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September 16, 1974

Black Urine

Author Affiliations

Northfield, Ohio

JAMA. 1974;229(12):1580. doi:10.1001/jama.1974.03230500016013

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To the Editor.—  Dr. Leonard B. Berman's article, "Urine in Technicolor" (228:753, 1974), states: "For example, the massive hemolysis associated with falciparum malaria produces black urine, whence the name blackwater fever arises."In the journal Drug Therapy of April 1974, an article entitled "Patient Factors Governing Response to Drugs," by Dr. Peter Goldman, observes that genetic factors can determine an individual's response to drugs, and that differences are noted in dramatic side effects.Thus, "blackwater fever," a term which describes the presence of heme in the urine resulting from severe hemolysis, was found to occur in response to certain drugs. This condition is now known to be caused by alterations in the function of glucose-6phosphate dehydrogenase of the red blood cells of these patients. Apparently this single enzyme defect is responsible for the altered drug response which is found mainly in people who are black or of Mediterranean origin.Thus,