Causes of red urine: from dark pink to bright brown hues

Massive isolation of erythrocytes (haemolys) provokes a sharp change in the parameters of urine. 

Urine is dark red

Urine is dark red - an alarm signal, indicating the blockage of nephrons, the risk of hemolytic anemia and acute renal failure (acute renal failure). Urine dark red color is provoked by such factors:

1. Renal etiology of causes:

• kidney disease;
• pathology of the urinary canal;
• general intoxication of the body;
• pathology, damage to tubuli renales /  tubulus renalis  (renal tubules);

2. Somatic etiology of factors:

• pathology of internal organs, chronic form or exacerbation of the process.

3. Posterial etiology of causes:

• anuria;
• acute renal postrenal insufficiency;
• oliguria;
• chronic renal failure.

Causes that provoke such a symptom as urine of red color:

1. Nephrosclerosis.
2. Amyloid dystrophy.
3. Glomerulonephritis
4. Inflammation of renal pelvis, pyelonephritis.
5. Urolithiasis disease.

Typical differential signs, according to which the urine of dark red color differs from the physiological transient state, which causes red color of urine, are as follows:

• Associated symptoms - fever, chills.
• Persistent nausea, recurrent urge to vomit.
• Jaundice staining of fibrous eye tissue (icteric sclera of the eye).
• Weakness, fatigue.
• Drawing pain in the right side (hypochondrium).
• Anuria.
• Bleeding in the urinary tract.
• Crash syndrome (Bywaters, a syndrome of prolonged compression).

Other reasons:

• Bright, dark crimson color of urine occurs in patients taking drugs containing phenolphthalein. Such cases are not pathology, the color of urine is restored quickly enough, after the end of the drug intake.
• Brownish, dark red color of urine can be after taking medications based on Rubiceae (madder dyeing).

In combination with the urine of a dark red color, these signs indicate a disturbing state:

1. Haemoglobinaemia (hemoglobinemia).
2. Bilirubinemia.
3. Haemoglobinuria (hemoglobinuria).

Massive hemolysis manifests an indicative symptom - urine, which in color resembles the color of water in which meat is washed ("meat slops"). This indicator indicates a total disintegration of red blood cells, the release of hemoglobin and the excretion of it through urine. If this condition does not apply for medical care, there is a risk of rapid development of acute renal failure (acute renal failure).

Urine of a reddish brown color

An unaccustomed shade of urine, urine of red-brown color is one of the signs of the pathological process of hemolysis of erythrocytes, which is called methaemoglobinuria. Methemoglobinemia can be congenital or develop due to intoxication. The state of the blood, when about 50% of hemoglobin takes the form of ferrimoglobin (3-valent iron), can develop due to exposure to the following substances and factors:

• Aromatic chemical dyes (benzenes - aniline, nitroaniline, methylaniniline).
• Reaction to chlorobenzene, silver nitrate, naphthalene, products with nitrates, chlorates.
• Complications after a long course of ABT (antibacterial therapy) or long-term intake of nitroglycerin, chloroquine, metronidazole, rifampicin.
• Taking drugs from a number of sulfonamides, phenacetin.
• Treatment with preparations containing resorcinol.
• Reaction to the introduction of lidocaine, novocaine.
• Intoxication with nitrate, copper sulfate.

In addition, the urine of the red-brown color may be a consequence of a pathological abnormality of the internal organs - liver, gallbladder. Hepatopathology (hepatitis) stains urine in a brownish hue, acute forms of the disease provoke capillary bleeding, which is clinically manifested as the discharge of erythrocytes into the already browned urine. Such a mixture of shades has an important diagnostic value, of course, not being an independent accurate marker of the disease.

Also, reddish brown urine is one of the symptoms of advanced oncoprocess (melanoma), hemolytic anemia, cirrhosis, glomerulonephritis in acute form or one of the forms of hepatitis in the terminal stage.

Less frequently, the change in urine to a reddish-brown shade occurs after severe angina, extensive burns, after bites of venomous snakes, insects or poisoning with fungi.

Urine bright red

Erythrocytes in the urine give it a vivid shade. Urine is bright red - first of all evidence of a neutral or alkaline reaction. The higher the acidity of urine, the brighter its color index. Other causes that cause urine to be bright red may be:

1. Somatic factors:

• Thrombocytopenia.
• Anemia.
• Hemophilia.
• Systemic vasculitis.
• Intoxication with chemicals.
• Intoxication with bites of poisonous insects, snakes.
• Somatic diseases of viral or bacterial etiology.

2. Renal reasons:

• Autoimmune pathology is glomerulonephritis.
• Pyelonephritis.
• Trauma, rupture of the kidney tissue.
• Amyloidosis.
• Kidney infarction.
• Hydronephrosis.
• Nephrolithiasis.

3. Emergency factors:

• Injury, rupture of the bladder.
• Cystitis.
• Bladder cancer in the terminal stage with bleeding.
• Urolithiasis disease.

In addition, red blood cells (erythrocytes) in urine, urine of bright red color may indicate bleeding of uterine origin, an erosive process in the cervix in women.

Urine of pink red color

The onset of microhematuria can only be detected by a laboratory, using urine tests. Urine of pink color is already transition of a final stage of invisible allocation of erythrocytes in other kind - a macrohematuria or the transitory phenomenon connected with a food ration.

The reasons why pink urine can be released:

• Adding rhubarb root to the food, various rhubarb dishes (jelly, salad, pies, garnish).
• The use of beets of pink varieties, cranberries, black currants, blackberries (plant pigments).
• Taking medications based on aminofenazone, a course of treatment with anthraquinone, propofol.
• The appointment of salicylates, ibuprofen, can also trigger a change in the color of urine to a pink tint.
• The initial stage of inflammation of the bladder.
• Benign tumor process (urethral polyps).
• Back injuries in the kidney area.
• Alcohol intoxication.

If the urine is pink colored due to the food factor, the intensity of its color depends on the pH. The acidic environment of urine enhances the brightness of the hue, a pale pink color is clear evidence that urine shows an alkaline reaction.

For other reasons for the appearance of red urine, see this article.