ZSFG AM Report Pearls 12/6/17: Can You Paint with All the Colors of the Urine?……Yes. You. Can.

Thank you to Mike for presenting a case of a man with hematuria/”dark urine” who ultimately was found to have a large pelvic mass extending into the scrotum, removed by Urology with pathology pending. This case brought up the differential of all the things that can discolor your urine.


Differential Diagnosis for Discolored Urine:

Pyuria, phosphate crystals, chyluria, Propofol
Uric acid crystals (may be 2/2 Propofol)
Food dye

Meds: Amitriptyline, indomethacin, propofol

Familial benign hypercalcemia: sometimes called, “blue diaper syndrome,” because children with this disorder have blue urine

Ochronosis (black urine disease 2/2 excretion of homogentisic acid)
Bacteruria (esp with Providencia, Klebsiella, Proteus)
Blood: hematuriaMyoglobinuria (eg rhabdomyolysis)

Foods: Beets, blackberries, rhubarb

Medications: Rifampin, Pyridium, senna-containing laxatives, sulfasalazine

Urocolonic fistula
Darker Than Normal
Bilirubin (biliary obstruction or liver injury)

Food: fava beans, aloe

Meds: anti-malarials (chloroquine, primaquine), Flagyl


Glomerulonephritis (dysmorphic RBCs)




  • DDx for Discolored Urine: https://www.evernote.com/shard/s509/sh/8582ac3a-de7f-4a8e-91a2-624f1d51e1c5/3c444537fab2540d80040e9d9e40e00f



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