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& 2014 International Society of Nephrology Kidney International (2014) 86, 655; doi:10.1038/ki.2014.23
White urine due to urinary tract infection Shota Sakaguchi1, Keiko Nishi1, Yasuhiro Yamashita2, Takeaki Hiratsuka1, Seiichiro Hara1 and Akihiko Okayama3 1
Department of Internal Medicine, Miyazaki Prefectural Hospital at Nichinan, Miyazaki, Japan; 2Department of Urology, Miyazaki Prefectural Hospital at Nichinan, Miyazaki, Japan and 3Faculty of Medicine, Department of Rheumatology, Infectious Diseases and Laboratory Medicine, University of Miyazaki, Miyazaki, Japan Correspondence: Akihiko Okayama, Faculty of Medicine, Department of Rheumatology, Infectious Diseases and Laboratory Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan. E-mail: [email protected]
Figure 1 | The urine was whitish, turbid, and runny.
Figure 2 | Hyperdense fluid with niveau formation in the urinary bladder was shown by the non-enhanced computed tomography.
A 75-year-old woman with rheumatoid arthritis was admitted to our hospital because of fever and nausea. Urinary catheterization yielded a large amount of white urine (Figure 1). Non-enhanced abdominal computed tomography showed hyperdense fluid in the urinary bladder (Figure 2). She had not undergone any enhanced radiography within 3 months prior to admission. One of the most common causes of white urine is phosphaturia. Phosphaturia is transiently observed after consuming large quantities of milk or milk products; however, this patient denied consuming such quantities of milk or milk products. Pyuria, chyluria, and other crystaluria may also be considered in the differential diagnosis, although pyuria and chyluria hardly show high intensity in computed tomography. Urine culture tested positive for Morganella
morganii, prompting a diagnosis of urinary-tract infection (UTI). In addition, the urine was alkaline, and amorphous phosphate granules and crystals resembling magnesium ammonium phosphate (MAP) were found. When hydrochloric acid was added to the urine, the crystals vanished. Analysis of urinary components revealed MAP. Treatment with antibiotics for UTI was initiated and the white urine disappeared within a few days. UTI caused by urease-producing bacteria such as Proteus, Klebsiella, and Morganella can lead to the formation of MAP crystals. This is because bacterial urease splits urea into ammonia and carbon dioxide and drives alkalization of urinary pH. This could be the cause of MAP crystals. In conclusion, MAP is a possible cause of white urine, especially in the presence of UTI by urease-producing bacteria.
Kidney International (2014) 86, 655
655
nephrology image
& 2014 International Society of Nephrology Kidney International (2014) 86, 655; doi:10.1038/ki.2014.23
White urine due to urinary tract infection Shota Sakaguchi1, Keiko Nishi1, Yasuhiro Yamashita2, Takeaki Hiratsuka1, Seiichiro Hara1 and Akihiko Okayama3 1
Department of Internal Medicine, Miyazaki Prefectural Hospital at Nichinan, Miyazaki, Japan; 2Department of Urology, Miyazaki Prefectural Hospital at Nichinan, Miyazaki, Japan and 3Faculty of Medicine, Department of Rheumatology, Infectious Diseases and Laboratory Medicine, University of Miyazaki, Miyazaki, Japan Correspondence: Akihiko Okayama, Faculty of Medicine, Department of Rheumatology, Infectious Diseases and Laboratory Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan. E-mail: [email protected]
Figure 1 | The urine was whitish, turbid, and runny.
Figure 2 | Hyperdense fluid with niveau formation in the urinary bladder was shown by the non-enhanced computed tomography.
A 75-year-old woman with rheumatoid arthritis was admitted to our hospital because of fever and nausea. Urinary catheterization yielded a large amount of white urine (Figure 1). Non-enhanced abdominal computed tomography showed hyperdense fluid in the urinary bladder (Figure 2). She had not undergone any enhanced radiography within 3 months prior to admission. One of the most common causes of white urine is phosphaturia. Phosphaturia is transiently observed after consuming large quantities of milk or milk products; however, this patient denied consuming such quantities of milk or milk products. Pyuria, chyluria, and other crystaluria may also be considered in the differential diagnosis, although pyuria and chyluria hardly show high intensity in computed tomography. Urine culture tested positive for Morganella
morganii, prompting a diagnosis of urinary-tract infection (UTI). In addition, the urine was alkaline, and amorphous phosphate granules and crystals resembling magnesium ammonium phosphate (MAP) were found. When hydrochloric acid was added to the urine, the crystals vanished. Analysis of urinary components revealed MAP. Treatment with antibiotics for UTI was initiated and the white urine disappeared within a few days. UTI caused by urease-producing bacteria such as Proteus, Klebsiella, and Morganella can lead to the formation of MAP crystals. This is because bacterial urease splits urea into ammonia and carbon dioxide and drives alkalization of urinary pH. This could be the cause of MAP crystals. In conclusion, MAP is a possible cause of white urine, especially in the presence of UTI by urease-producing bacteria.
Kidney International (2014) 86, 655
655
