Urine Analysis…what does it all mean?

Urine Analysis results...what does it all mean?

By: Anna Myers, MSN, WHNP-BC, FNP-BC, CUNP, RN

A urine analysis or dipstick test, is a thin plastic strip treated with chemicals. It’s dipped in your urine, and the chemicals on the stick react and change color if levels are above normal. Findings from the dipstick test include:

Heme: This is a screening test for blood in the urine.  Positive for heme requires microscopic evaluation to determine if in fact there are blood cells noted and how many. A urine microscopic evaluation of greater than 3 blood cells is indicative of microscopic hematuria. Possible causes of blood in the urine include urinary tract infections, kidney stones, malignancy and certain medications.  False positives can occur due to menstrual blood, concentrated urine, and strenuous exercise. If the acidity of the urine is less than 5.1 it will not necessarily pick up heme.

Urobilinogen: This is a substance normally found in urine that occurs from the reduction of bilirubin.  Too little urobilinogen can indicate liver dysfunction, too much may indicate liver disease such as cirrhosis or hepatitis.

Bilirubin: This is a normal substance made by the liver from the breakdown of red blood cells.  The healthy liver removes bilirubin from your body. However, if your liver is not functioning properly, the bilirubin can leak into the blood or urine.  This may be an indicator of liver disease.

Protein: Low levels of protein in the urine is normal.  Elevated protein may reveal that your kidneys are damaged.  The kidneys filter waste products out of the blood, and your body needs protein.  

Nitrites: This is an indirect measure of nitrate reducing bacteria.  This part of the test is most accurate if the urine has been held in the bladder >4 hours, that’s why first morning void is the most accurate.  Most bacteria that cause urinary tract infections (UTI) reduce nitrate to nitrite in the urine. However, if the nitrite is negative that does not rule out a UTI as there are some bacterias that do not reduce nitrites.

Ketones: Normally, your body burns glucose (sugar) for energy. If your cells don't get enough glucose, your body burns fat for energy instead. This produces a substance called ketones, which can show up in your blood and urine. Elevated ketones in the urine may indicate diabetic ketoacidosis (DKA), a possible complication of diabetes that can lead to a coma or even death.  Ketones noted on a urine test treated early may avert a medical emergency.

Glucose: Normally glucose in the urine is so small that it is not detected.  Glucose in the urine is an indicator of uncontrolled diabetes. However, recently a class of diabetes medications has come on the market that works by eliminating glucose through the kidneys and may be noted in the urine.

pH or Acidity: If the urine is more acidic than normal, this could be an indicator of kidney stones or a urinary tract infection.

Specific Gravity: This is a measure of the concentration of the particles in your urine, a higher than normal concentration may be indicative of not drinking enough fluids

Leukocytes: This part of the test picks up an enzyme produced by white blood cells, the cells that fight infection.  A positive result indicates anything from trace to many white blood cells may be present, but doesn’t tell you how many white blood cells there actually are.  The number of white blood cells can be evaluated from a microscopic examination of the urine. This part of the UA has a low specificity to urinary tract infection as other conditions may show increased white blood cells as well including chlamydia, bladder tumors, or contamination.

If you have had a urinalysis with abnormal results, you would want to talk to your provider about what these results mean with regard to your health and if any follow up testing would be recommended.  I hope you learned a few things about urine analysis testing.  If you have any questions or desire to further discuss your urological concerns, please call our office at (440) 202-1515.  Thank you!


Anna Myers is a women’s health, urology and family board certified nurse practitioner working in our office here in Richfield, Ohio.