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What Causes Cloudy Urination?

Posted on Thu, 20 Feb 2014

Question: Hello and thanks for your time. I've had cloudy urine for last 2 months. Cloudy urine occurs once every other day or so; the other urinations look normal. Multiple urine dipstick tests showed blood in urine but when a sample was sent for a formal urinalysis, it was negative for blood and everything looked normal. The doctor said sometimes the dipstick gives a false positive. Bloodwork showed a low glomular filtration rate (61) and high creatinine (1.1) but doctors didn't mention it (I didn't see a urologist but an urgent care physician's assistant). As far as I could tell, these numbers were both on the borderline of normal. The urinalysis, dipstick and bloodwork were done about a month and a half ago. I had a ultrasound of my upper abdomen (kidney, liver, gall bladder, etc) around the same time and the result was "unremarkable." Two days ago, I urinated and saw something unexpected and disturbing come out in my urine stream. I took the pieces out and that's what's in the picture. Could you please tell me what these are, and what is causing them? I have no pain and no real change in urinary habits with the exception of the intermittent cloudy urine. Thank you for your timely response. Namaste, XXXXXXX

Answered by Dr. Ravi Bansal (47 minutes later)

Brief Answer: passage of fleshy material in urine. Detailed Answer: Hi XXXXXXX The material passed in urine can be necrosed tissue as in papillary necrosis, it can also be fibrin strands, fungal balls and stones. Best way to differentiate is to submit the material for pathological examination at any pathology laboratory. they can do histopathology and see what it is. Your problem of white urine can be due to - Chyluria ( Abnormal lymphatic connections in the urinary system do to any chronic disorder affecting Lymph nodes and lymphatics), Urinary tract infections or excess phosphorus in urine. Correct approach will be to get CT Scan abdomen to rule out these above disorders, most of which can be picked on CT. For infection you have to get Urine routine examination to see number of WBC in urine . You can also do urine phosphorus and chlomicrons to confirm other causes. you have to take help of your doctor and discusses these issues with him. Best wishes, in case of any doubts please write in.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (25 minutes later)

Thank you for your speedy response. One physician's asst. seemed to suspect I had kidney stones at one point. But this material -- the yellow stuff - is soft. The black string with two clumps on either end is also soft. If I remember correctly, my white blood cell count was normal. Are my glomular filtration rate & creatinine cause for concern? The physician asst's I saw didn't even mention them. I accept that there is no way to know without a histological workup. But in your own experience, have you ever seen something like this before? And if so, from your experience, what's your best guess? I understand and respect it is just a guess without a lab analysis. Thank you very much XXXXXXX

Answered by Dr. Ravi Bansal (1 hour later)

Brief Answer: white material in urine Detailed Answer: Yes I have seen this many times . Mostly these are sluffed renal papilla which do not require any intervention unless there is a urine infection or any obstruction. Secondly we see fungal infection or sometimes bladder tumors fragmenting and coming out like this. Still primary investigation of choice remains ct scan and urine microscopy for malignant cells and wbc. The white count I am talking about is not in blood but in urine . Gfr 60 is slightly low but serum creatinine is normal. Gfr is generally calculated with formulas and can show variation. It may be worth repeating it. Still it is not so low that you should worry.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (14 hours later)

Namaste Thank you again for your response. When you say, "Mostly," do you mean "most of the time" or most of what you see in this picture? If the yellow pieces are (may be) renal papillae, what is your assessment of the black, stringy object? Is it normal for renal papillae to be sloughed off, or is it always pathological? I know only a lab analysis and medical evaluation can determine if it is pathological in this case, but since you said intervention may not be necessary if other conditions are eliminated, I wonder, does this ever happen to people with a healthy kidney and execretory system? Thank so much for your time and contribution to my understanding. I am currently uninsured so I don't have a regular doctor; your help is invaluable. XXXXXXX

Answered by Dr. Ravi Bansal (7 hours later)

Brief Answer: white material i urine Detailed Answer: Hi, "Mostly," means the most common causes described and also what we see. But overall these are not very common occurrences. to give you an idea if i am seeing 500 patients a month of kidney disease. this condition would occur in one patient in 2 to 3 months. Don't go by the colour of the sample. It is not normal phenomenon to have papillary necrosis. but secretion of fibrin strands and mucus can be normal. You cannot treat yourself. I would strongly suggest to meet a doctor. secondly, next time when you pass anything in urine please keep the sample in a clean container or preferably a sterile urine sample container. if you are passing fragments daily , you can pass the urine first in a mug and then collect the sample in a separate bottle, and submit for analysis. best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (15 hours later)

Thank you again, doctor. I understand and agree that it is impossible for me to treat myself. I understand a lab exam and CT scan need to be done. I'm glad you wrote down the names of the specific blood tests I can ask for. My last question is if there is a way to distinguish between sloughed papillae, bladder tumor or fibrin strands or fungus based on gross examination? Just curious if doctors have simple guidelines or ways to distinguish them non-microscopically? Does the presence of the strange black fiber (please see photo) help in figuring out the likely cause? Necrosis and cancer are alarming. Please forgive me my worry. Any further clues help. It may be a while until I can afford a lab test. Namaste XXXXXXX

Answered by Dr. Ravi Bansal (4 hours later)

Brief Answer: white material in urine Detailed Answer: Hi XXXXXXX there is no gross way to distinguish these. but in case of sloughed papilla or tumor you mostly , but not always, do get hematuria ( blood in urine). this may occur only once or may have been missed by the patient. Infections generally will have associated fever and pus cells in urine exam. the strange black fiber is of no help. keep your calm and do not worry , nothing will worsen in few days. Thanks, take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (40 hours later)

Dear Dr Bansal Thanks for your help. I went yesterday to an urgent care clinic and had my blood, urine and tissue samples sent to the lab. I am waiting for the reports. Yesterday afternoon, I began having a dull ache pain in my lower left back. Then, this morning, I am apparently releasing urine through my rectum. I checked a couple times to make sure I wasn't just making a mistake. It comes out as a fluid and looks like urine, with a few fecal particles. When I urinated a few minutes ago, my urine was clear, but what came out of my rectum was yellow. Please advise. Namaste XXXXXXX

Answered by Dr. Ravi Bansal (10 hours later)

Brief Answer: urine through rectum Detailed Answer: Urine through rectum is a bad thing to happen . two ways to confirm. First. When you feel you want to pass urine go to the loo and start to pass urine . If at that time fluid comes from rectum as well as urine opening it confirms. Second the fluid coming out per rectum can be collected in a container and tested for creatinine levels . In any case this is an urgent situation and you should consult your doctor immediately. He could confirm this by a ct scan. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (13 minutes later)

Thank you. When I urinate, nothing comes out from my behind. I have urinated multiple times and nothing at all leaks out from my anus. I guess I will see if it recurs with my next bowel movement and collect the fluid as you suggest. What would it indicate? I know it's bad, but I like to know so that when I see another doctor, I will have more than one opinion. I showed what you wrote to the Physician's Asst yesterday and she said it was helpful. So if you wouldn't mind, what conditions or diseases suggest this situation? By the way, I got back my blood and urinalysis today. All numbers were in normal range, and my GFR was over 100, creatinine .6. Urine was negative for blood on micro. Namaste XXXXXXX

Answered by Dr. Ravi Bansal (26 minutes later)

Brief Answer: urine through rectum Detailed Answer: Can you please attach all the reports which have been done so that i come to know what all have been done and does that cover all investigations that are required for you. Urine through rectum , means a communication between urine passage and food passage. This cannot occur as a normal phenomenon. There has to be some disease process causing this. But as you describe nothing comes out of anus immediately or within 5 minutes after urination, then why do you suspect that your urine is coming through rectum/anus ( Food passage)? anyway be observant as you have planned, so we will be able to pinpoint the trouble. bye.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (41 minutes later)

Hi Dr Please forgive me, I just saw a bright yellow fluid that looked like urine. But when I did urinate from my penis, the urine was almost clear. So now that I understand what you are saying, it doesn't make sense that the two fluids could come out of the same bladder seconds apart and be totally different colors. I really appreciate the offer to look over my blood test #s. I can't copy and paste, unfortunately, so I will write them out for you below. Comprehensive Metabolic Glucose 91 BUN 16.0 Creatinine .8 BUN/Creat ratio (calc) 20 GFR (calc) 106 AST(SGOT) 15 ALT (SGPT) 22 Alkaline phosphatase 59 Bilirubin, total .2 Calcium 9.7 Sodium 141 Potassium 4.0 Anion gap (calc) 14.0 Chloride 104 CO2 27 Total Protein 6.8 Albumin 4.6 Globulin 2.2 A/G Ratio (calc) 2.1 Urinalysis w/ Rfx micro Color Yel Appearance Clear pH 7.0 Sp Grav 1.021 Leuk Neg Nitrite Neg Urobil .2 Protein Neg Blood Neg Ketone Neg Bilirub Neg Glucose Neg THANK YOU! XXXXXXX

Answered by Dr. Ravi Bansal (17 hours later)

Brief Answer: urine from rectum Detailed Answer: Hi XXXXXXX Dont go by colour. Colour of urine will become dirty and yellow if it comes out through rectum due to mixing with fecal matter. But it is the timing and creatinine content which is important. Your blood and urine reports are normal. Take care. Bye

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar