Urinalysis —
what every
result line means.
A urine dipstick test reports 10 or more results in seconds. Each line tells a different story about your kidneys, bladder, and metabolic health. Here's exactly what each positive finding means — and what to do next.
Dr. Priya Nair, MBBS, DCP
Diagnostic Pathology, Urinalysis ·
The essentials — before you read the full guide below.
What a urinalysis tests
A standard dipstick tests 10 parameters: pH, specific gravity, protein, glucose, ketones, blood, nitrites, leucocytes, bilirubin, and urobilinogen. Microscopy adds cells, casts, and crystals.
Protein in urine
Trace protein can be normal or a sign of early kidney damage. Persistent protein above 150 mg/day (proteinuria) requires investigation. The urine protein:creatinine ratio (PCR) is more accurate than dipstick alone.
Blood vs myoglobin
Dipstick blood detects haemoglobin and myoglobin — not just red blood cells. A positive dipstick should be confirmed by microscopy. Menstrual contamination is a common cause of false positives in women.
Nitrites = bacteria
Nitrites are produced by gram-negative bacteria (E. coli, Klebsiella). A positive nitrite test strongly suggests bacterial UTI. Combined with positive leucocytes, it has >90% specificity for infection.
Reference Ranges
What does your number
actually mean?
Use the interactive slider below, or read the range cards for a full clinical breakdown.
Urinalysis (Urine Dipstick & Microscopy) Reference Ranges
mg/dL (Protein)Enter your result
Drag to see what your Urinalysis (Urine Dipstick & Microscopy) means
The Science
What each dipstick line actually detects
A urine dipstick is a remarkable screening tool — but each pad on the strip uses a different chemical reaction, and each has its own false positive and negative profile. Understanding the mechanism helps you know which findings to take seriously and which to repeat.
Nitrites detect gram-negative bacteria
Gram-negative bacteria (E. coli causes 80% of UTIs) convert urinary nitrate to nitrite. The test requires bacteria to have been in the bladder for at least 4 hours — a first-morning specimen is most reliable. Gram-positive bacteria (enterococcus, staph) do not produce nitrites, so a negative result doesn't exclude UTI.
Leucocyte esterase detects white blood cell enzyme
The dipstick doesn't detect white blood cells directly — it detects esterase, an enzyme released by lysed WBCs. A positive leucocyte esterase with negative nitrites suggests urethritis, interstitial cystitis, or a false positive. Microscopy of the spun urine sediment is needed to count actual cells.
Urine glucose appears only above the renal threshold
Glucose appears in urine when blood glucose exceeds the renal threshold (~10 mmol/L or 180 mg/dL). In most adults this means glucose has been significantly elevated — making glycosuria an important incidental finding for diabetes. In pregnancy, the threshold lowers, so glycosuria is common without diabetes.
When to Test
Signs your doctor will
order this test
These are the most common reasons a Urinalysis (Urine Dipstick & Microscopy) test is requested — from symptoms to routine screening.
Dysuria, frequency, urgency — UTI symptoms
Urinalysis is the first-line investigation for suspected urinary tract infection. Positive nitrites + leucocyte esterase has high specificity for bacterial UTI.
UTI screenVisible or suspected blood in urine
Haematuria (blood in urine) visible to the naked eye always requires cystoscopy and upper tract imaging to exclude bladder/kidney malignancy, especially in adults over 40.
HaematuriaAnkle swelling and suspected kidney disease
Proteinuria + oedema suggests nephrotic syndrome or severe CKD. Urinalysis is the first test in any patient with suspected renal pathology.
Kidney screenDiabetic monitoring
The albumin:creatinine ratio (ACR) from an early morning urine sample is the gold standard screen for diabetic nephropathy — more sensitive than dipstick protein alone.
Diabetes monitoringAntenatal screening
Urinalysis at every antenatal visit screens for pre-eclampsia (proteinuria + hypertension) and asymptomatic bacteriuria, which increases premature labour risk.
AntenatalPre-operative or annual screening
Urinalysis is standard pre-operative screening and often included in comprehensive annual health checks to detect asymptomatic kidney disease, diabetes, or infection.
Routine screenTesting Schedule
How often should
you get tested?
Frequency depends on your current health status and your doctor's guidance.
Annual health screen
Urinalysis is included in comprehensive annual health checks to screen for asymptomatic kidney disease and diabetes.
Every antenatal appointment
Urine protein is checked at every antenatal visit to screen for pre-eclampsia.
Diabetes management
ACR (albumin:creatinine ratio) from early morning urine is checked at least annually in all diabetics — and every 6 months if ACR is already elevated.
UTI or kidney symptoms
Urinalysis is ordered immediately for symptoms of UTI (dysuria, frequency) or pyelonephritis (loin pain, fever).
If Your Result Is Abnormal
What to do next based on your urinalysis findings
Different positive findings lead to completely different pathways — use the finding, not just the report.
Positive nitrites + leucocytes → urine culture
Midstream urine (MSU) culture confirms the bacterial species and antibiotic sensitivities. Treatment with a broad-spectrum antibiotic may be started empirically while awaiting culture, but culture is essential to confirm and guide therapy.
MSU culture before antibioticsBlood on dipstick → microscopy + ACR + imaging
Confirm with microscopy (how many RBCs per high-power field?). Add ACR to check for glomerular disease. Persistent haematuria without infection requires urgent cystoscopy and renal ultrasound.
Microscopy + cystoscopy if unexplainedPersistent proteinuria → ACR + eGFR
Trace or + protein should be repeated with a first-morning ACR. An ACR above 3 mg/mmol (microalbuminuria) with declining eGFR indicates CKD — add BP measurement and review medications (NSAIDs, contrast agents, diuretics).
ACR + eGFR + BPGlucose in urine → fasting glucose + HbA1c
Glycosuria means blood glucose has been exceeding the renal threshold. Fasting glucose and HbA1c are the next step — glycosuria can be the incidental discovery of previously undiagnosed diabetes.
Fasting glucose + HbA1c