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| IMAGES IN NEPHROLOGY |
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| Year : 2013 | Volume
: 23
| Issue : 4 | Page : 319 |
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Indigo color urine in hemodialysis patient
P Nasa1, A Gupta2, S Jain3, M Khanal4
1 Department of Critical Care Medicine, Max Superspeciality Hospital, Shalimar Bagh, New Delhi, India
2 Department of Nephrology, Max Superspeciality Hospital, Shalimar Bagh, New Delhi, India
3 Department of Microbiology, Max Superspeciality Hospital, Shalimar Bagh, New Delhi, India
4 Department of Neurology, Max Superspeciality Hospital, Shalimar Bagh, New Delhi, India
| Date of Web Publication | 4-Jul-2013 |
Correspondence Address:
P Nasa
71/9, 1st Floor, Prem Nagar, Janakpuri, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-4065.114494
How to cite this article:
Nasa P, Gupta A, Jain S, Khanal M. Indigo color urine in hemodialysis patient. Indian J Nephrol 2013;23:319 |
A 35-year-old man with chronic kidney disease (CKD) secondary to neurogenic bladder on long-term indwelling Foley's catheter was noted to have indigo-colored urine in the bag [Figure 1]. There were no symptoms suggestive of urinary tract infection. Urine routine, microscopy and culture were sent. Microscopic examination of the urine sample revealed 10-12 leukocytes/hpf and leukocyte esterase was positive. Urine culture showed the growth of Pseudomonas aeruginosa. The patient was started on oral ciprofloxacin in renal-modified doses and Foley's catheter was changed. He was treated for 7 days and repeat urine culture was sterile with normal-colored urine on his next hemodialysis session.
Urinary tract infection with microbes like Providencia stuartii, Providencia rettgeri, Klebsiella pneumoniae, Proteus mirabilis, Escherichia More Details coli, Morganella morganii, and Pseudomonas aeruginosa can produce the enzyme indoxyl phosphatase. This converts indoxyl sulfate in the urine into indirubin and indigo-colored metabolites. [1] Our case highlights this association for the first time in a hemodialysis patient. Nephrologists and dialysis unit staff should be aware of this entity while managing patients on long-term indwelling Foley's catheters.
| References | |  |
| 1. | Tan CK, Wu YP, Wu HY, Lai CC. Purple urine bag syndrome. CMAJ 2008;179:491. 
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[Figure 1]
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