PEDIATRICS Vol. 41 No. 3 March 1968, pp. 654-658
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DIAGNOSIS AND TREATMENT: SOME SYNDROMES, DISEASES, AND CONDITIONS ASSOCIATED WITH ABNORMAL COLORATION OF THE URINE OR DIAPER

A Clinician's Viewpoint

Thomas E. Cone Jr. M.D.1

1 Department of Pediatrics, Harvard Medical School, and The Children's Hospital Medical Center, Boston, Massachusetts

This Abbreviated Quotation from the writings of Hippocrates is evidence that he shared with the modern physician an awareness of and concern for the color of the urine. Parents often seek professional advice because of their anxiety about the color of their child’s urine or diaper. The physician often finds himself wondering whether the parents’ description of what they believe is an abnormally colored urine represents either an inconsequential finding or one manifestation of a serious illness.

Uroscopy by both parents and physicians has led to the discovery of a number of commonly, as well as rarely, encountered diseases of childhood. It was Sir Archibald Garrod’s2 interest in the color changes in the urine of patients with alcaptonuria that led him to develop his whole concept of inheritable metabolic diseases. More recenfly, the finding of a bluish discoloration of the diapers in two male siblings led to the description of a new and rare familial disease known as thee "blue diaper syndrome."3

Before discussing syndromes associated with abnormally colored urine, a brief description of the normal color of children's urine seems appropriate.

Normal Color of Urine and Causes for it Being Unduly Pale or Dark

The normal amber color of urine is due to the pigment urochrome, the excretion of which is roughly correlated with basal metabolism.1 The normal amber or yellow color may be diminished, increased, or altered in character.

Unduly Pale Urine

Urine may he unduly pale due to a temporary diuresis resulting from (1) a large fluid intake or or (2) a sudden absorption of edema fluid (e.g., children receiving treatment for nephrosis, congestive heart failure, acute glornerulonephritis, or chronic nephritis), or to either (3) diabetes insipidus or (4) mellitus.