The kidneys remove waste (metabolism byproducts, broken-down components of drugs, any oversupply of various salts, excess hormones, and surplus vitamin or red blood cell byproducts).
They also remove surplus fluid from the body. We introduce a variety of materials into our bodies daily.
The body’s organs process and metabolize them, and send whatever is left for detoxification and removal.
Importance of Urine
Excreted urine carries the record of intake and processing activities. Urine reveals our body’s efficiencies (and insufficiencies) in doing its various cleansing jobs.(1)
Urine is a liquid byproduct secreted by the kidneys and exiting the body through the urethra.
Its characteristics are defined by color, transparency, odor, acidity, and density. It has a yellow color, but abundant water in the diet may dilute it and lighten its color while low hydration may concentrate and darken it.
It may have a red tint when red blood cells or dietary dyes are present or when renal damage or disease is present. Its smell may be affected by diet or disease.
Typically, urine demonstrates an ammonia odor when the sample is older. Its acidity by pH level is typically around 6.0, but value reflects dietary protein (higher pH) or vegetarian diet (higher alkaline levels).(2)
Its specific gravity ranges from 0.001 to 0.035. (Urine’s “density” is based on urine volume compared to an equal volume of distilled water).
This “amber fluid” may appear transparent, cloudy, milky, or opaque. Particles within the urine define its clarity.
“Turbidity” is technically the extent that “cloudiness” darkens the urine sample. It may be judged subjectively by visual assessment (e.g., unaided or via microscopy), but it is best defined by the suspension of particles within the urine.
These particles and their sediment sinking to the bottom of a urine sample define the suspended material by its contents, cells present, infections noted, or particle obstructions identified. The sediment reveals metabolic imbalance, disease, damaged renal structures, etc. (3)
Urine is key to understanding a host of health complaints based on a range of symptoms.
The Mayo Clinic website notes related symptoms: “nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, changes in how much you urinate, decreased mental sharpness, muscle twitches and cramps, swelling of feet and ankles, persistent itching, chest pain if fluid builds up around the lining of the heart, shortness of breath if fluid builds up in the lungs, high blood pressure (hypertension) that’s difficult to control.” (4)
It is significant that these symptoms are varied as to the source, but the chemistry of the kidney’s urine output helps define the even remote disease.
Milky or Cloudy Urine
We can evaluate a turbid sample of urine, but it may indicate normal renal function or pathology.
Urine “concentration, pH, ingested substances, and various metabolic abnormalities” affects color and clarity. History, as in all medicine, defines both problem and cause, so determining drug, environmental background, diet, and family histories will determine diagnosis and possible causes.
Abnormal color by itself has limited utility. Specific gravity, pH, and microscopy will focus a diagnostic process. Use of ferric chloride and UV light may aid the assessment.
Three decades ago physicians saw urine color as the beginning of a differential diagnosis of disease using urine characteristics. They proposed a diagnostic algorithm to sort potential evaluation components related to abnormal color.(5)
Unfortunately, any urine that is not clear or brighter yellow may be characterized as “turbid,” since turbid just means that there is some cloudiness present.
As discussed above, the causes may be “normal.” There may be no symptoms and change in color may be transient and not significant for health. However, high protein and crystalline levels causing foamy or cloudy urine for extended times may be significant and suggest developing the disease.
Although diet may have turbid effects on urine quality, it rarely causes “cloudiness”. Microscopic blood in urine may cause that turbidity. Small numbers of blood cells may present as cloudiness ranging from darker red to bright red to brown or cloudy red.
“Cloudiness” may be related to urinary tract infection (UTI) when blood components are found in the urine.
Bladder infection (e.g., cystitis) may produce coloring and be associated with pain on urination and increase frequency.
Kidney stones may be associated with turbid urine, but its color reflects pus. UTI may arise from abrasive kidney stones working their way to the urethra and excretion, but causing blood to show up as that turbid condition.
Sexually Transmitted Disease (STDs)
Venereal disease may bring on cloudiness related to pus generated by the STD or yeast present in the urinary tract or related structures.
Pain with odd color urine argues for an evaluation with a physician ASAP.
WebMD discusses 26 different entities associated with cloudy urine.(6)
Here are a number of them, each related to turbidity:
- UTI may present with an intense desire to urinate but urination being painful.
- Renal infection (pyelonephritis) secondary to bacteria and renal cancer have associated fever or chills with pain, nausea, and urinary tract problems.
- Bone infections (osteomyelitis) may cause pain, swelling, and/or redness.
- An inflamed pancreas with stomachache is associated with swelling, nausea, and increased pulse rate.
- Renal cell and small intestine cancer may have bloody urine and persistent pain.
- Embolism in the respiratory tract may cause blood clotting, shortness of breath, pain in the chest, etc.
- Bladder cancer with pain, bleeding in the UT, and increased urination may have that cloudy urine.
- Dermatomyositis may bring on swollen muscles and weakness in the head and joints.
- Interstitial cystitis, helicobacter pylori infection, and hydronephrosis bring pelvic or bladder pain and changes in urination.
- Lumbar herniated disk, fractured shoulders, compression fractures in the lumbar and thoracic regions, and whiplash are all related to back pain, swelling, and potential turbid urine.
- Tick bites and shingles are infections with blisters or rash on back or neck with turbidity.
- Endocarditis infects the heart and may have associated rash, along with sinus problems, nausea, and that turbid urine symptom.
One Common Symptom of Many Diseases
NIH’s “Bladder Health for Older Adults” organizes these maladies from the perspective of bladder issues. It discusses indications of bladder health, noting that turbid urine is just one sign of bladder-related problems.
In the elderly, muscle fatigue and weakness of muscles or abdominal pain may accompany other symptoms of bladder dysfunction. At the top of the list for UTI is “cloudy, bloody, or foul-smelling urine.” Additional or related complaints relate to uncomfortable urination, desires for frequent urination, and mild fever.
Kidney Involvement in UTIs
When an infection moves beyond the bladder to the kidneys, new complaints present: chills and shaking, sweats in the night, fatigue, fever greater than 101 F, pain in the groin, side, or back, flushed skin, confusion, and nausea with emesis.
It is noteworthy that some patients show no symptoms despite bacteria being present in the urine. This is the point that medications (including antibiotics) enter the picture.
Checking the System
The methodology for evaluation begins with a physical exam, and continues with the collection of a urine sample, endoscopy of the bladder and urethra using a cystoscope, verification of the bladder’s retention capabilities, and monitoring of the bladder via ultrasound as the patient empties a full bladder of all its urine. (7)
Treatment Dependent on Diagnosis Strategy
The concept of “differential diagnosis” is extremely important to consider.
In the case of a presenting complaint of turbid urine, its potential causes run the gamut from normal to major infectious or metabolic disorder. In a differential diagnosis, a clinician seeks answers to a series of yes or no questions.
Answers may come from the patient directly or remotely–think of clinician-patient dialogue versus laboratory, imaging, or other evaluations performed beyond the direct interaction with the patient. The answers in either or both cases hone in on the cause of that turbid urine.
Once the cause is delineated, then treatment commences. The connection between the two has been reviewed in detail.(8)
Primary Cause of UTIs
No one treatment is a magic answer. Infections of the urinary tract are most often caused by bacteria. Generally, they can be managed by medications, usually antibiotics.
Adding fluids to the diet to flush the system by increasing urination sometimes speeds healing. Painkillers or use of back or stomach heating pads may bring relief. (9)
There are a number of avenues open for management of cloudy urine that require no medical intervention, but more serious problems will require medical intervention.
Alternative medicine has been found effective for recurring UTI “based on parsley and garlic, L-arginine [an amino acid], probiotics, and cranberry tablets.” (10)
Use of the probiotic lactobacillus rhamnosus GR-1 repopulates urinary tract and “augments” the immune activity operating in the system.(11)
The flavonoid quercetin (e.g., leafy greens, broccoli, berries, etc.) function as an antioxidant and suppressant of symptoms like urinary urgency, pain of infection, and the swelling or burning concurrent with infection.(12)
Apigenin, found in parsley, has diuretic qualities as well as anti-inflammatory.(13)
Garlic and cranberries suppress infection and potentially reduce cloudy urine. Garlic and parsley together inhibit bacteria growth.(14)
While some foods affect UTIs positively, there are others that inhibit healthy urinary tracts. Simple elimination of some foods lessens symptoms. (15)
Other foods worsen UTI symptoms in a matter of a couple hours of ingestion. Problematic foods include “alcoholic beverages, carbonated drinks, caffeine, spicy foods, tomatoes, citrus fruits and vinegar.” Other foods (“bananas, beer, cheese, mayonnaise, nuts, onions, raisins, sour cream, wine and yogurt”) will increase symptoms.(14)
When to See a Doctor
“There is no perfect urine.” How much and its character reflects life style, and we need to know what is our personal normal. Our urine’s color will reflect our fluid intake and diet. Our “chemical intake (e.g., chemotherapy medications, laxatives, and vitamins) may make urine appear blue or green.
Citrus, beets, and carrots may induce a bright yellow or orange character to our urine. Liver-related problems cause a deep orange or brown to our urine. Urine may tint toward red from food dyes, trauma, or renal disease. Simple turbidity may relate to the presence of phosphates or infection.
When color changes and urination burns or is urgent, that’s a good indication we need to visit that doctor. (16)
The human body is complicated and “wonderfully made” (Psalm 139:14). Often taken for granted, it only becomes a concern when something’s not working right.
We know urine because we exercise our bladders numbers of times a day and have done so since birth. We know “normal” because of our urine’s consistency.
When past consistency changes from clarity to cloudiness, we know it. When change continues, that is our red flag for getting help in determining what problem we have. If discomfort and urgency accompany change, it is time to call our primary care provider for guidance in getting a formal evaluation.
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