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DIFFERENTIAL DIAGNOSIS OF DARK URINE

OP Kapoor

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

If a patient gives the history of passing a very dark (Coca-Cola type) urine, the following are the three important causes:-

1.Haemoglobinuria : Often seen in a patient with G6PD deficiency after having taken some drugs. Microscopic urine examination will not show any RBCs while the blood levels of Hb will be very high.

2.Massive Haematuria : It may be due to a stone, or a bladder or kidney tumour. The microscopic examination of the urine will show plenty of RBCs.

3.Myoglobinuria : In modern days, when hundreds of patients are put on ‘statins’ (HMG COA Reductase Inhibitors), in patients having ischaemic heart disease, do not forget that occasionally myoglobinuria can occur and the drug should be stopped immediately and the doctor should look out for the complications of acute renal failure.

There are other three less important causes of ‘darkish urine’:-

1. History of beetroot consumption in the food.

2. Patients consuming rifampicin.

3. An occasional patient of porphyria (usually in such patients the urine colour changes, after the urine is left in a container for some time unlike patients of Alkaptonuria).

Finally, in a jaundiced patient though the urine is dark coloured, it is not opaque, but opalescent.

ACKNOWLEDGEMENT

I am thankful to Dr. Sunil Parekh for his suggestions.



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