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Elucidation of the etiology and characteristics of pink urine in young healthy subjects

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Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Pink urine syndrome (PUS) is attributed to the precipitation of uric acid caused by low urinary pH (U-pH). However, the reasons for the lower U-pH are unclear.

Objectives

To investigate the occurrence of PUS and verified the cause of U-pH reduction.

Methods

Participants comprised 4,940 students who had undergone a physical examination. Data on the presence [PUS (+)] or absence [PUS (−)] of PUS, as well as age, gender, body mass index (BMI), blood pressure (BP), heart rate (HR), and U-pH were collected. Of these participants, 300 randomly selected individuals were evaluated for their waist circumference, as well as their levels of urinary C-peptide, angiotensinogen, methylglyoxal, thiobarbituric acid-reactive substances (TBARS), and Na+ excretion. Independent risk factors of lower U-pH were decided by a multiple-regression analysis.

Results

PUS was observed in 216 students (4.4 %). A greater number of men comprised the PUS (+) group compared with the PUS (−) group, and subjects in this group had high BMI, BP, and HR values, as well as low U-pH. A logistic regression analysis revealed that the BMI and U-pH were independent risk factors for PUS (+). The decrease of U-pH was closely related to the progress of chronic kidney disease (CKD). BMI value was related to PUS (+) in the CKD (−) subjects. On the other hand, low U-pH was related to PUS (+) in the CKD (+) subjects. All factors other than HR showed a significant negative correlation with U-pH. However, multiple-regression analysis revealed that TBARS and angiotensinogen were independent risk factors.

Conclusion

Obesity and lower U-pH were each independently related to PUS, whereas increased intrarenal oxidative stress and exacerbation of the renin–angiotensin system activation were associated with the lowering of U-pH. U-pH low value is related to potential CKD.

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Abbreviations

PUS:

Pink urine syndrome

BMI:

Body mass index

U-pH:

Urinary pH

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

HR:

Heart rate

RAS:

Renin–angiotensin system

ROS:

Reactive oxygen species

TBARS:

Thiobarbituric acid-reactive substances

NHE:

Na+–H+ exchanger

CKD:

Chronic kidney disease

Cre:

Creatinine

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Acknowledgments

The authors acknowledge the editorial assistance and clinical support of Miss Manami Shimizu for her help with preparing the references and for her expert assistance in the preparation of the tables and figures. The authors wish to thank Miss Manami Shimizu, Miss Asako Chiba and Mrs. Yasuko Sato for their assistance with gathering the urine samples for the study. We also wish to thank nurses Eiko Mitsui, Yoko Hasegawa, Michiko Ota, Megumi Ito and Hiromi Sato for their efforts in gathering student data. This work was supported by a 21st Century Center of Excellence Program Special Research Grant from the Ministry of Education, Sports and Culture, and Tohoku University’s Center for the Advancement of Higher Education President’s Research Fund.

Conflict of interest

All authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Susumu Ogawa, Kazuhiro Nako, Masashi Okamura, Takuya Sakamoto, Takefumi Mori & Sadayoshi Ito

  2. Section of Clinical Medicine, Division of Research in Student Support, Institute for Excellence in Higher Education, Tohoku University, Sendai, Japan

    Susumu Ogawa, Junko Takiguchi & Yoshitaka Kinouchi

  3. Trim Medical Institute Co., Ltd., Osaka, Japan

    Shigeru Kabayama

Authors
  1. Susumu Ogawa
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  2. Junko Takiguchi
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  3. Kazuhiro Nako
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  4. Masashi Okamura
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  9. Sadayoshi Ito
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Correspondence to Susumu Ogawa.

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Ogawa, S., Takiguchi, J., Nako, K. et al. Elucidation of the etiology and characteristics of pink urine in young healthy subjects. Clin Exp Nephrol 19, 822–829 (2015). https://doi.org/10.1007/s10157-014-1066-y

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  • DOI: https://doi.org/10.1007/s10157-014-1066-y

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