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Red Urine
1. Approach to Red Urine Helen Healy Department of Renal Medicine Royal Brisbane Hospital
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9. Microscopic evidence of an increased number of RBC in the urine discriminates Not all urine that is red is hematuria
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Editor's Notes
Three urine samples are shown. The one at the left shows a red, cloudy appearance. The one in the centre is red but clear. The one on the right is yellow, but cloudy. www.nephron.com
Coloration of dipstick is detecting heme pigment, not RBC and will detect - free heme & - myoglobulinuria - strong oxidising agents as well as - heme bound in RBC Dipstick is positive when > 0.15 g/L of free hemoglobulin in urine or ~ 5,000 RBC/ml (manufacturer’s information). Therefore specific but not terribly sensitive. May increase if on anti-coagulants - unmasks pre existing hematuria but not cause it
He was referred to me when this sequence of events were repeated. On the second occasion, he saw his GP immediately who witnessed clear red urine that tested negative on dipstick and microscopy for RBC. Careful history revealed a history of a significant event prior to each episode of red urine. Each episode of red urine occurred in the early afternoon.
It is normal for RBC to be excreted in the urine - picked up on scanning electron microscopy of n=27 normal volunteers - 526 +/- 146 rbc/ml of urine or in a concentrated specimen after centrifuge, 203 +/- 72 with 95% < 950 rbc/ml Therefore > 1,000 rbc/ml are abnormal or 10 RBC/ l in a study of n=27 volunteers and published in 1979 Prevalence up to 4% in children 1-13% in adults In populations followed t=15y, 38.7% men have hematuria at least once and 16.1% on > 1 examination within 5 years
hematuria is responsible if the red colour is seen only in the urine sediment, with the supernatant being clear if the supernatant is red, then the supernatant should be tested for heme with a urine dipstick a supernatant that is negative for heme is a rare finding that can be seen in several conditions, including porphyria, the use of the bladder analgesic phenazopyridine and the ingestion of beets in susceptible subjects a red supernatant that is positive for heme is due to myoglobinuria or hemoglobinuria Beeturia refers to the presence of red urine after the ingestion of beets. It occurs in approximately 14% of people and is due to the excretion of the reddish pigment betanin.
