A unique case of purple urine: A case report and literature review

Aklilu, Abinet; Avigan, Zachary M.; Brewster, Ursula C.

doi:10.5414/cn110272

Cited by 5 publications

(6 citation statements)

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“…Pigments and other compounds in certain foods (including beets, berries, and food colorings) and drugs (sulfonamides, ibuprofen, salicylates, phenothiazines, metronidazole, phenolphthalein, chloroquine, deferoxamine, etc.) can change the color of urine [ 4 ].…”

Section: Definitions and Detection Of Hematuriamentioning

confidence: 99%

How to define and assess the clinically significant causes of hematuria in childhood

2022

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Given the wide diversity of causes of hematuria, ranging from simple urinary tract infections with rapid recovery to severe glomerulonephritis with fast decline in kidney function, it is essential to recognize the underlying disease. The first objective of the assessment is to determine whether the cause of the hematuria is medically significant. The combination of hematuria with proteinuria, the presence of hypertension, or worsening kidney function can represent signs of progressive kidney disease. Differentiating the various causes of hematuria is often simple and obvious based on the clinical signs and gross appearance of the urine. However, in some instances, additional non-invasive investigations, such as ultrasound imaging, urinary red cell morphology, measurement of calcium and other solutes in the urine, evaluation of kidney function, and protein excretion, are needed to elucidate the nature of the hematuria. Taking a detailed family history can help in establishing the underlying cause in cases of familial hematuria. On the other hand, the decision to perform a kidney biopsy in children with asymptomatic hematuria remains a challenging issue for clinicians. Ultimately, the frequency of diagnosis of glomerular involvement causing hematuria may depend on the threshold for performing a kidney biopsy. The following review will focus on the diagnostics of hematuria, starting with difficulties regarding its definition, followed by various means to differentiate between urinary, glomerular, and other causes, and finally reviewing the most common diseases that, due to their frequency or their effect on kidney function, present a diagnostic challenge in everyday practice.

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Section: Definitions and Detection Of Hematuriamentioning

confidence: 99%

How to define and assess the clinically significant causes of hematuria in childhood

2022

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“…At the time of this report, there has only been one other study which describes the rare iatrogenic clinical entity of purple urine secondary to hydroxocobalamin and methylene blue co-administration [ 15 ]. Aklilu et al speculated that there did not seem to be any known pathway that would generate a purple metabolite, and that the urine coloration was likely the result of the combination of the blue and red colors from methylene blue and hydroxocobalamin, respectively [ 15 ]. Our analysis set out to definitively answer this question.…”

Section: Discussionmentioning

confidence: 99%

Spectrophotometric analysis of purple urine secondary to methylene blue and hydroxocobalamin co-administration

Hardin,

Galust,

Clark

et al. 2023

J Nephrol

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Background The development of purple urine after methylene blue (methylthioninium chloride) and hydroxocobalamin co-administration is a rare clinical entity that has not been fully elucidated. A 47-year-old male presented to the emergency department with hypotension, cyanosis, and depressed mental status. The patient was noted to have profound peripheral and central cyanosis, as well as chocolate-colored arterial blood. He was treated with both methylene blue and hydroxocobalamin and developed purple urine for approximately 1 week. Methods Color chromatography was performed by placing the patient’s urine directly onto absorbent filter paper. Urine spectrophotometry was performed utilizing the NanoDrop One/One C UV–Vis Spectrophotometer. Results Color chromatography of the urine was demonstrated clear separation of distinct red and blue phases. Urine spectrophotometry demonstrated near perfect overlap between the methylene blue + hydroxocobalamin absorbance spectrum and the patient’s purple urine absorbance spectrum. Conclusion Purple urine secondary to methylene blue and hydroxocobalamin co-administration is due to combined urinary excretion of methylene blue (blue) and hydroxocobalamin (red), and not a novel purple metabolite. We anticipate that this is going to be an increasingly common clinical entity as the roles of both hydroxocobalamin and methylene blue expand from toxicologic antidotes to adjunct therapies for vasoplegia, poor cardiac output, and sepsis.

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“…Contrary to deductive reasoning, which produces either true or false output, probabilistic reasoning requires retrieving prior knowledge from memory and has distinct neurocognitive process. 1 Clinical reasoning previously depended on the hypothetico-deductive approach for deriving diagnosis or result interpretation, but uncertainty surrounding clinical scenarios, especially in nephrology ones, may necessitate a probabilistic approach to circumvent errors. Historically, nephrology's development closely intertwines with technological advancements and computer-aided modelling.…”

Section: Emphasizing Probabilistic Reasoning Education: Helping Nephr...mentioning

confidence: 99%

“…There are many causes of urine discoloration including several endogenous and exogenous substances, the differential diagnosis of blue or green urine is also diverse. 1 Ingestion of propofol and methylene blue are the most typically causes of green urine, other medications are also associated with blue-green urine, such as amitriptyline, cimetidine, triamterene, phenacetin, methocarbamol, sildenafil, flurpitine, and metoclopramide. 2,3 Some known diseases can also cause green or blue discoloration of urine, such as urinary tract infections caused by P. aeruginosa, obstructive jaundice, hartnup's disease, and familial hypocalciuric hypercalcemia.…”

mentioning

confidence: 99%

“…2,3 Some known diseases can also cause green or blue discoloration of urine, such as urinary tract infections caused by P. aeruginosa, obstructive jaundice, hartnup's disease, and familial hypocalciuric hypercalcemia. 1,[3][4][5] In addition, water-soluble arti- literature. 6 Despite this phenomenon may have pathological effects that we have not discovered, it is worth remembering this side effect is reversible with the discontinuation of indomethacin.…”

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Rare blue‐green urine due to excess indomethacin: A case report

Xu,

Wang

2023

Nephrology

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A unique case of purple urine: A case report and literature review

Cited by 5 publications

References 0 publications

How to define and assess the clinically significant causes of hematuria in childhood

How to define and assess the clinically significant causes of hematuria in childhood

Spectrophotometric analysis of purple urine secondary to methylene blue and hydroxocobalamin co-administration

Rare blue‐green urine due to excess indomethacin: A case report

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