Urinalysis results: what each part of a routine urine test means
A urinalysis is a physical, chemical and microscopic check of your urine. It looks at how the urine looks, tests it with a dipstick whose pads change color, and examines it under a microscope. (MedlinePlus urinalysis) You may have one during a checkup, in the hospital, before surgery or in pregnancy. (MedlinePlus)
Is it a screening test?
- Routine urinalysis: not on the USPSTF list of recommended (A and B) services for adults without symptoms. (USPSTF A and B list)
- Bacteria in the urine without symptoms: the USPSTF recommends against screening adults who are not pregnant (grade D). It found that treating bacteria found this way in adults who are not pregnant has no benefit, and that treatment has harms. This does not apply to people with long-term medical or urinary tract conditions, people in hospital or people living in places such as nursing homes. (USPSTF, 2019)
- In pregnancy: the USPSTF recommends a urine culture (grade B) at the first prenatal visit or at 12 to 16 weeks, whichever is earlier. A culture grows bacteria in a lab; it is a different test from the dipstick. (USPSTF, 2019) The other tests by week: pregnancy screenings by week.
- Bladder cancer: the USPSTF says the evidence is not enough to weigh the benefits and harms of screening adults without symptoms (I statement). The tests it looked at include checking the urine for blood with a dipstick or microscope. It notes that no major organization recommends screening for bladder cancer in adults without symptoms. (USPSTF, 2011)
Where they differ: MedlinePlus says a urinalysis may be done as part of a routine medical exam to screen for early signs of disease, (MedlinePlus urinalysis) while the USPSTF gives no recommendation for a routine urinalysis and grades two of its uses D and I. (USPSTF A and B list) (USPSTF, 2019) (USPSTF, 2011) The American Cancer Society, as the USPSTF summarizes it, says prompt attention to bladder symptoms is the best way to find bladder cancer early in people with no known risk factors. (USPSTF, 2011) More tests with a D or I grade: screening tests you may not need.
The test
You give a urine sample, often by the "clean catch" method: wash your hands, clean the genital area with the wipe you are given, start urinating into the toilet, then collect an ounce or two midstream in the cup without letting it touch your body. This keeps germs from your skin out of the sample. (MedlinePlus nitrites) It involves only normal urination, with no discomfort and no risks. (MedlinePlus urinalysis)
- If you are having your period or have bleeding hemorrhoids, tell your provider before the test, because outside blood can get into the sample. (MedlinePlus blood in urine)
- Tell your provider about everything you take. Some medicines change urine color or other results, but do not stop any medicine unless your provider tells you to. (MedlinePlus urinalysis) (MedlinePlus blood in urine)
Each part and its typical result
These are the usual results printed by MedlinePlus. Labs can use different measurements, so compare your result with the range on your own report. (MedlinePlus urinalysis)
| Part | What it checks | Typical result |
|---|---|---|
| Color and appearance | How the urine looks: clear or cloudy, pale or dark yellow or another color | Almost colorless to dark yellow. Some foods, such as beets and blackberries, may turn urine red. (MedlinePlus urinalysis) |
| Specific gravity | How concentrated the urine is, which reflects your body's water balance | 1.005 to 1.030 (MedlinePlus specific gravity) |
| pH | How acidic the urine is | 4.6 to 8.0 (MedlinePlus urine pH) |
| Protein | Protein, including albumin | Usually not detectable. A random sample is normally 0 to 14 mg/dL. (MedlinePlus urinalysis) (MedlinePlus protein dipstick) |
| Glucose (sugar) | Sugar in the urine | Usually not detectable (MedlinePlus urinalysis) |
| Ketones | Substances made when the body breaks down fat for fuel | Usually not detectable (a negative test). If present, results are often listed as small, moderate or large. (MedlinePlus urinalysis) (MedlinePlus ketones) |
| Bilirubin | A waste product made when old red blood cells break down | Usually not detectable (MedlinePlus urinalysis) (MedlinePlus bilirubin) |
| Blood (hemoglobin) | Blood on the dipstick | Not normally found (MedlinePlus urinalysis) |
| Nitrite | A chemical that many urinary tract infection bacteria make | Not normally found (MedlinePlus urinalysis) (MedlinePlus nitrites) |
| Leukocyte esterase | A substance that suggests white blood cells | Negative (MedlinePlus leukocyte esterase) |
| Red blood cells (microscope) | Red cells counted per high power field (HPF) | 4 per HPF or fewer (MedlinePlus RBC urine) |
| White blood cells (microscope) | White cells, a possible sign of a urinary tract infection | Not normally found (MedlinePlus urinalysis) (MedlinePlus nitrites) |
| Epithelial cells (microscope) | Cells that line the urinary tract or skin | "Few" (MedlinePlus epithelial cells) |
| Casts (microscope) | Tiny tube-shaped particles whose content helps show whether the kidneys are healthy | No cellular casts. A few hyaline casts are normal. (MedlinePlus casts) |
| Crystals (microscope) | Minerals that clump together in the urine | A few small crystals are normal (MedlinePlus crystals) |
- Specific gravity: the dipstick gives only a rough result; a lab can measure it more exactly. (MedlinePlus specific gravity)
- pH: what you eat changes it. A diet high in fruits and vegetables can raise urine pH, and one high in meat, fish or cheese can lower it. (MedlinePlus urine pH)
- Protein: small amounts are normally present but a routine dipstick may not detect them. A urine albumin test finds small amounts of albumin that a dipstick can miss. (MedlinePlus protein dipstick) That test, the urine albumin-to-creatinine ratio (uACR), is explained on kidney test results.
- Glucose: urine glucose was once used to test for diabetes; blood tests are now usually used instead. (MedlinePlus urine glucose) Blood sugar results: A1C and blood sugar test results.
Why one flag is often rechecked
A result outside the usual range does not always mean a condition that needs treatment; you may need more tests. (MedlinePlus epithelial cells) These are the general reasons the sources give.
- Blood: many things can cause blood in urine, and most of them are not serious. It may come from certain medicines, intense exercise, sexual activity or menstruation. (MedlinePlus blood in urine) In some cases your provider tests the urine again to confirm it, and someone who was menstruating may be asked to repeat the test after the period ends. (NIDDK) If it is confirmed, you may need more tests to find out why. (MedlinePlus blood in urine)
- Protein: it can be high for a short time because of strenuous exercise, dehydration, diet, stress or pregnancy, so your provider may repeat the test to see whether it stays high. If it stays high, it is likely a sign of kidney disease or damage, and more tests are needed to find the cause. (MedlinePlus protein in urine) Recent contrast dye from a scan, fluid from the vagina in the sample or a urinary tract infection can also affect the dipstick. (MedlinePlus protein dipstick)
- Leukocyte esterase and nitrite: a positive leukocyte esterase suggests a possible urinary tract infection, and the urine should then be looked at under a microscope. Vaginal secretions or some other infections can make it positive without a urinary tract infection. (MedlinePlus leukocyte esterase) Nitrites usually mean a urinary tract infection, but a negative nitrite does not rule one out, because some bacteria do not make nitrites. (MedlinePlus nitrites)
- Epithelial cells: squamous cells in the sample may mean it was contaminated, for example if the genital area was not cleaned well enough. "Moderate" or "many" cells do not always mean a condition that needs treatment; you may need more tests. (MedlinePlus epithelial cells)
- Glucose: a small rise after a large meal is not always a cause for concern. Up to half of women have glucose in their urine at some time during pregnancy. (MedlinePlus urine glucose) The pregnancy blood sugar tests: gestational diabetes glucose test results.
- Specific gravity and casts: a few hyaline casts often come from dehydration or hard exercise. (MedlinePlus casts) Specific gravity goes up when you have lost body fluids and down when you drink a lot. (MedlinePlus specific gravity)
Abnormal results overall can come from conditions such as kidney disease, a urinary tract infection, kidney stones, poorly controlled diabetes, or bladder or kidney cancer. (MedlinePlus urinalysis) Your provider also looks at the other results of the urinalysis, not one part alone. (MedlinePlus nitrites) Your doctor decides what your result means for you.
This page does not give diagnosis, medicine or treatment advice. If you have a flagged result, see after an abnormal screening result for questions to ask.
Questions people ask
What is checked in a routine urinalysis?
Three things: how the urine looks (color and clearness), chemicals on a dipstick (such as specific gravity, pH, protein, glucose, ketones, blood, bilirubin, nitrite and leukocyte esterase), and what a microscope shows (cells, crystals, casts and germs). (MedlinePlus urinalysis) (MedlinePlus)
Is a urine test a recommended screening test?
Not for most adults. A routine urinalysis is not on the USPSTF list of recommended (A and B) services. The USPSTF recommends against testing adults who are not pregnant for bacteria in the urine when they have no symptoms (grade D), and finds the evidence not enough to judge bladder cancer screening (I). In pregnancy it recommends a urine culture (grade B). (USPSTF A and B list) (USPSTF, 2019) (USPSTF, 2011)
Why would I need to repeat a urine test?
Several results can be off for a short time. Blood can come from menstruation, hard exercise or sexual activity, protein can rise with hard exercise, dehydration or stress, and skin cells in the sample can mean it was contaminated. A repeat test shows whether the result stays the same. (MedlinePlus blood in urine) (NIDDK) (MedlinePlus protein in urine) (MedlinePlus epithelial cells)
Does blood in my urine mean cancer?
Usually not. MedlinePlus says many things can cause blood in urine and most of them are not serious. Bladder, kidney or prostate cancer is one possible cause among many, and if blood is found you may need more tests to find out why. (MedlinePlus blood in urine) (NIDDK)
Is the urine protein on a urinalysis the same as a uACR test?
No. The dipstick measures all proteins and may miss small amounts. A urine albumin test (uACR) finds small amounts of albumin that a dipstick may not detect. (MedlinePlus protein dipstick)