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Milky urine (cloudy urine) - causes, symptoms, therapy

Milky urine (cloudy urine) - causes, symptoms, therapy


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These are the causes and backgrounds of milky urine
There are many different types of urine clouding. While slight urine discoloration is often only due to harmless causes, such as a temporary lack of fluid, severe cloudiness is usually not fun. Milky urine in particular indicates serious underlying illnesses in most cases, which is why a doctor should be consulted promptly if symptoms persist. Additional discoloration can also be a worrying warning signal.

Definition

The color of urine is determined by numerous factors. Basically, it consists of the body's own breakdown products, which the metabolism cannot utilize and which therefore have to be flushed out. A distinction must be made between the primary urine and the final urine. The still relatively clear primary urine is the unconcentrated urine substrate (also: ultra substrate), which flows together in the collecting tubes of the kidney. It is mainly formed from aqueous blood plasma, which is secreted via the kidney's bloodstream and still contains unfiltered metabolites. These have a maximum diameter of 4.4 nanometers and are composed of proteins, glucose, amino acids and electrolytes.

In the next step, the primary urine is filtered from the kidney corpuscles to final urine in order to recover the last substances that can be used by the body. About 99 percent of the water is also removed from the urine, which changes its material composition so that it receives its typical yellow color.

So-called urochromes are responsible for the urine color. These are yellowing metabolites that are produced in the kidney when hemoglobin is broken down from filtered blood plasma. Together with other filter materials, urochromes make up 5% of the final urine filtrate. There are other filter substances in the final urine in this regard

  • Fragrances
  • uric acid
  • urea
  • Hormones
  • organic acids
  • and water soluble vitamins

The special composition of the final urine results in a particle density of 1015 to 1024 g per 1 l urine. Turbidity is always associated with an increased particle concentration of over 1024 g per l urine. Depending on which cause is responsible for the increased particle density, urine discoloration may also occur. They often give first indications of the type of cause, since only certain particle concentrations can be used for different colors.

Roughly divided urine turbidity can be divided into four different color classes:

  1. yellow opacities
  2. red cloudiness of the urine
  3. brown urine clouding
  4. whitish urine

While slight deviations from the natural yellow shade of urine are usually no cause for concern, there are sometimes very sensitive reasons for all other types of cloudiness that should not be taken lightly.

Yellow opacities are usually harmless

A serious underlying disease does not always have to be behind a clouding of the urine. If this only appears a little darker than usual, a short-term dehydration can be responsible, for example. It then has a dark yellow to orange color, which is reminiscent of naturally cloudy apple juice and one increased urochrome concentration is to be returned. Such urinary disorders are favored by inadequate hydration, the consumption of certain foods (e.g. citrus fruits) and water-consuming body processes such as those caused by alcohol consumption and intensive physical activity.

Another cause of cloudy yellow or milky yellow urine can be pregnancy-related hormone changes be. Above all, an increased concentration of the pregnancy hormone hCG (human chorionic gonadotropin) often changes the composition of the urine so that on the one hand it appears extremely yellow and possibly visibly cloudy. In addition, an increased hCG value in the urine can influence its smell, which is why the urine of pregnant women often has a sweet note.

Sometimes a cloudy, yellowish color does not come from the urine itself. For example, natural secretions of vaginal secretions in women can temporarily cause clouding. In the pent-up urine there is also an increase Failure of salt crystals, which can cause cloudy morning urine every now and then. As long as fresh urine is still warm, the salts remain undissolved in the urine filtrate. However, if it cools down, the salts solidify into crystalline structures that require a short-term change in color. With an increased salt concentration, this can range from yellowish to slightly reddish.

Beware of red urine

Red urine does not necessarily mean that blood is added to the urine. In addition to urine salts, there are also foods with one high content of carotene or betanine able to transfer their orange to reddish coloring properties to the urine. At first glance, the red discoloration terrifies those affected, but is completely harmless to health. Typical foods that can cause this harmless urine clouding are carrots and beetroot.

Far from the nutritional aspect, however, it must be pointed out that red urinary disorders are more common due to the so-called Hematuria to be triggered. The term describes the admixture of blood in the urine and is an alarm sign for internal bleeding. In this regard, bright red cloudiness suggests a particularly fresh wound or an only slightly pronounced blood flow in the area of ​​the urinary tract (e.g. in the case of severe cystitis). Dark red to reddish-brown urine, on the other hand, indicates either a strong blood flow or another type of disease.

Important: Urinary tract bleeding as the cause of red cloudy urine can be clearly distinguished from bleeding in the course of the female cycle. These are of course harmless, even if they sometimes discolour the urine significantly.

Brown clouding of the urine is an alarm sign

In fact, there are significantly more causes for red-brown or black-brown urinary disorders than it initially appears. In addition to hematuria, there is, for example Alkaptonuria conceivable. Behind this lies an innate disorder of the tyrosine metabolism, which leads to an increased storage of the degradation product homogentisate. In the urine, this breakdown product oxidizes to the black-brown coloring alkapton, hence the disease name alkaptonuria.

The disease is particularly problematic because, in addition to substance deposits in the urine, there may also be crystal deposits of homogenate or alkapton in the joints, eyes and kidneys. The latter increases the risk of kidney stones.

Another conceivable cause of a reddish-brown discolouration of the urine is increased blood pigment levels. On the one hand, the blood pigment bilirubin should be mentioned here. It is a breakdown product of the red blood pigment 'heme' and can cause unnatural storage of bilirubin in the body in the event of disorders in the blood metabolism. In this way, the well-known arises Jaundice (Jaundice), which in addition to eyes, skin, mucous and conjunctiva can also discolour urine. However, while other parts of the body take on the yellow color typical of the disease in the course of jaundice, the blood pigment in the urine tends to cause a brownish-cloudy color change.

The second blood pigment that can cause brownish cloudiness is the red blood pigment heme itself. A disease that causes brownish cloudiness in this context is the metabolic disorder Porphyria. As with jaundice, degradation products of the blood pigment accumulate in the body in the course of the disease. Hereditary enzyme defects in the heme structure are responsible for the metabolic disorder.

Danger: Both jaundice and porphyria are associated with severe liver damage. Appropriate urinary disorders therefore require prompt treatment!

There is another disease that is particularly dangerous for brown discolouration. It is meant Black skin cancer (Malignant Melanoma). It affects the pigment cells of the skin and, as the disease progresses, can lead to increased excretion of dead pigments in the urine, which subsequently becomes cloudy and turns brown.

Whitish / milky urine can mean a lot

In common parlance, the term “milky urine” is often used for all of the above-mentioned urine clouding. Really milky urine, in addition to the turbidity itself, has an unusual, whitish color. It is due to an increase in whitish staining urine particles, which is not infrequently connected with malfunction of the kidney, wound processes in the urinary tract or fine tissue residues in the urine. Causes that make milky urine extremely serious.

Cause urinary disorders

The milky cloudy urine occurs particularly often in the context of Urinary tract infections like the bladder infection. But an inflamed prostate and kidney stones are always associated with this type of discoloration. When it comes to the diagnosis of said urinary tract diseases, doctors take a close look at the leukocyte values ​​in the urine as standard. With good reason, because the white blood cells known as leukocytes not only cloud the urine milky, but are also a sign of an advanced course of the disease.

The reason for the increased leukocyte content is immune processes, in which the body's defense reacts to infectious agents such as bacteria or viruses. Leukocytes act as immune cells that track down pathogens in the body and render them harmless. If bacteria and the like have nested in the urinary tract, the number of white blood cells in the urine will increase. In this case, one speaks of a leukocyturia, whereby in addition to leukocytes there may also be miracles or residues of infectious agents in the urine. In addition to the milky color goes Leukocyturia also accompanied by other accompanying symptoms of an infection. Among them are:

  • general feeling of sickness
  • fever
  • increased urge to urinate
  • Urination problems
  • Painful urination
  • Bleeding into the urine

Danger: Urinary bleeding, kidney pain and fever are particularly alarming for leukocyturia. These are clear indications that a urinary tract infection is already very advanced. In the worst case, there is a risk of kidney inflammation, which can also lead to kidney failure.

Milky urine with impaired lymphatic drainage

Another critical cause are Lymphatic drainage disorders. A scenario that occurs primarily in the course of serious illnesses and therefore requires a prompt diagnosis. The milky clouding of the urine occurs when more lymph fats enter the urine cycle. More specifically, they are so-called Chyle fats, which in this case trigger the whitish-cloudy color.

Infections by parasites are one possible way of causing increased chyle fat in the blood. Especially tropical Nematodes like to nestle in their host's lymphatic system, where they create small food cysts that subsequently disrupt lymphatic drainage. Since the lymph fats can no longer be completely broken down in this way, they are increasingly transported via the bloodstream to the kidney, from where they continue to pass into the urine. Wucheria bancrofti is a possible nematode type that has been shown to lead to corresponding lymphatic disorders as well as disturbance-related urine clouding.

An increased concentration of chyle fats in the urine is also possible Adhesions in the lymphatic tissue. The course up to the clouding of the urine is relatively identical to that of a roundworm infection and is largely due to a disturbed fat metabolism in the lymphatic system. Beyond that Lymphoma cancer mentioned as a possible cause for said disorders in the lymphatic drainage. Not only does the tumor-related drainage disorders favor a milky urine, there is also a risk with this cancer that tumor cells will detach from the lymphomas, migrate to other parts of the body via the lymph channels and ultimately form metastases there. The urinary tract is not excluded from this risk of metastases. Patients should therefore pay close attention to the following accompanying symptoms:

  • Exhaustion
  • Loss of appetite
  • fever
  • increased risk of infection
  • Lymph node swelling
  • unexplained weight loss
  • itching
  • Night sweats
  • Enlarged spleen

Milky clouding of the urine - signs of renal failure?

Nutrients such as proteins are usually absorbed and returned to the body when primary urine is filtered. However, if there are malfunctions of the kidneys or kidney corpuscles, an increased protein concentration due to insufficient urine filtering can result. In this so-called proteinuria, the cloudy urine usually still appears slightly yellow, but the color is significantly lighter and almost goes white.

Main cause of one Proteinuria is mostly chronic Renal failure. In rare cases, the disease is favored by malformations or congenital genetic defects. However, it is more often caused by previous underlying diseases. Especially as a side effect of diabetes mellitus, kidney weakness often occurs, which can lead to complete failure of the kidney in the further course. Kidney cysts, circulatory disorders of the kidney and inflammatory processes in the area of ​​the kidney body, for example due to an advanced Inflammation of the kidney, are also considered risk factors. In such cases, dialysis is often inevitable in order to be able to guarantee an adequate metabolism between the blood and kidneys. Noticeable accompanying symptoms of renal insufficiency are also:

  • Loss of appetite
  • Shortness of breath
  • mental performance loss
  • noticeable skin changes
  • Seizures
  • Nausea and vomiting
  • increased water retention

Increased protein concentrations in the blood are harmless if they only last for a short time. Frequently, natural secretions of the urinary mucosa can be identified as the cause of the milky urine. The remains of the mucous membrane contain a lot of protein and arrive as small clouds of mucus, so-called Nubecula in the urine as it passes through the urinary tract. There is generally no need to worry about this form of cloudiness.

When to see a doctor for urinary disorders?

As shown at the beginning, a clouding of the urine does not always have to speak for a disease. There is usually no need to worry if it only lasts for a short time, is due to certain eating or everyday habits (e.g. eating coloring food or physical exertion) and there are no accompanying symptoms. In the case of alcohol consumption and a lack of hydration, the urgency of visiting a doctor depends on the frequency of the corresponding habits. If you consume a lot of alcohol or drink too little chronically, you must urgently change your behavior and have a routine check up with your doctor for safety reasons.

A visit to the doctor is definitely advisable if the urine is very cloudy and discolored. There are usually health problems behind the complaint, which must then be clarified as soon as possible. Accompanying symptoms such as fever, frequent urge to urinate, pain when urinating or a general feeling of illness speak a clear language in this regard. As a rule of thumb, milky, reddish and reddish brown opacities should always be examined for safety.

Diagnosis

The main examination consists of a detailed urine test for every form of turbidity. After taking a final urine sample, all relevant urine values ​​are checked. In the case of urinary tract infections, for example, increased leukocyte and / or protein values ​​can be determined in the course of the laboratory tests. If erythrocytes (red blood cells) can also be detected in the urine, there is a suspicion of an advanced infection with bleeding wound involvement. In addition, potential infectious agents, details such as the pH value of the blood and salt and electrolyte distribution can be assessed as part of the test.

In addition, further follow-up examinations may be necessary. Metabolic diseases such as diabetes mellitus, jaundice or porphyria usually require an additional blood test. If suspected diseases such as renal insufficiency, lymph gland or skin cancer, organ mirroring and tissue samples are also common. The same applies to advanced diseases of the metabolism, provided that these have already led to organ problems such as liver, spleen or kidney weakness.

Therapy for clouded urine

The treatment depends on the underlying cause. Various measures are available, ranging from simple dietary changes to surgical interventions:

Hygiene

To treat cloudy urine as the cause of urinary tract infections, it is extremely important to keep the genital area germ-free. Appropriate hygiene measures are therefore an important part of personal therapy support. This is the only way to prevent infectious agents from entering the urinary tract again and thus causing further urine contamination. As a precaution, aggressive care products, unsuitable clothing (e.g. string thong) and sexual intercourse should be avoided during healing to avoid irritation of the weakened urinary tract and its intimate surroundings.

Nutritional therapy

In the area of ​​nutrition, a targeted diet with diuretic foods is recommended for cleaning the urine. Vegetables such as cucumbers, tomatoes, celery or asparagus are just as suitable here as water-rich fruit types (e.g. watermelons or grapes). A targeted hydration should not be missing. At least 2.5 to 3 l per day are essential for a good flushing of the urinary tract. In this regard, water, unsweetened teas and warm broths that do not further burden the damaged fluid balance are clearly preferred.

Naturopathy for milky urine

The right drinking habits can also counter diseases such as cystitis with a view to cloudy urine and even support their healing process positively. On the one hand, infectious agents are reliably flushed out of the urinary system by a good fluid supply, on the other hand, certain medicinal herbs help wonderfully in healing inflammation.

According to studies, the apple berry known as aronia is considered an excellent natural remedy for urinary tract infections. The antibacterial and disinfectant tannins and anthocyanins of aronia are primarily responsible for the healing effects. They have an antibacterial, disinfectant and immune-boosting effect. In addition, the apple berry contains numerous vitamins and minerals that quickly help weakened urinary tract again.

The effect and composition of ingredients are relatively similar to those of other cherries, blueberries and currants. Prepared as juice or tea, the healing berries strengthen the urinary tract and help the immune system to fight pathogens quickly. Cloudy urine should therefore no longer be a problem with regular use.

Natural diuretics such as nettle, tarragon, elderberry or rosemary are also well suited for treating infection-related opacities. They can also be easily brewed into tea and their decoction drunk to flush the urinary tract. A special tip is also fresh salads with draining vegetables, which are then filled with said herbs.

Medical therapy

The doctor must decide in each individual case whether and which medication is necessary. Infections such as bladder, prostate, or renal pelvic inflammation generally require antibiotic treatment to ensure that the disease heals quickly and that no bacterial residue remains in the urinary tract. In the worst case, this could flare the infection up again and cause chronic illnesses. Parasitic infections can also be remedied with antibiotics.

If the pain and inflammation in urinary tract disorders are particularly bad, doctors occasionally prescribe painkillers and anti-inflammatory drugs. Preparations such as acetylsalycilic acid (ASS), ibuprofen or diclofenac are often the first choice. However, it should be noted that some of these medications, like antibiotics, can temporarily intensify urinary problems.

Lymph gland and skin cancer as the cause make therapy with cytostatics inevitable. Radiation therapy may also be required. Here, too, the urine cloudiness may initially increase further in the course of medication or the radiation procedure.

Inpatient and surgical treatment

If a stone problem is responsible, you can first try to dissolve the kidney stones with medication. However, this only works with stones with a certain material composition. In addition, stone particles are repeatedly left in the kidney during drug treatment, which then grow into new kidney stones. It is better to remove the crystalline deposits by surgery. In this regard, extraction using a sling is now considered obsolete. Instead, modern medicine relies on endoscopic destruction using shock waves, lasers or ultrasound (nephrolitholapaxy). After the stone has been removed, its mineral failures in the urine are also prevented, which gives the urine a clear yellow color.

With diabetes mellitus, dialysis in the hospital is often unavoidable. A well-adjusted patient can prevent disease-related renal insufficiency and thus cloudy urine discoloration for a long time, but sooner or later the kidney's health burden often becomes so great that the blood must be cleaned by machine.

If kidney failure causes massive health problems in addition to cloudy urine, the only solution is a kidney transplant. As soon as a new kidney was inserted, the urine filtering should also work smoothly again, so that the clouding no longer becomes a problem. (ma)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Swell:

  • Armin Mainz: invisible hematuria (NSH), DEGAM S1 recommendation for action, German Society for General Medicine and Family Medicine e.V., (accessed 02.09.2019), AWMF
  • Stephan vom Dahl et al .: Congenital metabolic diseases in adults, Springer Verlag, 2014
  • Thomas Gasser: Basic knowledge of urology, Springer Verlag, 6th edition, 2015
  • DGU guideline program: Interdisciplinary S3 guideline: epidemiology, diagnostics, therapy, prevention and management of uncomplicated, bacterial, community-acquired urinary tract infections in adult patients. Long version 1.1-2, 2017 AWMF register number: 043/04, (accessed 02.09.2019), AWMF


Video: Signs u0026 Symptoms of Urinary Tract Infections. Dr Sudeep Singh Sachdeva (October 2022).