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Urine discoloration / Urinalysis

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

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