Purple urine bag syndrome in end-stage chronic kidney disease

When faced with violet, purple or purplish-blue urine, clinicians should consider urinary tract infection in their differential diagnosis.

A 60-year-old woman with end-stage kidney disease and non-adherence to renal replacement therapy was admitted to our hospital for placement of hemodialysis catheter. During her hospitalization she had purple urine, and purple urine bag syndrome (PUBS) was diagnosed. She was effectively treated with antibiotics and her urine returned to a dark yellow color.

Although this condition is often easily treated, diagnosing PUBS in chronic renal patients probably means an increased serum concentration of indoxyl sulfate, metabolite that is involved in the progression of both CKD and cardiovascular disease.

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