Collapse
Definition ○ ± Splenomegaly Diagnostic Overview
Urine that is any color other than transparent • Muscle damage A comprehensive urinalysis (p. 1390) is the
yellow or amber is discolored urine. It is a ○ Weakness most important step to help determine the
common finding, most often caused by the ○ Signs of pain source of discolored urine. Evaluation of urine
presence of blood, hemoglobin, myoglobin, ○ Signs of blunt trauma or prolonged color as compared to serum color also helps
or bilirubin. recumbency narrow the differential diagnosis list.
• Icterus
Epidemiology ○ Yellow mucous membranes, sclera, skin Differential Diagnosis
SPECIES, AGE, SEX ○ ± Change in liver size Urine may be contaminated with blood from
Depends on underlying cause outside the urinary tract or with other sub-
Etiology and Pathophysiology stances, causing it to be mistaken for discolored
Clinical Presentation • Amber, light to dark yellow, clear: urine.
HISTORY, CHIEF COMPLAINT normal
• Owner may note discolored urine with no • Colorless: very dilute urine (e.g., any Initial Database
other clinical signs. cause of polyuria/polydipsia, fluid therapy, Urinalysis is the single most important initial
• Signs may be related to primary cause diuretics) diagnostic test. If hematuria is suspected (red
○ Pollakiuria, dysuria, stranguria associated • Cloudy, variably opaque urine: pyuria, other color), avoid cystocentesis until hemostatic
with lower urinary tract disease sediment such as crystals, lipiduria disorders and bladder cancers have been
○ Weakness, collapse, pallor associated with • Red, pink, red/brown, orange: hematuria reasonably discounted.
severe hemolysis (pp. 428 and 1229), hemoglobinuria Urinalysis:
○ Weakness or pain associated with severe (p. 1352), myoglobinuria (p. 1367) • Comparing free-catch to cystocentesis sample
muscle damage • Orange/yellow: very concentrated normal often aids in localization.
urine, excess urobilin or bilirubin (pp. 528 ○ Discoloration of both samples suggests a
PHYSICAL EXAM FINDINGS and 1314) systemic, renal, ureteral, or urinary bladder
Exam may be normal or may find any of the • Yellow/brown, green/brown: bile pigments disorder.
following: • Brown to black: methemoglobin (p. 1365), ○ Discoloration of free-catch urine but
• Lower urinary tract disease myoglobin, intravascular hemolysis of any normal-color cystocentesis urine suggests
○ Vaginal disease (infection, inflammation, cause (e.g., Heinz-body anemia, microangio- a urethral, uterine, prostatic, testicular,
mass): vulvar discharge, vaginal mass, pathic hemolysis, some immune-mediated preputial, vulvar, or vaginal problem.
vulvar abnormalities possible hemolytic anemias), bile pigments ○ Discoloration of cystocentesis urine with
○ Prostatomegaly • Other colors: sometimes associated with a normal-color free-catch sample suggests
○ Thickened, abnormal urethra ingestion of water-soluble, colored substances erroneous switching of the samples or
○ Distended bladder (e.g., water-soluble markers, food dyes), other error.
• Hemolysis pigments from drugs (e.g., rifampicin, • Hematuria: positive for blood by urine
○ Pallor methylene blue), or foods (e.g., beets, dipstick and intact red blood cells (RBCs)
○ Tachycardia asparagus) seen on sediment exam. Consider hemostatic

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