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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT  
Year : 2021  |  Volume : 32  |  Issue : 2  |  Page : 530-531
Purple urine bag syndrome


1 Department of Nephrology, King Fahad Hospital, Jeddah, Saudi Arabia
2 Prince Abdul Majeed Dialysis Center, King Fahad Hospital, Jeddah, Saudi Arabia
3 Prince Abdul Majeed Dialysis Center, King Fahad Hospital Jeddah, Saudi Arabia
4 Department of Medicine, Soliman Fakeeh Hospital, Jeddah, Saudi Arabia

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Date of Web Publication11-Jan-2022
 

   Abstract 


Purple urine bag syndrome is very rare in which urine color changes, and it becomes purple. This occurs when patients with a urinary catheter are bedridden, and suffer from urinary tract infection caused by specific organisms.

How to cite this article:
Shaeriya F, Al Remawy R, Makhdoom A, Alghamdi A, M. Shaheen FA. Purple urine bag syndrome. Saudi J Kidney Dis Transpl 2021;32:530-1

How to cite this URL:
Shaeriya F, Al Remawy R, Makhdoom A, Alghamdi A, M. Shaheen FA. Purple urine bag syndrome. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 Jan 26];32:530-1. Available from: https://www.sjkdt.org/text.asp?2021/32/2/530/335466



   Case Report Top


We present the case of a 75-year-old female with known diabetes mellitus, HPT, and a prior CVA, who was bedridden and admitted due to stage IV diabetic nephropathy with perforated viscus. Her white blood cell count was 7.4, her serum creatinine level was 6.2 mg/dL, her blood urea nitrogen level was 122 mg/dL, her sodium level was 130, her potassium level was 5.1 mmol/L platelets 240,000, and her hemoglobin level was 10 g/dL.

She was started on conservative treatment. Her clinical condition was stable, and no fever was present. During admission, purple urine was observed in the drainage bag [Figure 1].
Figure 1: Violet/purple urine bag.

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The urine pH was 8.9, with hematuria, pyuria, and bacteria. Urine culture showed Proteus Mirabilis. She was given treatment in accordance with the microbial resistance results. Clinical progression was favorable, and the urine color gradually normalized.


   Discussion Top


Purple urine bag syndrome is very rare and was first described in 1978.[1] It develops in patients with long-term urinary catheters, in bedridden patients, in chronic kidney disease[2] or in those affected chronic constipation. In this syndrome, a change in urine color to blue and purple shades, and are often associated with lower urinary tract infection. Its actual pathogenesis is not well known, but it is believed that it is due to ingestion of foods rich in tryptophan, which is then transformed into indoles by bacterial flora in the gut.

The indoles are then absorbed by the portal system to later be excreted by urine. In this case, due to the presence of bacteria able to produce sulfatase and phosphatase enzymes, which change to indigo (which is blue) and indirubin (which is red), turning the urine into a purple color. These chemical changes occur in alkaline urine, although a case in acidic urine has also been reported.[3] The bacteria most associated with this process are Providencia spp., Escherichia coli, Proteus spp., and enterococci.

This syndrome is a benign condition. The urine normally clears and returns to its usual color when the bacterial infection has been resolved and the urine has been acidified.

Conflict of interest: None declared.



 
   References Top

1.
Harun NS, Nainar SK, Chong VH. Purple urine bag syndrome: A rare and interesting phenomenon. South Med J 2007;100:1048-50.  Back to cited text no. 1
    
2.
Yang CJ, Lu PL, Chen TC, et al. Chronic kidney disease is a potential risk factor for the development of purple urine bag syndrome. J Am Geriatr Soc 2009;57:1937-8.  Back to cited text no. 2
    
3.
Lee J. Images in clinical medicine. Purple urine. N Engl J Med 2007;357:e14.  Back to cited text no. 3
    

Top
Correspondence Address:
Faissal A M. Shaheen
Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah
Saudi Arabia
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DOI: 10.4103/1319-2442.335466

PMID: 35017348

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