Urinalysis (urine test): what the results mean (BŠT)

A urinalysis is a quick and widely used way to assess the state of the urinary tract and the kidneys, and also to check some metabolic markers. The test looks at the appearance of the urine (colour, clarity), its physical properties (pH, specific gravity) and its chemical composition — a test strip is dipped into the urine sample and changes colour depending on the amount of the substances being tested. In a healthy person's urine there should be no glucose, ketones, protein, bilirubin, haemoglobin or nitrites, and the number of leukocytes (white blood cells) and erythrocytes (red blood cells) should be minimal. In some laboratories, urine sediment microscopy is also carried out when needed — looking for cells, crystals or bacteria. A urinalysis is often done as part of a routine health check-up, and it also helps raise the suspicion of a urinary tract infection, kidney disease, diabetes mellitus or liver disorders. The result is always assessed together with symptoms and other tests — a single deviating value does not establish a diagnosis on its own.

• As part of a routine health check-up
• When a urinary tract infection is suspected — frequent or painful urination, lower abdominal pain
• To monitor diabetes mellitus or kidney disease
• When blood or an unusual colour is noticed in the urine
• Before surgery or during pregnancy, as part of routine testing
• When kidney stones or another urinary tract disorder are suspected

When a dipstick test shows glucose, ketones, protein, bilirubin, haemoglobin or nitrites, this is considered a deviation from the norm according to MedlinePlus. The causes differ depending on which indicator has deviated — from a urinary tract infection to poorly controlled diabetes or kidney disease. The result should always be discussed with a doctor together with the symptoms.

• A urinary tract infection — the most common cause of raised nitrites and leukocytes
• Poorly controlled diabetes mellitus — when glucose or ketones are found in the urine
• Kidney disease — when protein is found in the urine
• Kidney or liver disorders — when bilirubin is found in the urine
• Bleeding in the urinary tract, kidney stones or (less often) a bladder or kidney tumour — when blood is found in the urine

What to discuss with a doctor

• Which indicator specifically has deviated — each one points in a different direction for further testing
• Whether there are symptoms of a urinary tract infection (pain on urination, a frequent urge, fever)
• A urine culture or urine sediment microscopy for a more precise picture
• Blood tests (glucose, creatinine) to assess kidney function or diabetes
• Whether any medicines or substances that could affect the result were taken at the time of the test

In a urinalysis, deviating indicators (raised, or detected at all) are discussed more often than a decrease — the exception is specific gravity, which can be below the normal range when the urine is too dilute. That can mean an excessive fluid intake, or a disturbance in the kidneys' ability to concentrate the urine.

• An excessive fluid intake
• Diabetes insipidus — a condition in which the kidneys cannot concentrate the urine
• Damage to the kidney tubules
• A decreased sodium level in the blood
• A severe kidney infection

What is looked at when the urine is too dilute

• An assessment of fluid intake and of how often you pass urine
• Blood electrolyte (sodium) and kidney function tests
• Whether a lot of fluid was drunk just before the sample itself was taken
• Repeating the test at another time of day, if the result is unclear

Related tests

If a urinalysis shows a deviation, the next steps usually looked at are a urine culture or urine sediment microscopy — done additionally when cells, crystals or bacteria need to be assessed under a microscope — and blood tests, glucose and creatinine, to assess kidney function or diabetes. When protein is found in the urine, the additional test that may be done is the albumin-to-creatinine ratio in urine, described on the urine albumin page; separate pages cover protein in urine and urea.