Normal urinalysis values
| Test | Normal | Abnormal results can mean |
|---|---|---|
| Specific gravity | 1.005 to 1.030 | Low: very dilute urine, too much fluid, diabetes insipidus. High: dehydration, glucose or contrast dye in urine |
| pH | 4.5 to 8.0 (usually about 6) | Alkaline and persistently high: urease-producing infection (Proteus), some kidney stones |
| Protein | Negative or trace | Kidney disease, diabetes, high blood pressure, pre-eclampsia in pregnancy; also fever and hard exercise |
| Glucose | Negative | High blood sugar (diabetes), pregnancy, SGLT2 inhibitor medicines, kidney tubule problems |
| Ketones | Negative | Fasting, vomiting, low-carbohydrate diets; with high sugar, diabetic ketoacidosis |
| Blood | Negative | Infection, stones, period blood, hard exercise, kidney or bladder disease; muscle breakdown (myoglobin) |
| Leukocytes | Negative | Infection or inflammation of the urinary tract; contamination from the vagina |
| Nitrite | Negative | Bacteria that convert nitrate (E. coli and other gut bacteria): urinary infection |
| Bilirubin | Negative | Liver disease or blocked bile ducts |
| Urobilinogen | 0.2 to 1.0 mg/dL | High: liver disease, red cell breakdown (haemolysis) |
| Red cells | 0 to 2 per high-power field | 3 or more: microscopic blood (haematuria), which needs a repeat test and often further checks |
| White cells | 0 to 5 per high-power field | Infection or inflammation; with no bacteria, consider TB, stones or chlamydia |
Getting a reliable sample
- Collect a clean-catch midstream sample: wash, pass the first part into the toilet, then catch the middle part in a sterile pot.
- Test within 1 to 2 hours, or keep it in the fridge. Old samples grow bacteria and give false results.
- Many skin cells (squamous epithelial cells) mean the sample is contaminated and should be repeated.
- Dipstick tests can be affected by vitamin C, some medicines and very dilute urine.
For students & clinicians (technical detail)
- Nitrite has high specificity but low sensitivity for UTI (needs about 4 hours of bladder dwell time; Enterococcus, Staphylococcus saprophyticus and Pseudomonas do not reduce nitrate).
- Dipstick haem positive with no red cells on microscopy suggests haemoglobinuria (intravascular haemolysis) or myoglobinuria (rhabdomyolysis): check CK.
- Dysmorphic red cells, red cell casts or proteinuria with haematuria point to a glomerular cause; refer for nephrology assessment.
- Dipstick protein mainly detects albumin; quantify with a urine albumin:creatinine ratio (ACR) or protein:creatinine ratio (PCR).
- In adults over 65, catheterised patients and asymptomatic people, a positive dipstick alone should not be used to diagnose UTI (asymptomatic bacteriuria is common). Treat asymptomatic bacteriuria in pregnancy.
- Persistent microscopic haematuria (3 or more RBC/hpf on two of three samples) in adults usually warrants assessment for urological cancer, depending on age and risk factors.