Abnormal Urine Color in Children: Causes and Solutions

Abnormal urine color?

My child is eight years old.
Since birth, the urine color has been normal when urinating, but after being left for a while, it turns darker, resembling dark brown.
I have consulted several pediatricians, and they all said it’s not a concern.
Recently, I heard that this might indicate an endocrine issue.
I would like to know how to address this.
Thank you!

vivi, 30~39 year old female. Ask Date: 2005/11/17

Dr. Xu Shanjing reply Rare Disease

Dear Sir/Madam,
There are several metabolic disorders that can cause discoloration of urine after it has been left to stand.
It is important to observe if the child has any symptoms.
The possible conditions associated with the color change of urine are summarized as follows:
1.
Alkaptonuria: The urine turns dark brown or black.
This condition is due to an enzyme deficiency that leads to the accumulation of homogentisic acid in the body, resulting in the deposition of pigment in the sclera, cartilage, and skin.
This may lead to complications such as arthritis in the future.
2.
Blue Diaper Syndrome: The urine turns blue.
This is a disorder characterized by defective absorption of tryptophan in the small intestine, leading to the conversion of tryptophan into indole in the intestine, which is then converted to indican and excreted in the urine.
The child may exhibit restlessness, poor appetite, vomiting, constipation, or failure to thrive.
3.
Hartnup Disorder: The urine also turns blue.
This condition involves defective absorption of several neutral amino acids in the small intestine and renal tubules.
Most patients are asymptomatic, but nutritional deficiencies can lead to various neurological symptoms.
These disorders can be diagnosed through urine amino acid and organic acid tests, which can be arranged at many pediatric genetic counseling clinics in teaching hospitals.
I hope this information is helpful to you and your child.
Sincerely,
Xu Shanjing, Taichung Veterans General Hospital

Reply Date: 2005/11/17

More Info

Understanding abnormal urine color in children can be a source of concern for many parents. In your case, your eight-year-old child has normal urine color when fresh, but it turns dark brown after sitting for a while. While several pediatricians have reassured you that this is not a cause for alarm, it is understandable to seek further clarification, especially with the mention of potential endocrine issues.

Firstly, urine color can be influenced by various factors, including hydration levels, diet, and certain medical conditions. When urine is fresh, it typically appears pale yellow to amber, depending on the concentration of waste products and hydration status. However, when urine is left to sit, it can undergo changes due to oxidation and the breakdown of certain compounds, which may result in a darker color.

The dark brown color you describe could be attributed to several benign causes, but it is essential to consider potential underlying conditions. Here are some possible explanations:
1. Dehydration: If your child is not drinking enough fluids, the urine may become concentrated, leading to a darker color. Ensuring adequate hydration can help maintain normal urine color.

2. Diet: Certain foods, such as beets, blackberries, or foods high in artificial coloring, can alter urine color. If your child has recently consumed such foods, this could explain the change.

3. Medications and Supplements: Some medications or vitamin supplements can change urine color. If your child is taking any medications, it would be worth checking if this is a known side effect.

4. Metabolic Disorders: As mentioned by the pediatricians you consulted, there are metabolic conditions that can lead to abnormal urine color. For instance, Alkaptonuria can cause urine to turn dark upon exposure to air due to the presence of homogentisic acid. This condition is rare and usually presents with other symptoms, such as joint pain or discoloration of the skin.

5. Infection or Hematuria: Although less likely in your case since the urine appears normal initially, urinary tract infections or the presence of blood in the urine can also cause discoloration. If there are any accompanying symptoms such as pain, fever, or changes in urination patterns, further evaluation would be warranted.

Given that multiple pediatricians have assessed your child and deemed it not concerning, it may be a benign issue. However, if you continue to have concerns, especially with the mention of endocrine problems, it would be prudent to consult a pediatric nephrologist or a specialist in pediatric metabolic disorders. They can conduct further tests, including urine analysis and possibly blood tests, to rule out any underlying conditions.

In conclusion, while the change in urine color you observe may not be alarming, it is essential to monitor your child's overall health and hydration status. Keeping a record of any dietary changes, medications, or accompanying symptoms can be helpful for healthcare providers. If the dark color persists or if you notice any other concerning symptoms, seeking further medical evaluation is advisable.

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