What does cloudy urine mean?
Cloudy urine means opaque urine. Cloudy urine can be white (hazy, foggy, smoky, murky, milky) or dark (yellow, orange, brown or red) and can be caused by physical stress or various foods, supplements, drugs or diseases.
Cloudy urine may indicate the presence of protein, fat, phosphate or urate crystals, bilirubin, mucus, epithelial cells, pus (white blood cells) or blood (red blood cells) in the urine [2,3].
The medical term for cloudy urine is turbid or nebulous urine .
How does normal urine look and smell?
In a well hydrated healthy individual, urine is clear, like water, or slightly yellow. Normal urine can have some odor, which can depend on the food consumed; for example, beer, garlic and coffee can give urine a strong but usually not “foul” odor.
Clear urine at drug test does not mean that the urine has been diluted.
Cloudy and WHITE Urine
HAZY but NOT Foamy Urine
- Increased phosphate excretion in the urine (phosphaturia) can be caused by :
- Eating large amounts of milk, cheese, organ meats, fish or fast food
- Phosphate supplements
- Vitamin D intoxication
- Increased excretion of oxalic acid in the urine (hyperoxaluria) [7,26]:
- Foods rich in oxalate (chocolate, nuts, spinach, beets, purslane, tea, rhubarb, wheat bran), animal fat or vitamin C
- Low calcium intake or impaired calcium absorption
- Vitamin B6 (pyridoxine) deficiency
- Genetic disorders with increased oxalic acid production (primary hyperoxaluria)
- Intestinal diseases with increased oxalate absorption: Crohn’s disease, chronic pancreatitis, bowel resection, intestinal bypass surgery, cystic fibrosis
- Increased amount of leukocytes in the urine, with no bacteria (sterile pyuria):
- Tuberculosis, strep infections, Kawasaki disease (vasculitis in children), kidney toxins, sepsis (infection of the blood) 
Semen makes urine frothy.
Cloudy and foamy urine can be caused by increased protein excretion in the urine (proteinuria) [5,6]:
- Strenuous exercise, fever, emotional stress, exposure to cold or heat, orthostatic proteinuria that occurs when a person is upright (a harmless condition in children and adolescent boys or girls, rarely after 30; morning urine is usually clear, cloudy urine comes and goes)
- Heart failure with increased blood flow through the kidneys
- Kidney disease (glomerulonephritis, interstitial nephritis) with nephrotic syndrome, in which increased amounts of protein and fat appear in the urine (proteinuria and lipiduria) 
- Diseases with increased protein production: rheumatoid arthritis, pericarditis, amyloidosis, sarcoidosis, infections (hepatitis, syphilis, HIV/AIDS), multiple myeloma (a type of bone cancer), leukemia, lymphoma (night sweats), severe muscle damage (rhabdomyolysis)
- Chyluria–very thick, milky and, sometimes, foamy urine due to presence of chyle (a mixture of lymph, chylomicrons, proteins and fats from the intestine) in the urine . Chyluria is extremely rare in Europe; parasitic chyluria occurs mainly in India, Taiwan, China, Japan, western parts of Africa and in Central and South America [11,12]. Causes include [11,12]:
- A connection (fistula) between lymphatic vessels and the urinary tract, which results in leakage of the lymph into the urine, can occur in parasitic infestations, such as filariasis (groin pain and swelling), schistosomiasis and ascariasis, tuberculosis, malaria, congenital disorders of the lymphatic vessels, cancers in or around the kidneys, kidney trauma, aortic aneurysm, surgical kidney removal
- Excessive excretion of fats into the urine can occur in nephrotic syndrome, hypertriglyceridemia
- Heavy metal poisoning
- Drugs: nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, indomethacin), antibiotics, penicillamine, gold, angiotensin-converting enzyme (ACE) inhibitors.
Other causes of foamy urine:
- Abnormal connection (fistula) between the bowel and bladder, which can occur in Crohn’s disease, ulcerative colitis or diverticulitis . A connection between the vagina and bladder can develop after gynecological surgery. Fistulas are associated with common urinary tract infections.
Cloudy and COLORED Urine
DARK YELLOW, AMBER or ORANGE Urine
- Dehydration, usually due to insufficient water drinking, is the most common cause of dark yellow, orange or brown but not foamy urine. Having cloudy and dark urine every morning can speak for chronic dehydration. Cloudy urine only at night and in the morning can speak for mild dehydration.
- Foods high in beta-carotene: carrots, sweet potatoes, winter squash (butternut), pumpkin, sweet peppers, kale, spinach, collards; vitamin C: “juicing” with acerola, guava, peach, black currants, kiwifruit, orange or lemon juice; artificial colors in candies 
- Liver disease (hepatitis, cirrhosis) or gallbladder disease with gallstones or pancreatitis that result in impaired bile flow (cholestasis) and yellow, itchy skin (jaundice), upper abdominal pain, upset stomach, dark, foamy urine (due to increased bilirubin content) with a musty odor  and very pale stools (due to decreased bilirubin content) [9,13,14]
- Increased uric acid excretion in the urine (hyperuricosuria) caused by [25,29,30]: :
- Eating foods high in purines: certain fish (anchovies, cod, haddock, herring, mackerel, mussels, sardines, scallops, tuna), organ meats (brain, heart, kidneys, liver, sweetbreads), goose and duck meat, meat extracts, gravies, mincemeat, beer, whisky, liquers and other alcoholic beverages, legumes (beans, peas), mushrooms, asparagus, spinach, cauliflower.
- Yeast extract supplements
- Gout. Allopurinol, the drug that reduces the amount of blood uric acid in gout, can cause cloudy urine .
- Intestinal bypass surgery
- Gonorrhea 
- In newborn infants: neonatal jaundice, and breast milk jaundice, a benign disorder that usually spontaneously disappear in several weeks 
- Drugs and supplements: alprazolam , beta carotene, chlorpromazine, ethoxazene, methyldopa, phenacetin, senna (laxative), sulfasalazine, tetracycline, vitamin B2 or riboflavin (energy drinks, liver, spirulina, whey, cereals ready-to-eat), which can make urine bright, fluorescent yellow; vitamin C, warfarin 
PINK, RED or BROWN Urine
- Foods causing tea-colored urine: aloe vera, beets, blackberries, fava beans, rhubarb [9,17,18]
- Blood in urine (hematuria) from any cause [8,19,39]: contamination from menstruation, strenuous exercise (marathon), urinary tract infection, kidney stones, trauma, injury of the testicles, low platelet count, blood clotting abnormalities, paroxysmal nocturnal hemoglobinuria, hemochromatosis (bronze skin, fatigue, impotence), polycystic kidney disease, bacterial endocarditis (fatigue, joint and muscle pain, rash, night sweets), vasculitis, cancer, hemolytic anemia, sickle cell anemia, thalassemia, vitamin C deficiency (scurvy); drugs: aspirin, heparin, penicillin, cyclophosphamide, chemotherapy treatment of lymphoma or leukemia resulting in tumor lysis syndrome
- Exposure to cold (hypothermia) or heat (heatstroke)
- Muscle damage (rhabdomyolysis) with myoglobin (a muscle protein) in the urine:
- After distance running (marathon, triathlon), prolonged immobilization, compression of the limb due to prolonged lying after severe alcohol intoxication, muscle tremor, seizures, severe trauma, burns
- Medications: antidepressants (tricyclic: amitriptyline, doxepin; SSRIs: citalopram, sertraline), barbiturates, caffeine, ketamine, methadone, propofol infusion, protease inhibitors (to treat AIDS), salicylates, statins and other cholesterol-lowering drugs (clofibrate, gemfibrozil), steroids, theophylline
- Illegal drugs: amphetamine, barbiturates, cocaine, heroin, LSD, methadone, phencyclidine (PCP)
- Low blood phosphate levels
- Infections: influenza (fever, headache, fatigue), HIV/AIDS, infectious mononucleosis caused by Epstein Barr virus (headache, fever, rash, enlarged lymph nodes), citomegalovirus infection, herpes genitalis (burning blisters on genitals), food poisoning with diarrhea (Salmonella, Shigella, E.coli), dengue fever
- Porphyria 
- Drugs: acetaminophen (paracetamol) overdose, antibiotics (furazolidone, metronidazole, nitrofurantoin, rifampin), drugs to treat malaria (chloroquine, primaquine), laxatives containing cascara or senna, methocarbamol, phenazopyridine, propofol, sorbitol and sulfasalazine
- Urinary catheter
- Acute poisoning with ethanol, ethylene glycol, isopropanol, methanol, phenol; chronic poisoning with copper, lead, mercury
- Other references: [9,17,18,20,33]
In individuals with alkaptonuria (a rare metabolic disease) and melanoma (malignant skin cancer), urine can turn black after sitting for a while in the toilet bowl.
Cloudy Urine With Strong Odor
Individuals with ketosis (high blood ketone levels) who are fasting, starving or are on a low-carb diet or have poorly controlled diabetes mellitus can excrete ketones with urine, which can give a sweet, acetone-like odor to urine.
In dehydration the urine can be cloudy, yellow, orange or brown and can have an ammonia-like odor. The frequency of urination and the amount of urine are decreased. Other typical symptoms and signs of dehydration include thirst, dry mouth, fatigue, decreased skin turgor and loss of body weight.
Urinary Tract Infection (UTI)
Apart of cloudy and foul smelling urine, UTI symptoms may include: frequent urination, uncomfortable, burning or painful urination (dysuria), blood in urine, kidney pain (flank pain), fever, nausea, fatigue and loose stools (diarrhea) .
Typical symptoms of the infection of various parts of the urinary tract:
- Kidneys (pyelonephritis): right or left flank pain, fever, nausea, vomiting, blood in urine, diarrhea, skin rash
- Ureter (ureteritis): right or left side abdominal pain
- Bladder (cystitis): pelvis pain or pressure, fever, nausea, blood in urine, urine leakage
- Urethra (urethritis): burning feeling in the urethra, usually only during urination
Kidney disease, high blood pressure including multiple myeloma.
Autoimmune Diseases: Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE)
Typical symptoms include painful and swollen joints in fingers and other joints.
Cloudy Urine and Lower Back (Kidney) Pain
- Kidney stones can cause severe lower back or side abdominal pain (colic) at any time.
- Urinary tract infection can cause kidney pain, which can be constant, and pain in the urethra, usually only during urination.
- Prostate infection or cancer can cause pain upon pressure in the perineum (behind the shaft of the penis)
Cloudy Urine in Men
- After sex, sperm that has remained in the urethra (or in the bladder in retrograde ejaculation) can cause bubbles in the form of froth on the surface of the urine in the toilet bowl when urinating after sex. In healthy men, sperm can find its way into urethra during the night even without sex and cause frothy urine, which usually clears within a minute.
- Enlarged prostate in men after 40: difficulty starting urinating, dribbling on the end, possible blood in urine 
- Prostate infection (prostatitis): constant urge to urinate, urinating at night, pelvic pain, fever 
- Prostate cancer: chronic pelvic pain, fatigue, difficulty starting urinating, blood in urine, unintentional weight loss 
- Epididymitis (infection of the epididymis): swelling of the scrotum, fever, groin pain, blood in the urine 
- Urethral stricture after trauma, sexually transmitted diseases, urinary tract infections, surgery or endoscopic procedures can be associated with frequent urination and occasional dark urine due to blood in the urine .
- Infection with chlamydia can cause frequent urination and cloudy urine and abnormal discharge from the penis . Gonorrhea can cause cloudy, yellow or green urine .
Cloudy Urine in Women
Cloudy Urine and Discharge
- Yeast (Candida) infection of the vagina (vaginitis) or gonorrhea can cause discharge, which can contaminate a urine sample and make it cloudy.
- A sexually transmitted disease (STD), like infection with chlamydia or gonorrhea can cause cloudy urine and thick vaginal discharge [21,22].
- Endometriosis (uterine tissue in the bladder) can, rarely, result in blood in the urine .
In preeclampsia and eclampsia (high blood pressure during pregnancy, usually in the 3rd trimester) the blood can appear in the urine and make it cloudy .
To find a cause of cloudy urine a doctor can order urine culture, tests for blood and white blood cells and urinalysis to check for minerals.
If the urine is cloudy due to increased phosphates, a drop of vinegar (acetic acid) will clear it immediately.
Frequently Asked Questions
1. Can taking milk of magnesia cause cloudy urine?
There seems to be no reliable sources that would list cloudy urine as a side effect of milk of magnesia.
2. Does increased glucose excretion in urine in diabetes cause cloudy urine?
No. Glucose excretion with urine (glycosuria) is typically associated with excessive excretion of diluted and hence clear urine (polyuria)
3. Is cloudy urine a sign of ovulation?
Some mucus produced by the neck of the uterus (cervix) after ovulation may contaminate urine, which appears as white flakes in the urine.
4. Is cloudy urine an early sign of pregnancy?
No. Pregnancy as such does not cause cloudy urine.
5. Is there any remedy to cure cloudy urine?
To cure cloudy urine you need to treat the underlying cause. To cure foggy urine caused by dehydration or high phosphate or purine intake (milk, fish), you can drink water, which dilutes urine. Drinking water will likely clear cloudy urine from other causes but will not cure the underlying diseases.
- Frequent urination
- Dehydration symptoms and signs
- Dehydration in elderly
- Urine color chart
- What does kidney pain feel like?
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