Color of urine in an unusual color, color change is a visible indicator of the effect on the renal system of various factors. Such a sign in clinical urology and nephrology is commonly called hematuria. The causes of red urine can be associated with diseases, but also in some cases can be explained by factors related to physical activity, eating habits or taking medications.
The color of urine depends on the process of catabolism (dissimilatio) of hemoglobin, as a result of which specific pigments are produced. The concentration and appearance of the pigment are influenced by external and internal causes:
- Age indicator.
- Ambient temperature.
- Environmental factors.
- Specificity of food assortment.
- The course of treatment with medicines.
- Water balance of the body, the regime of fluid intake.
- Physical activity and load on the body (hematuria Montenbeiker).
- Congenital or acquired diseases.
- Specificity of metabolism.
- Injuries, bruises.
- Genetic diseases.
The basic causes of urine are red:
- Permeability of capillaries of the glomerulus of nephrons.
- Thickening of the Glomerular basement membrane (glomerular membrane).
- Intravascular destruction of blood cells, hemolysis.
- Inflammation t. Interstitialis of the kidney (interstitial tissue).
Classification of hematuria by the intensity of the process:
- Erythrocyturia can be detected only with the help of a laboratory study of urine. Microhematuria.
- Urine of red color (various shades) is clearly visible as a clinical sign. Macrohemuria.
On the specifics of manifestation and defeat of organs, hematuria is divided into the following categories:
- Physiological haematuria or false hematuria, not associated with pathologies of the urinary system.
- Orthostatic haematuria.
- Haematuria renalis (renal hematuria).
- Haematuria postrenalis (postrenal hematuria), lesion of the lower zone of the urinary system.
Changes in urine in hematuria are also divided into species that indicate an etiologic factor:
- Haematuria is isolated when a urine test does not show a critical abnormality on the part of the protein. The isolated process most often occurs in the zone from urethra to pelvis renalis (from the urethra to the renal pelvis). These can be traumas, prostatitis (prostatitis), anemia (anemia), nephrolithiasis, kidney tuberculosis, oncoprocess in the organs of the urinary system
- Haematuria in combination with an increased level of protein in urine (proteinuria), with pyuria (leukocyturia), with cylindruria (detection of urine in the elements of the protein precipitate).
With the course of the process, hematuria differs in this way:
- An initial haematuria (red urine is visible in the first portion when urinating).
- Haematuria terminalis (terminal) - urine stained at the end of urination.
- Haematuria totalis (total) - uniform coloring of urine, the release of red blood cells throughout the act of urination.
Let's consider more in detail the reasons of urine of red color, having divided them into two big groups:
- Physiological factors associated with the process of digestion and secretion:
- Food containing natural dyes can color the urine from greenish-yellow to red or pink. Beets impart a characteristic color to urine due to the dye - betatsiana, which in turn helps to cope with cardiovascular diseases. Anthocyanins contained in red, lilac berries are also capable of changing the color of urine from pale pink to maroon. Blueberry, dark grapes and its derivative - wine, red or black currant, cherry, strawberry and list leader - the blackberry, passing through the gastrointestinal tract, color the urine quite intensively depending on the acidity level of the gastric juice (the lower the acidity of the medium, the brighter the color).
- Medicinal products are aspirin (Acidum acetylsalicylicum) and all salicylates, amyloprenazine (Aminophenazonum), Milgamma, sulfonamides, diuretics, methyldopa, phenacetin, phenolphthalein, nitrimidazoles, rifampicin, paracetamol, preparations containing anthraglycosida (anthraglikosides), nalidixic acid, some anesthetics (Propofol), Metronidazole, tetracyclines, cytostatics (Rubomycin) affect the color urinae - the color of urine in the direction of the red spectrum.
- Pregnancy. Urine of red or pink color during pregnancy can be associated with increased work of the kidneys, carrying a double load, or with features of a woman's nutrition. If, in addition to the temporary (24 hours) change in the color of urine, there are no other clinical manifestations and uncomfortable symptoms, this phenomenon can be considered a transient physiological condition.
- Infant age. During the first 10-14 days, the modified color of urine, having a pale pink, red shade, is allowed and considered normal in newborns. This can be explained purely by physiological factors - active metabolism of organic purine compounds, elevated levels of uric acid.
- Increased physical activity, training, which affect the structure of muscles. Muscular striated fibers are damaged and release a specific protein-myoglobin, myoglobinuria develops, the color of urine changes toward red shades.
- Intoxication with mercury vapor, lead.
- Urine red can be during the menstrual cycle.
- Medical urological procedures (catheterization) can also cause red urine.
- Thrombosis of hemorrhoidal rectal veins (hemorrhoids) is often a factor affecting the color of urine. A differential sign is the simultaneous staining of feces in a red tint.
- Pathological causes of urine red:
- Micro or macrohematuria (blood, the presence of blood cells in the urine). The causes of red urine in hematuria are manifold as well as its types - initial, false, total, terminal.
Hematuria is a symptom. It provokes diseases in acute or chronic form, related to the organs of the urinary system, and other pathologies:
- nephrolithiasis ( urolithiasis );
- nephritis ( nephritis );
- Tumor process;
- hereditary nephritis ( Alport syndrome );
- cyst or polycystic kidney tissue;
- club nephritis (glomerulonephritis);
- nephropathy associated with diabetes;
- arteriovenous malformations (pathological proliferation of vessels in the tissues of the kidney);
- hypernaroid cancer;
- balanytis (balanitis);
- genitourinary schistosomiasis;
- infectious endocarditis, which may be accompanied by hematuria;
- hereditary pathology - Osler's syndrome;
- hemolytic anemia;
- ankylosing spondylitis;
- systemic vasculitis;
- endometriosis of the bladder;
- aorto-mesenteric tweezers syndrome ("nutcracker" syndrome).
If the change in the shade of urine is not due to transient physiological factors, the causes of red urine require careful examination, differential diagnosis and treatment of the underlying disease.
Diseases that cause red urine
Pathological causes of a red shade of urine are associated with hematuria, which in turn is considered one of the leading signs in the clinical picture of a variety of nephropathologies. Diseases that cause red urine discharge are the etiological factors of the appearance of erythrocytes or other forms of blood flow in the blood. Therefore, hematuria is classified as follows:
- Erythrocyturia (red corpuscles in urine).
- Hemoglobin Cylindyria (pigmentary cylinders in the urine).
- Hemoglobinuria (iron-containing chromoprotein in urine).
Diseases that cause the discharge of urine of red color, hematuria:
- Urolithiasis (urolithiasis), urolithiasis. According to statistics, 15-20% of all cases are accompanied by macroscopic hematuria. The onset of the process can also manifest itself as a sign, like red urine, but the red blood cells are detected only in the laboratory. Moving concrements injure the tissue of the urinary system, bleeding is clearly visible in the urine, acquiring a non-standard shade.
- Adenocarcinoma (defeat of the pelvis), renal cell carcinoma (hypernephroma) - 90 -95% of all tumor processes in the kidneys. More rarely - nefroblastoma, bright cell sarcoma. Benign oncology processes - oncocytoma (oncocytoma), AML (angiomyolipoma), renal adenoma. Macrogematuria is manifested by blood clots in urine, but in the initial stage the process proceeds almost asymptomatically.
- RMP ( bladder cancer ), ureter cancer (more often as metastases of adenocarcinoma), cancer of the urethra.
- Gn (glomerulonephritis). Urine of red color at the GN is considered a clinical manifestation of the progression of the pathological process.
- Autoimmune systemic diseases of various types of connective tissue. In nephropathology, this is systemic vasculitis (Wegener's granulomatosis), angiitis, tubulointerstitial nephritis (interstitial), SLE (lupus erythematodes, systemic lupus erythematosus), reactive arthritis, gouty arthritis, ankylosing spondylitis, ankylosing spondylitis, RA (rheumatoid arthritis, rheumatoid arthritis).
- PBC (polycystic kidney disease). Congenital pathology, often developing without clinical signs. Staining of urine in red shades indicates complications of an infectious nature, about the syndrome of insufficientia renalis: acute renal failure, acute, insufficientia renalis acuta or chronic renal failure, renalis chronica - renal insufficiency.
- Medicinal interstitial nephritis, which can provoke more than 50 types of medications of different groups. Antibiotics, NSAIDs (non-steroidal anti-inflammatory drugs) that provoke hematuria are leading in the list and can lead to acute renal failure with uncontrolled admission. List of drugs:
- Necrosis of the renal papilla can be manifested by hematuria, leukocyturia, pain symptoms (colic). Causes papillary necrosis group of drugs NSAIDs, analgesics, Acidum acetylsalicylicum (aspirin).
- Cystitis with blood (hemorrhagic). It is provoked by cytostatics (Cyclophosphamidum, Mitotanum).
- Education of kidney stones. Adverse manifestations of treatment with long-term courses of ART (antiretroviral therapy) - Ritonavir, Triamterenum, Indinavirum, as well as anxiolytics - Remeron, Mirtazapinum.
- The risk of developing the tumor process and the corresponding symptom - hematuria, is when self-treated with phenacetin, with long-term administration of cyclophosphamide.
- Narrowing of urethra (urethral stricture), doubling of the kidney, renovascular hypertension, nephroptosis. Injuries of the pelvis renalis membrane, caused by intra-vessel pressure of urine, its poor outflow, lead to hematuria.
- Infectious disease - pyelonephritis, pyelonephritis. Infringement of the blood supply to the kidney, an insufficient outflow of urine provokes the appearance of blood in the urine.
- The inflammatory process in prostata, prostatitis is prostatitis. Hematuria with prostatitis is quite rare, but it can also serve as a clear sign of an exacerbation of the disease.
- Tuberculosis of the kidneys (tuberculosis of the parenchyma, tuberculous papillitis). It is accompanied by macrogemuria.
- Venous hypertonia (hypertension).
- Nutcracker syndrome, compression of left kidney vein, varicocele.
- Focal necrotic lesion of the kidney, infarct of the kidney.
- A bruise, a trauma to the kidney.
- Violation of blood coagulability, coagulopathy.
- Haemoglobinuria, hemoglobinuria due to intoxication, intravascular hemolysis, trauma, compressive character (SDR - crash syndrome)
Diseases that cause the discharge of urine of red color, are diverse, they can be divided and in terms of severity:
Diseases of moderate severity
Diseases that respond well to therapy at an early stage of the process
- Carcinoma of the kidney
- RMP - cancer of the vesica urinaria (bladder)
- Nephrolithiasis with stones in the ureter
- Carcinoma prostata (prostate)
- PCB - polycystic kidney disease
- Tuberculosis (kidney tuberculosis)
- Hydronephrosis (hydronephrosis)
- Nephrolithiasis (kidney stones)
- Infectious processes in the MVS (urinary system)
- Concrements in the bladder
- Interstitial cystitis
BPH, benign hyperplasia (hyperplasia) of the prostate
A wide range of diverse diseases that cause red urine secretion requires differential diagnosis. Diagnostic search in turn may require the involvement of doctors not only of urological specialization, but also of endocrinologists, infectious disease specialists, and oncologists. Early diagnosis can speed up the preparation of a therapeutic result and significantly reduce the risk of complications and negative predictions.
Urine red in cystitis
Inflammation of the mucosal tissue of the bladder, cystitis, it is more likely one of the manifestations of the main, provoking the inflammatory process, the disease. This is especially true for secondary cystitis in acute form. Urine red in cystitis is a clinical sign of infection in the inner layers of the epithelium, when the tissue vessels are damaged and bleed. Depending on the course of inflammation, red urine with cystitis occurs with such forms of the disease:
- Hemorrhagic form of cystitis.
- Necrotic form, ulcerative cystitis.
- Cystitis with blood, a hemorrhagic form of inflammation is a process that affects the inner layers of the epithelium. This form is most common and is caused by a variety of pathological factors. Urine of red color can appear already in the first day from the beginning of infection. The hue of urine changes rapidly from light pink to red and even dark brown if the inflammation is not treated and transformed into a neglected stage. Provoke infection with a wide range of bacteria, adenoviruses, Escherichia coli, Staphylococcus saprophyticus, Candida, Trichomonas and Herpesviridae.
- Necrotic form is rare, because it is considered a complication after a specific radiation treatment or a consequence of tuberculosis, syphilis.
Urine red in cystitis can be triggered by such diseases and conditions:
- Injuries or damage to the urethra during special urological procedures.
- Adenoma of the prostate gland in men.
- Taking cytotoxic drugs and other medicines that have side effects associated with the urinary system.
- STDs - the whole list of sexually transmitted diseases.
- Concrements in the bladder.
- Chronic constipation.
- Oncoprocess in the organs of the urinary system.
- A gross violation of the rules of personal intimate hygiene.
For hematuria caused by cystitis, the appearance of a red shade of urine is characteristic at the end of the urination process. There are fewer cases of urine staining at the beginning and in the middle of the act, which may indicate a chronic course of inflammation.
Urine red after alcohol
The toxicity of ethanol deserves a separate, extensive and well-reasoned description. All drinks containing alcohol have a negative effect on the function of the urinary system, especially on the filtration capacity of the kidneys. Urine red after alcohol is a visible sign that parenchyma cells and other renal structures. Ethanol provokes excessive activity of the main points of the "mandatory" program of the kidneys:
- Glomerular ultrafiltration of metabolic products.
- Reabsorptio - reabsorption.
- Allocation, secretio.
- Metabolic function is gluconeogenesis.
- Cleansing, kidney clearence (clearance).
Ethanol adversely affects the MF (urinary system) as a whole and can lead to such conditions and pathologies:
- Acute or chronic inflammation in the vesica urinaria (bladder), in pelvis renalis (renal pelvis).
- Endocrine disorders, pathologies of glandulae suprarenale (adrenal glands).
- Urolithiasis, nephrolithiasis (formation of kidney stones).
- Oncopathology in the organs of the MF (urinary system).
- General intoxication of the body.
- Chronic kidney pathologies, CKD (chronic kidney disease) - chronic kidney disease.
- OPN - acute renal failure.
- CRF - chronic renal failure.
- Acute glomerulonephritis.
- Focal proliferative glomerulonephritis.
Urine red after alcohol is due to elevated levels of IgA in the blood (alcoholic hematuric nephritis). This in turn is explained by the compensatory mechanism of immunoglobulins against the background of total damage to the liver and pancreas. In clinical practice, it is customary to differentiate typically alcohol glomerulonephritis from other pathologies. The main difference is the absence of pain during urination, microhematuria at the beginning of the process, a sharp increase in blood pressure (arterial pressure). In addition, the staining of urine in red shades is observed with APNP - alcoholic polyneuropathy, polymyopathy, when the blood contains a hemoglobin, a hemoglobin, into the urine.
Toxic nephropathy is a very formidable pathology that rarely stops at the ischemic stage. The favorable outcome depends on the refusal to use ethanol-containing fluids, timely treatment to doctors and from long-term, comprehensive treatment, preventing uremia and restoring the kidney function.
Red color of urine under saturnism
Saturnism or chronic intoxication with polytropic poison - lead often proceeds without clinical manifestations until the critical level of carcinogens accumulates and the disease does not acquire a severe form, affecting totally the human organs and systems. The red color of urine under saturnism is one of many symptoms that indicate a violation of the enzymatic function, pathological processes in the cardiovascular, hematopoietic, urinary and nervous system, dysfunction of immunity and metabolism in general. WHO regularly publishes alarming statistics on the effects of environmental pollution on lead compounds:
- Annually, information is confirmed on the number of diagnosed mental retardation of children as a result of lead intoxication. From 500 to 600 thousand children of all countries of the world are born with pathologies or suffer from acquired specific diseases associated with Plumbum.
- Each year, from the intoxication of lead compounds, up to 140,000 people die in the world, overwhelming in most of this tragic statistics falls on Asian countries.
- The most vulnerable to the risk of lead intoxication children under 5 years, because the baby's organism is able to absorb up to 40% of lead compounds. In comparison with adults (5,5-10%) this figure looks alarming.
- Lead removal by 75-80% is a function of AIM (urinary system).
- Intoxication occurs when a person gets 1 to 3 milligrams of lead into the human body. Life-threatening, lethal dose - 9-10 milligrams.
Target organs for lead poisoning:
- Bone system.
- Peripheral nervous system.
- The hematopoietic system.
- The kidneys.
Urine red in saturnism is noted already at the stage of kidney damage (nephropathy) and is combined with such laboratory indicators:
- Proteinuria (increase in the level of protein in urine).
- Hyperuricemia (elevated uric acid level).
- Cilindrarium (the presence of blood cells and epithelial elements in urine).
- Hematuria (erythrocytes in urine).
Saturnism is easier to prevent than to conduct long courses of treatment. Prevention is the only way to reduce the risk of severe intoxication. In lead-related industries, regular check-ups should be conducted. Children and adults living in an environmentally unfriendly environment in industrial areas need enhanced vitaminization, specific methods that reduce the risk of intoxication, in constant supervision of the attending physician.
Urine red after catheter placement
Catheterization in urology is used for quite a long time, the procedure began to be carried out at the end of the XIX century. It is used for such indications:
- Verification of ureteral patency.
- Fence is clean, without microflora, urine for laboratory research.
- Exclusion or confirmation of leukocyturia.
- For pyelourethrography.
- Decompression procedure with neurogenic bladder syndrome.
- Monitoring the amount of urine at specified times of the day.
- Urodynamic studies.
- Urine collection from the right and left kidneys (separately) - for research.
- To clarify the sector of obstruction in the ureter.
- For the purpose of administering medication directly to the vesica urinaria or urethra.
- Operations aimed at removing urine.
- Antiseptic washing of the bladder.
- To improve the outflow of urine in inflammatory processes in the prostate.
- Restoration of urinary function (patency).
At the end of the procedure, many patients note that after the catheter is installed, urine is red. This is because the catheterization, even with all the rules, is a mechanical effect on the ureter's mucous tissues. Consequently, it is inevitable that microtraumas and the entry of erythrocytes into urine are considered. A similar transient side effect is the introduction of a catheter into the vesica urinaria (bladder). The permissible period of hematuria after manipulation is not more than 3 days. If, after the catheter is inserted, urine of red color lasts longer than 2-3 days possibly, post-manipulational complications develop, which can be as follows:
- Perforation of urethra walls. Strictura (constriction) of the urethra.
- Blood loss, which causes a sharp drop in blood pressure.
- Purulent inflammation of the subcutaneous tissue (carbunculosis).
- Infection of the urethra, urethritis, bacteriuria.
Catheter-associated urinary tract infections accompanied by hematuria require additional therapeutic measures, a comprehensive antibacterial treatment.
Drugs that color urine in red
More than 20 thousand medical preparations in various forms have an arsenal of pharmaceuticals, which is used in medicine of the XXI century. About 40% of the world's adult population take medicines every day. Each drug is able to have a specific effect not only on the pathological target, but also on the results of laboratory studies, distorting their indicators initially. Chemical components of drugs are stored in the blood, tissues and organs of a person for a certain period. These ingredients actively interact with special laboratory reagents, changing the final analysis information. In laboratory practice, this process is called chemical interference. That is why it is important to take into account all the anamnestic details when diagnosing on the basis of examination, including remembering that there are drugs that color the urine red, without changing its other indicators.
A list of medicines that can color the urine in shades of red:
- Anti-TB drug - Rifampicin.
- Antiseptics - Besalol, Phenylsalicylate, Salol.
- Acidum acetylsalicylicum - aspirin.
- Antimicrobial agents - Furagin, Furadonin, Urofuragin, Nitrofuran.
- Anti-inflammatory drugs - Alamidon, Pirafen, Novamidon, Pyrazon, Antipyrine.
- Laxative - Phenolphtaleinum, phenolphthalein.
- Uroantiseptic medicinal product - Nitroxoline.
- Anesthetic - Analgin.
- Antibiotics from the group are carbapenems. Meropenem, Cilastatin, Propinem, Tienam.
- Non-steroidal anti-inflammatory drugs - Ibuprofen, Brufen, Ibunorm, Nurosan.
- Preparations containing leaves of hay, aloe, buckthorn, rhubarb root (anthraglycosides).
- Antiprotozoal drugs - Trichopol, Gravagin, Metronidazole.
- Medicines containing riboflavin (vitamin B2) - Lactoflavin, Flavitol, Vitaplex B2, Ribovin, can stain urine not only in a yellow tint, but also give it a red color.
- Hypotensive drugs - Methyldopa, Dopanol, Aldomet.
- Antipsychotics - Chlorpromazine, Aminazine, Thiotidazine, Mellerill, Tyson.
- Cytostatics - Phosphamide, Cyclophosphamide, Azathioprine.
Drugs that color urine in red are excreted more often with the help of the urinary system, having a temporary effect on urine indicators. At laboratory researches it is necessary to take into consideration, that color, a smell and a transparency of urine can be changed under action of medicines and deviate from frameworks of norm.
Urine red when taking regulon
Oral contraceptives, like other preparations containing estrogen, steroids, can change the biochemical processes in the liver, blood counts. One of the most popular drugs in this category is Regulone, a hormonal combination drug designed to suppress FGS and LH (follicle-stimulating and luteinizing gonadotropins) to reduce and inhibit ovulation. The drug includes Aethinyloestradiolum (ethinyl estradiol) and Desogoestrelum (desogestrel).
With a regulone, red urine may be present in women who have increased sensitivity to steroid components of medicines, as well as in those who have hyperlipidemia diagnosed, and liver dysfunction. Regulon is capable of
Change and disrupt the normal cycle of metabolism of a specific pigment - porphyrin, a precursor of hemoglobin and increase its release in the urine 9-14 days after the start of taking the contraceptive.
A long course of admission or incorrectly matched dosage OK (oral contraceptives) is capable of causing the following side effects:
- Arterial hypertension (more than 140/90).
- Rarely - hemolytic-uremic syndrome, health and life threatening state characterized by acute renal failure (acute renal failure), thrombocytopenia and anemia.
- Porphyrinemia and porphinuria.
Hematoporphyrinuria (the presence of pigments - porphyrins in urine) as a secondary clinical symptom may be due to the medicinal effect on the liver. With a regulone, urine of red color is a clear sign of a violation of pigmented blood metabolism and an indication of discontinuation of the drug.
Milgamma stains urine in red
Milgamma is prescribed as a neurotropic multivitamin agent for the treatment of such diseases and conditions:
- Strengthening the immune system.
- RNH is a retrobulbar neuritis.
- Recurrent viral infections (Herpesviridae group).
- Stabilization of the process of hematopoiesis.
- Activation of blood microcirculation.
Milgamma stains urine in red due to the content of Cyanocobalaminum. Cyanocobalamin is metabolized and deposited in the liver, does not lose its activity during the biotransformation and is eliminated with urine in a practically unchanged form.
Vitamin B12 is indispensable as an anti-anemic, erythropoesthetic. This vitamin was found and synthesized in the middle of the last century and has since become a real salvation for patients with disorders of the nervous, cardiovascular system. Especially useful is cobalamin for the elderly, suffering from hearing loss, diabetes, polyneuropathy. Thus, milgamma stains urine in red, but does not provoke true hematuria. Changing the shade of urine is a temporary phenomenon, which is eliminated after 2-3 days.
Blood in the urine, urine of an atypical, reddish hue is a clinical sign of the abnormal state of the urinary system in general and of the urine composition in particular.
Risk factors that can trigger a red urine:
- Category of people suffering from a chronic form of various nephrologic pathologies:
- Patients with proteinuria.
- Patients with clinical symptoms of renal failure.
- Patients whose urine analysis shows an increase in the level of creatinine in the analysis of serum.
- People at risk of urological pathologies:
- The occupational risks of intoxication are workers in the chemical industry.
- Harmful habits, unhealthy lifestyle - smoking, narcotic, alcohol dependence.
- Age features also affect risk factors. Persons over 45 years, especially men, fall into the category of risk of urological pathologies.
- Presence of an earlier history of uropathology in the anamnesis.
- Single or recurrent urination disorder.
- Infectious diseases of the genitourinary system.
- STDs are sexually transmitted diseases in history.
- Long course of treatment with analgesics.
- Patients suffering from such diseases:
- Anemia of various kinds.
- Cardiovascular diseases.
- Diseases associated with the hematopoietic system - leukemia, lymphomas.
- Congenital pathologies of the liver, kidneys, other organs and body systems.
Risk factors should be considered when prescribing drugs, as well as in general in differential diagnosis of clinical manifestations of pathology in the form of hematuria - true or physiological.