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What color is your urine when your kidneys are failing?

The color of your urine can provide important clues about your health, especially the health of your kidneys. Abnormal urine color may be the first sign of kidney disease. As kidney function declines, the color of the urine tends to darken and change hue. Understanding the reasons for color changes in urine can help you identify potential problems early and seek appropriate treatment.

Normal Urine Color

Normal and healthy urine can range in color from pale yellow to deep amber. The pigment urochrome, a breakdown product of hemoglobin, is responsible for the yellow color. The more concentrated the urine, the darker the yellow color.

Other factors that contribute to urine color include your fluid intake, diet, medications, and health conditions. For example, eating beets can turn urine pink or red. Vitamin B supplements can turn it a bright yellow.

As long as you stay hydrated, your urine should be a pale straw color. Dark yellow urine usually indicates concentration due to inadequate fluid intake.

Causes of Abnormal Urine Color

Many conditions can cause your urine to become an abnormal color, including:

– Dehydration – Darker yellow or amber urine
– Urinary tract infection – Cloudy or bloody urine
– Kidney stones – Pink, red, or brown urine
– Food dyes – Orange, blue, green urine
– Medications – Brown, black, blue, green urine
– Liver disease – Dark brown urine
– Porphyria – Dark purple or red urine
– Rhabdomyolysis – Brown, tea-colored urine
– Hemoglobinuria – Red, pink, or black urine
– Bilirubinuria – Dark brown urine
– Alkaptonuria – Black urine upon standing

However, the most important cause of abnormal urine color is kidney disease. As kidney function deteriorates, the urine color progresses through various shades.

Urine Color in Kidney Disease

In advanced kidney failure, the glomerular filtration rate (GFR) falls substantially. The GFR is the measurement of how efficiently the kidneys filter wastes from the bloodstream. With a low GFR, the kidneys cannot adequately remove waste products from the body. These waste products build up in the blood and alter the composition and color of urine.

Some key changes in urine color associated with worsening kidney disease include:

Pale Urine:
In early kidney disease, the urine may become pale due to a decrease in urochrome as the kidneys lose the ability to concentrate urine effectively.

Straw or Tea-Colored Urine:
As kidney disease progresses, the urine becomes more concentrated and turns a straw or tea color. This darker color results from greater amounts of waste products excreted into the urine, such as creatinine and urobilinogen.

Orange Urine:
In advanced kidney failure, metabolic wastes like phosphates and sulfates build up in the blood. These substances may interact with light to produce an orange hue in the urine.

Pink or Red Urine:
When nearing kidney failure, urine may turn pink or red due to the presence of blood. The medical term for blood in the urine is hematuria. It can result from fragile kidney structures bleeding.

Blue or Green Urine:
Buildup of urobilinogen and certain urinary tract infections can sometimes cause blue or green hues in the urine.

Brown or Black Urine:
Very dark brown or black urine occurs when you are not making urine at all. This condition is called anuria and requires emergency medical treatment.

Here is a table summarizing the urine color changes at different stages of kidney disease:

Stage of Kidney Disease Urine Color Description
Early kidney disease Pale yellow Kidneys less able to concentrate urine, decreased urochrome pigment
Moderate kidney disease Straw yellow More concentrated urine due to waste buildup
Advanced kidney failure Orange, pink, red High levels of phosphates, sulfates, blood causes color change
End-stage kidney failure Brown, black Complete kidney shutdown, no urine production

When to See a Doctor

Consult your doctor any time you notice a significant change in urine color, especially if the change persists for more than a day or two. Dark yellow, orange, pink, red, brown, or black urine all warrant medical evaluation.

See a doctor right away or go to the emergency room if you have:

– Pink, red, or brown urine accompanied by pain or burning during urination
– Cloudy or foul-smelling urine
– Back pain, stomach pain, or other unexplained pain along with color changes
– High fever with altered urine color
– Confusion, fatigue, or other symptoms of systemic illness
– No urine production or very dark urine

Catching kidney disease early makes it more possible to slow or halt disease progression. Prompt treatment of urinary tract infections can prevent kidney damage. Seeking timely care for blood in the urine can reveal underlying health issues.

Diagnosing the Cause of Urine Color Changes

To determine the cause of abnormal urine color, the doctor will typically:

– Ask about your symptoms and medical history
– Perform a physical examination
– Have you provide a fresh urine sample for dipstick testing and microscopic analysis
– Order a urine culture to check for infections
– Perform blood tests to assess kidney function
– Obtain imaging tests of the kidneys and bladder

Based on the results of this workup, your doctor can diagnose any related conditions. Additional testing may be needed in some cases to pinpoint the root cause.

Treating Conditions Causing Urine Color Changes

How underlying conditions are treated depends on the specific cause:

– Dehydration – Increased fluid intake
– Urinary infections – Antibiotics
– Kidney stones – Lithotripsy, surgery
– Liver problems – Treat underlying condition
– Bilirubinuria – Phototherapy, blood transfusion
– Hemoglobinuria – Relieve cause of hemolysis
– Kidney disease – Kidney-friendly diet, medication, dialysis

If kidney disease is leading to urine color changes, treatment focuses on slowing the progression of kidney damage with:

– Medications, such as ACE inhibitors or ARBs
– Dietary changes to reduce phosphorus, potassium, and waste buildup
– Dialysis if kidneys can no longer filter blood adequately

Lifestyle changes like controlling blood sugar and blood pressure, staying active, maintaining a healthy weight, and quitting smoking are also important.

Outlook for Abnormal Urine Colors

The outlook depends on the underlying condition behind urine color changes:

– Simple dehydration: Excellent, if treated
– Urinary infection: Good, with prompt antibiotic treatment
– Kidney stones: Good, depending on response to treatment
– Liver disease: Variable depending on diagnosis and severity
– Kidney disease: Progressive decline if untreated; can slow with treatment

If urine changes are due to kidney disease, the prognosis relates to the stage of kidney damage. Mild changes may not affect kidney function much, while advanced kidney failure requires dialysis or transplantation.

Some urine color changes reverse quickly once the underlying problem is treated, while others may persist chronically if damage has occurred. Close follow-up care is recommended.

Prevention of Urine Color Changes

Some tips to help prevent unhealthy changes in urine color include:

– Drinking enough fluids daily
– Controlling risk factors for kidney disease like diabetes and hypertension
– Getting regular checkups to catch problems early
– Not ignoring symptoms like changes in urination
– Avoiding exposure to toxins and kidney irritants
– Following proper hydration around exercise
– Obtaining prompt treatment for infections
– Taking medications as directed
– Avoiding excessive vitamin supplements that alter color

Monitoring your urine color and watching for changes from your normal shade can also help detect problems at an early stage.


Changes in urine color often signal underlying health issues. While some causes are harmless, others can indicate a serious condition like kidney disease or failure. If you notice unusual urine colors, seek prompt medical evaluation to determine the cause. Based on the diagnosis, your doctor will recommend appropriate treatment to remedy the problem. Catching kidney damage early improves the chances of preserving more normal kidney function.