Urine Appearance (Clarity)

How clear your urine looks to the eye. Cloudiness is common and often harmless, so labs read it together with the dipstick and microscope results.

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What it is

Appearance (also called clarity) describes how clear or cloudy a urine sample looks. Fresh urine is usually clear. Labs use words like clear, hazy, cloudy or turbid to describe what they see. It's one of the first things checked in a urinalysis, along with color. It's a quick visual note that is read alongside the dipstick and microscope findings.

Why it matters

Cloudy urine can look alarming, but it is often caused by harmless things. Examples are minerals that settle out of urine (such as phosphate crystals), mucus, or secretions picked up while collecting the sample. Cloudiness can also come from white blood cells, red blood cells or bacteria. On its own, appearance says little. That's why the lab reads it with the dipstick and microscope results.

If it’s high

Cloudy urine means something is mixed in with the urine or has settled out of it. Most often it's something harmless, like phosphate crystals, mucus or secretions from collection. It can also be linked to white blood cells, bacteria, red blood cells or, less often, fat or lymph fluid in the urine. The rest of the urinalysis usually shows which one it is.

Common causes

Phosphate crystals in alkaline urine, which are often harmless
Mucus, skin cells or secretions picked up during collection, such as vaginal discharge, semen, talcum powder or creams
Uric acid crystals, which can follow a diet high in purine-rich foods
White blood cells in the urine (pyuria), which can be linked to a urinary tract infection or other irritation
Bacteria, from a urinary tract infection or from a sample that was contaminated or sat too long
Red blood cells or blood in the urine
X-ray contrast dye
Rarely, fat or lymph fluid in the urine, or an opening between the bowel and the bladder (a fistula)

What can help

Collect a midstream, clean-catch sample the way your lab asks, which cuts down on contamination
Get the sample to the lab quickly, or keep it refrigerated if you're told to
Ask your clinician whether the other urinalysis results explain the cloudiness

What can affect your result

How long the sample sat before testing: bacteria multiply and crystals and cells change as urine stands, especially at room temperature
Collection: secretions, menstrual blood, semen or creams can get into the sample
Urine acidity: alkaline urine tends to form cloudy phosphate crystals
Diet: for example, a diet high in purine-rich foods can lead to uric acid crystals
X-ray contrast dye given before the test
Different labs use different words (hazy, slightly cloudy, turbid), and there isn't one universal scale
Contamination during collection, such as vaginal discharge, menstrual blood, semen, talcum powder or creams, can make a sample look cloudy.
Urine changes as it stands. Bacteria multiply and cells, casts and crystals break down or form, especially at room temperature. One review advises testing within an hour or refrigerating the sample for up to 24 hours. One large lab accepts unpreserved urine for 2 hours at room temperature or 48 hours refrigerated, and urine in a preservative tube for up to 72 hours refrigerated.
X-ray contrast dye can make urine look cloudy.

First-morning urine is considered the most representative, but a random midstream sample is commonly used. Test it within 1–2 hours of collection, or refrigerate it. It reflects the sample at the moment of collection and can change from one void to the next.

When to talk to a clinician

Cloudy urine by itself is usually not urgent. Talk with a clinician if it comes with burning or pain when you urinate, needing to go often or urgently, blood in the urine, a strong or foul smell, or lower belly pain, or if it keeps happening. Get care promptly if you have a fever or chills with back or side pain, or if you feel very unwell.

Questions you could ask

Is there anything about how I collected or stored the sample that could have changed this result?
Do my other urinalysis results explain why my urine looked cloudy?
Could the sample have been contaminated, and should it be repeated?
Is any follow-up, such as a urine culture, worth considering for me?

Questions people ask

Is cloudy urine a sign of a urinary tract infection?

Not by itself. Cloudy urine is often caused by harmless things such as phosphate crystals, mucus or secretions from collection. White blood cells or bacteria can also make urine cloudy, which is why the lab checks the dipstick and looks at the sample under a microscope.

Why was my urine clear last time and cloudy this time?

Urine changes with what you eat, how much you drink, how acidic the urine is and how long the sample sits before it's tested. Alkaline urine, for example, is more likely to form phosphate crystals, which can make it look cloudy.

What is the difference between hazy, cloudy and turbid?

They are words for increasing cloudiness. There isn't one universal scale, so the same sample could be called hazy at one lab and slightly cloudy at another. The other urinalysis results usually tell you more than the label does.

Can the way I collected the sample cause cloudy urine?

Yes. Discharge, menstrual blood, semen, creams or powder can get into the sample and make it look cloudy. A midstream clean-catch sample reduces this. Follow your lab's collection instructions, and tell the lab if you think the sample may have been contaminated.

Show the science and sources

For clinicians and researchers

Clarity is a visual grade of turbidity, read by eye or by an optical analyzer depending on the lab. Fresh normal urine is clear to translucent (StatPearls). Turbidity comes from suspended particles: amorphous phosphates in alkaline urine and urates in acid urine, crystals, cells (red cells, white cells, epithelial cells), bacteria, yeast, mucus, lipids (chyluria, lipiduria), semen, contrast media and, with an enterovesical fistula, fecal material. AFP (2005) notes that cloudy urine is often due to precipitated phosphate crystals in alkaline urine, although pyuria can also be the cause. No standardized scale exists, so hazy, slightly cloudy and turbid are lab-specific terms. Because cells, casts and crystals are unstable in a standing specimen, clarity should be read on a fresh sample and interpreted with the chemical and sediment findings. StatPearls states that color, odor and appearance carry clinical significance in only a few instances.

LOINC 5767-9 (primary), 32167-9. Specimen: urine.

Sources

Urinalysis, StatPearls Publishing (NCBI Bookshelf) (2023)
Urinalysis: A Comprehensive Review, American Family Physician (2005)
Urinalysis, MedlinePlus (National Library of Medicine)
Urinalysis, Complete With Microscopic Examination (test 003772), Labcorp

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