Purple urine bag syndrome in end-stage chronic kidney disease

Delgado, Guillermo; Martínez‐Reséndez, Michel F.; Camacho-Ortíz, Adrián

doi:10.5935/0101-2800.20140077

Cited by 7 publications

(5 citation statements)

References 13 publications

(26 reference statements)

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“…It is more commonly seen among women. In a Mexican study, 73% of PUBS cases occurred among women 10 . In our study, 60% of PUBS cases occurred among women, and the mean age was 75.5 years, indicating that PUBS is most often seen in elderly women.…”

Section: Discussionsupporting

confidence: 50%

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Risk factors of mortality in patients with purple urine bag syndrome

Yang

2019

Journal of Drug Assessment

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Aim: Purple urine bag syndrome (PUBS) is rarely seen in clinical practice. Several studies have reported that PUBS is relatively benign in its clinical course, but this study aimed to identify risk factors for mortality related to PUBS. Materials and methods: In a PubMed search from October 1980 to August 2016, using the search term “Purple urine bag syndrome (PUBS)”, 106 articles (n = 174 cases) were identified. This study excluded 58 cases. Among them, 14 cases did not include information on patient sex and four cases did not include information on patient age. Thirty-seven cases did not report the white blood cell (WBC) count, shock, fever, or etiology. Three cases did not report patient survival. This study considered 116 PUBS cases. Chi-square tests were used to compare the survival and mortality groups. Results: In relative risk analysis, uremia (17.8), shock (14.4), diabetes (4.8), leukocytosis (1.1), and female sex (1.1) were significant risk factors for mortality after PUBS. However, it is possible that PUBS cases are under-reported worldwide. Conclusions: PUBS is a warning sign of a urinary tract infection, and it often follows a relatively benign clinical course. This study found that female sex, leukocytosis, shock at presentation, comorbidity with diabetes, and uremia are risk factors for mortality associated with PUBS.

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Section: Discussionsupporting

confidence: 50%

“…It slows gut motility and changes intestinal bacterial flora. Bowel bacterial flora containing tryptophanase convert dietary tryptophan to indole, pyruvic acid, and ammonia 3–5 , 8 , 10 . Indole is absorbed and enters the liver via the portal circulation.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of mortality in patients with purple urine bag syndrome

Yang

2019

Journal of Drug Assessment

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“…Nevertheless, in uremic patients with PUBS, the elimination of indoxyl sulfate during dialysis is limited as it is bound to albumin, leading to exponential increase in serum indoxyl sulfate concentration. When treating patients with CKD and PUBS, clinicians should consider the elevated serum and urinary concentration of indoxyl sulfate due to its potential role in the progression of CKD, as well as its contribution to cardiovascular events ( 57 ).…”

Section: Discussionmentioning

confidence: 99%

Trends in the epidemiology of purple urine bag syndrome: A systematic review

Yang

2018

biom rep

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Purple urine bag syndrome (PUBS) is rarely observed in clinical practice. The present study aimed to identify the epidemiological trends in PUBS in recent decades. A search of PubMed articles published between 1980 October and 2016 August was conducted, in which 106 articles (174 cases) described PUBS. Of these cases, 58 cases were excluded: 14 cases without mention of gender, 4 cases without description of age, 37 cases without mention of white blood cell (WBC) count, shock status, fever status or description of etiology, and 3 cases without information on mortality. The remaining 116 PUBS cases were collected and analyzed in the present study. The articles were divided into three groups by publication year: 1991 to 2000, 2001 to 2010 and 2011 to 2016. The χ2 test was used for statistical analysis, with P<0.05 (two-tailed) defined as the threshold for significance. Of the total enrolled cases, there were 47 men (40.5%) and 69 women (59.5%), with a mean age ± standard deviation of 75.6±12.8 years. Of these, 98 cases (84.5%) were elderly (≥65 years old). A total of 93.1% of cases had a urine pH >7 while 6.9% of cases had acidic urine (pH <7). Furthermore, although WBC count elevated progressively, the mortality rate of patients with PUBS decreased over subsequent decades. This necessitates the advancement of antibiotics and application of early goal-directed therapy. Additionally, the overall mortality rate of PUBS (1980–2016) was 6.8%, which decreased to 4.3% in the last 5 years (2011–2016). In conclusion, although PUBS has previously been considered a benign process in the majority of indwelling catheterized patients, emphasis is required on early examination and aggressive antibiotic administration.

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“…Certain drugs such as amitriptyline, indomethacin, triamterene, flutamide, phenol and Mitoxantrone and ingestion of berries, fava beans, red beet roots can cause such purplish colouration of the urine [17]. Several reports indicated a tepid course and minimal morbidity following PUBS, as most cases respond to a short course of an appropriately chosen narrow spectrum antibiotic [18]. The prognosis of PUBS is that of UTI, it is only affected by the underlying clinical condition of the patient and age [5].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2022

MCR

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The appearance of purple coloured urine within the Urethral Catheter-Urine Bag system is often frightening to patients and their relatives and gets health care givers perplexed. The purple colour is said to be a by-product of chemical transformation of indole to indigo or indirubin, or a mixture of the two. Both Indigo and Indirubin are derivatives of colonic bacterial metabolism of dietary Tryptophan using either the Sulphatase or Phosphate enzymes or both. It is seen in chronically ill patients with chronic constipation and on long standing urethral catheterisation. The organisms commonly cultured from such purplish urine are Escherichia coli, proteus mirabilis, klebsiella pneumoniae and Enterobacter species. We reported such a case in a 98-year old paraplegic male patient with a histologically proven metastatic prostate adenocarcinoma and chronic constipation. The urine and catheter tip culture yielded klebsiella specie. We wrote to draw attention to its occurrence and highlight a simple method of its treatment.

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Purple urine bag syndrome in end-stage chronic kidney disease

Abstract: Hence, in the context of our renal patients, perhaps PUBS is not as benign as supposed.

Cited by 7 publications

References 13 publications

Risk factors of mortality in patients with purple urine bag syndrome

Risk factors of mortality in patients with purple urine bag syndrome

Trends in the epidemiology of purple urine bag syndrome: A systematic review

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