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Red Urine

more about Red Urine

Hematuria when the red color is blood, "false hematuria" when the red color is not caused by blood

  • Red-colored urine is usually due to hemoglobin pigment or red blood cells (RBCs) in the urine.  Hemoglobin pigment alone, without the presence of RBCs, would give a clear appearance to the red urine.  The presence of RBCs would give a slightly cloudy or cloudy-red urine.
  • Hemoglobin is the red pigment inside the RBCs that makes a red cell look red.  Hemoglobin appears in urine alone, without RBCs, in any disease in which RBCs are destroyed in the bloodstream, and the hemoglobin pigment is "let loose."  The pigment then passes into the urine to be eliminated.
  • Two conditions that "let loose" hemoglobin pigment when RBCs are destroyed are:
    1. Sickle cell anemia; and
    2. Transfusion reaction in which the wrong blood type is given.
  • Red urine caused by hemoglobin pigment or by RBCs in the urine is properly called "hematuria."
  • In other situations, red urine is not due to blood and is not hematuria.  Thus, it is called "false hematuria."
  • Red or off-red color to the urine may have causes other than bleeding into the urine (these other causes are "false hematuria").

  • Symptoms depend on the disease
  • If the kidney or the urinary drainage system is deformed by a birth defect, urine may back up, enlarging the area before the blockage point, just as a dam keeps water behind the dam.  This may cause pain or a mass, or an inability to get rid of body waste.
  • Bloody urine may be due to infection.  Infection can cause fever, chills, back pain, painful urination, or shock.
  • Kidney stones, or stones in the urinary drainage system, can scratch these tissues and cause painful bleeding.

  • Conditions in which red urine is not due to blood:
    1. Myoglobin (a muscle breakdown product) will give a positive hematest reaction on dipstick, just as hemoglobin and RBCs will.  One can prove that a red color of urine is myoglobin by putting the urine through a spectrometer, by paper electrophoresis, or by immunoassay of urine (testing for a special antigen-antibody reaction). 
    2. Urobilin (a normal red pigment in the urine)
    3. Urates or uric acid crystals do not turn urine red, but may leave a red precipitate in the sediment.
    4. Beets will color the urine red, in a rare patient.
    5. Rhubarb will color the urine red, in a rare patient.
    6. Medications: possibly levodopa, rifampin
    7. Porphyrins (present in porphyria) may be colorless in urine when first voided, but may turn urine red upon standing the urine in sunlight.
  • Common conditions where red urine is due to blood (hematuria):
    1. Bleeding in the kidney itself, such as glomerulonephritis (a disease); or a familial tendency to pass a tiny amount of blood from the kidneys (this is actually not a disease)
    2. Bleeding in the urinary tract, below the point where the kidney first creates the urine, i.e., bleeding ureter due to some obstruction or stone, bleeding in the bladder due to infection, bleeding in the urethra due to "posterior" urethral valves.

  • A chemical test on the urine, showing hemoglobin present, or seeing RBCs when looking at urine under the microscope, indicates that the red urine color is due to blood.
  • Finding the source of the blood involves:
    1. History-taking, to look for kidney disease in the family or history of Trauma or infection
    2. Physical examination, looking for a mass in the kidney area or bladder area, or signs of infection such as a fever
    3. Laboratory tests: (a) RBC "casts" are like paraffin molds of the kidney regions.  Seeing RBC "casts" in the urine indicates the blood is coming from the kidney.  (b) White blood cells in the urine or bacteria in the urine might indicate infection.  (c) Ultrasound might show an abnormal anatomy in the kidney or urinary tract.

  • Focusing on conditions where red urine is due to blood:
    1. Birth defects involving the kidney, such as polycystic kidney
    2. Obstructions and partial obstructions to urine flow, usually from birth defects, as with obstructions: (1) where the kidney meets the ureter; or (2) where the ureter meets the bladder, or (3) in the urethra, which empties the bladder
    3. High amounts of calcium in the urine, which can cause stones
    4. Sickle cell anemia or SC disease (a disease related to sickle cell anemia)

  • A birth defect that causes a blockage or partial blockage in the urinary tract is usually treated by corrective surgery to remove the blockage.  If Trauma has caused bleeding, the bleeding might stop on its own.  Rarely, surgery is needed to tie off a bleeding blood vessel.
  • Infection in the kidney (pyelonephritis) is treated with antibiotics.  Sometimes treatment is started with an antibiotic injection and then later, antibiotic by mouth is used.  Infection in the bladder alone (cystitis) is usually treated with antibiotic by mouth, right from the beginning.
  • Kidney stones or stones in the urinary tract are treated in various ways.  Sometimes flushing the stones out by giving lots of fluids will solve the problem, or changing the acidity of the urine with medicines will help dissolve the stones.  Sometimes stubborn stones have to be removed surgically.

  • If myoglobin passes into the urine in large amounts, it can cause the kidneys to fail.  Possibly this occurs because myoglobin clogs up the kidney passages.
  • Loss of large amounts of blood into the urine can make a person anemic or can drop the blood pressure significantly.
  • Kidney stones, stones in the urinary tract, or birth defects that block the urine drainage system can make urine back up behind the blockage, distending the normal kidney passages.

  • A medical laboratory can do verification tests to see if red urine is due to blood or is due to pigments that look like blood ("false hematuria"). Bring the child to a physician for examination and laboratory tests if there is any red urine (or Injury that might involve the urinary tract).  Bring the child to a physician if there is painful urination or cloudy, smelly urine, and you suspect infection.  Bring a urine sample as well, if available.
  • If it is obvious that large amounts of blood are being passed in the urine, this is an urgent situation.

  • Pigments from food or medicine can make the urine appear red, even if the red color is not due to blood.

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