Purple Urine Bag Syndrome

Abstract

Pendahuluan: Purple Urine Bag Syndrome merupakan perubahan warna urin menjadi ungu pada pasien yang terpasang kateter yang lama atau berulang. Hal ini disebabkan oleh adanya bakteri dalam urin menyebabkan fermentasi indoksil sulfat menjadi indigo dan indirubin kemudian larut dalam urin bag.

Laporan kasus: Wanita usia 47 tahun dengan keluhan bengkak, sulit buang air besar, buang air kecil tidak lancar, urin bewarna ungu pada urin bag. Pasien hanya terbaring. Sudah terdiagnosis penyakit ginjal kronis dan sering dirawat di rumah sakit serta menggunakan kateter. Pada pemeriksaan tanda vital stabil dan pemeriksaan fisik konjungtiva pucat, vesikular menurun, ronkhi basah paru kanan atas, ascites dan edema. Pemeriksaan laboratorium menunjukkan terdapat anemia, leukositosis, ureum dan kreatini meningkat dengan eGFR 12,5 ml/menit serta kalsium rendah Urinalisis menunjukkan pH basa dengan nitrit, leukosit esterase positif. Kultur urin terdapat Enterococcus avium. Ultrasonografi sesuai dengan penyakit ginjal kronik.Diagnosis pasien adalah infeksi saluran kemih dengan Purple Urine Bag Syndrome, Penyakit Ginjal Kronis stadium 5, hipertensi, hipoalbuminemia, anemia, hipokalsemia, konstipasi dan efusi pleura kanan. Selama perawatan pasien mendapat antibiotik ceftriaxon 2 g/hari intravena, transfusi packed red cell dan persiapan hemodialisis. Pada hari rawatan ke 5 warna urin kembali normal, berwarna kekuningan.

Diskusi: Diagnosis purple urine bag syndrome berdasarkan urin bewarna ungu dalam urin bag dan kultur urin menunjukkan adanya Enterococcus avium. Angka kejadian purple urine bag syndrome meningkat pada pasien penyakit ginjal kronis. Pada kasus ini, faktor risiko PUBS adalah pemakaian kateter lama, wanita dan konstipasi. Tatalaksana purple urine bag syndrome terdiri dari perbaikan higiene, mengobati konstipasi dan eradikasi infeksi saluran kemih.

Simpulan:  Pasien didiagnosis purple urine bag syndrome kemudian dilakukan eradikasi kuman menggunakan antibiotik ceftriaxon 2 gram per hari didapatkan perbaikan pada warna urin berubah menjadi kekuningan.

Introduction: Purple Urine Bag Syndrome is a change in urine color to purple in patients who have had a long or repeated catheter inserted. This is caused by the presence of bacteria in the urine causing the fermentation of indoxyl sulfate to indigo and indirubin which then dissolves in the urine bag.

Case report: 47-year-old woman with complaints of swelling, shortness of breath, dry cough, costipation, not urinating smoothly, decreased appetite, purple urine in the urine bag. The patient is just lying on the bed. He has been diagnosed with chronic kidney disease and is often hospitalized and uses a catheter. Vital signs were stable and on physical examination, pale conjunctiva, vesicular decreased, rales in the upper right lung, ascites and edema. Laboratory examination showed anemia, leukocytosis, urea and creatinine increased with eGFR 12.5 ml/minute and low calcium. Urinalysis showed alkaline pH with positive nitrite and leukocyte esterase. Culture reveals the organism Enterococcus avium. Ultrasonography was in accordance with chronic kidney disease. The patient's diagnosis was urinary tract infection with Purple Urine Bag Syndrome, Stage 5 Chronic Kidney Disease, hypertension, hypoalbuminemia, anemia, hypocalcemia, constipation and right pleural effusion. Patient received ceftriaxone 2 g/day intravenously, packed red cell transfusion and hemodialysis preparations. On the 5th day, the urine color returned to normal.

Discussion: The diagnosis of purple urine bag syndrome based on purple urine in the urine bag and culture showed Enterococcus avium. Incidence of PUBS is increasing in patients with chronic kidney disease. In this case, the risk factors for PUBS were catheter, women and constipation. Management of this case consists of improving hygiene including changing catheters, treating constipation and eradicating urinary tract infections.

Conclusion: The patient was diagnosed with purple urine bag syndrome and then bacterial eradication was carried out using the antibiotic ceftriaxon, the urine color changed to normal.