Cloudy urine

Specialty: Nephrology and urology.

• urinary turbidity
• opaque urine
• non-transparent urine

Why it occurs

• Bacterial infection of the urinary tract (massive presence of leukocytes, bacteria and cellular debris that alter light refraction)
• Massive crystalluria (precipitation of calcium phosphate salts in alkaline urine, or of calcium oxalate and uric acid in acidic urine, due to dehydration or diet)
• Chyluria (passage of lymphatic fluid rich in fats into the urinary tract)
• Vaginal contamination (presence of mucus, scaly cells or fungal secretions in the urine sample)
• Retrograde ejaculation (presence of semen mixed with urine in the first urination after intercourse)

Initial workup

Physicochemical and microscopic examination of the urinary sediment to quantify leukocytes, pyocytes, bacteria and characterize the presence of crystals; urine culture with colony count and pathogen identification; renal and urinary tract ultrasound if there is suspicion of pyelonephritis, concomitant stones or underlying obstructive uropathy.

Standard management

• Fosfomycin trometamol — 3 g orally in a single dose for the treatment of uncomplicated bacterial cystitis in women
• Nitrofurantoin — 100 mg every 12 hours orally for 5 days as an antibiotic alternative in lower urinary tract infections
• Increase free water intake (2 to 3 liters per day, useful to resolve turbidity secondary to crystalluria due to dehydration).