Elucidation of the etiology and characteristics of pink urine in young healthy subjects

Susumu Ogawa, Junko Takiguchi, Kazuhiro Nako, Masashi Okamura, Takuya Sakamoto, Shigeru Kabayama, Takefumi Mori, Yoshitaka Kinouchi, Sadayoshi Ito

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Background: Pink urine syndrome (PUS) is attributed to the precipitation of uric acid caused by low urinary pH (U-pH). However, the reasons for the lower U-pH are unclear. Objectives: To investigate the occurrence of PUS and verified the cause of U-pH reduction. Methods: Participants comprised 4,940 students who had undergone a physical examination. Data on the presence [PUS (+)] or absence [PUS (−)] of PUS, as well as age, gender, body mass index (BMI), blood pressure (BP), heart rate (HR), and U-pH were collected. Of these participants, 300 randomly selected individuals were evaluated for their waist circumference, as well as their levels of urinary C-peptide, angiotensinogen, methylglyoxal, thiobarbituric acid-reactive substances (TBARS), and Na+ excretion. Independent risk factors of lower U-pH were decided by a multiple-regression analysis. Results: PUS was observed in 216 students (4.4 %). A greater number of men comprised the PUS (+) group compared with the PUS (−) group, and subjects in this group had high BMI, BP, and HR values, as well as low U-pH. A logistic regression analysis revealed that the BMI and U-pH were independent risk factors for PUS (+). The decrease of U-pH was closely related to the progress of chronic kidney disease (CKD). BMI value was related to PUS (+) in the CKD (−) subjects. On the other hand, low U-pH was related to PUS (+) in the CKD (+) subjects. All factors other than HR showed a significant negative correlation with U-pH. However, multiple-regression analysis revealed that TBARS and angiotensinogen were independent risk factors. Conclusion: Obesity and lower U-pH were each independently related to PUS, whereas increased intrarenal oxidative stress and exacerbation of the renin–angiotensin system activation were associated with the lowering of U-pH. U-pH low value is related to potential CKD.

Original languageEnglish
Pages (from-to)822-829
Number of pages8
JournalClinical and experimental nephrology
Issue number5
Publication statusPublished - 2015 Oct 1


  • Angiotensinogen
  • Methylglyoxal
  • Oxidative stress
  • Pink urine syndrome
  • Urinary pH

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Physiology (medical)


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