How to Read Urinalysis Results: What They Mean

What does a urinalysis actually test?

A standard urinalysis has three parts:

1. Visual inspection — color and clarity of the urine 2. Dipstick testing — a chemical strip dipped in the sample that detects several substances in seconds 3. Microscopic analysis — when ordered, a laboratory technician looks at the urine under a microscope to count cells, bacteria, and other particles

Results are usually reported as a table showing each marker and whether it falls within normal range. The NIDDK describes urinalysis as a routine test used to diagnose or monitor bladder infections, kidney problems, and diabetes 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2022).Diagnosis of Bladder Infection in Adults.Role of urinalysis in detecting white blood cells, protein, glucose, and blood in urine; use in diagnosing UTI, kidney problems, and diabetes.

What do common dipstick findings mean?

Leukocytes (white blood cells) — positive White blood cells in urine suggest inflammation or infection somewhere in the urinary tract. A positive leukocyte esterase test (the dipstick marker for WBCs) is one of the key signs of a urinary tract infection (UTI), but it can also appear with kidney inflammation or other irritation 1Ref 1Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE (2011).International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.Role of leukocyte esterase and nitrites in UTI dipstick diagnosis; interpretation in the clinical context of uncomplicated UTI. On its own, it does not confirm an infection — context and other markers matter.

Nitrites — positive Many bacteria that cause UTIs convert urinary nitrates to nitrites. A positive nitrite test alongside positive leukocytes strongly suggests a bacterial UTI 1Ref 1Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE (2011).International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.Role of leukocyte esterase and nitrites in UTI dipstick diagnosis; interpretation in the clinical context of uncomplicated UTI. Nitrites can be false-negative if the urine was not held in the bladder long enough or if the infecting organism does not produce nitrites (some do not, including Enterococcus).

Blood (hematuria) — trace or positive Blood in urine can be visible (red or pink urine) or microscopic (only seen on the dipstick or under a microscope). Causes range from benign (vigorous exercise, menstrual contamination) to conditions that need investigation, including kidney stones, bladder infection, bladder polyps, or tumors of the urinary tract 3Ref 3Barocas DA, Boorjian SA, Alvarez RD, et al. (2020).Microhematuria: AUA/SUFU Guideline.Definition of clinically significant microscopic hematuria (≥3 RBCs/hpf); risk-stratified workup including imaging and cystoscopy for persistent hematuria. Persistent microscopic blood warrants further workup.

Protein — trace or positive Small amounts of protein in urine (trace) can result from fever, strenuous exercise, or posture. Consistently elevated protein can signal kidney disease — the kidneys normally filter protein out, so when it appears in urine it may mean the filtration barrier is not working properly 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2022).Diagnosis of Bladder Infection in Adults.Role of urinalysis in detecting white blood cells, protein, glucose, and blood in urine; use in diagnosing UTI, kidney problems, and diabetes. Persistent proteinuria is evaluated with additional kidney function tests.

Glucose — positive Sugar in urine is unusual because healthy kidneys reabsorb glucose. Glucose in urine suggests that blood sugar is elevated above the kidney's reabsorption threshold — often a marker of diabetes or prediabetes 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2022).Diagnosis of Bladder Infection in Adults.Role of urinalysis in detecting white blood cells, protein, glucose, and blood in urine; use in diagnosing UTI, kidney problems, and diabetes.

Ketones — positive Ketones appear when the body breaks down fat for energy, typically during very low-carbohydrate diets, prolonged fasting, vomiting, or in uncontrolled diabetes (diabetic ketoacidosis). In a diabetic context, ketones in urine warrant immediate evaluation.

Specific gravity and pH Specific gravity reflects how concentrated the urine is. Very dilute urine (low specific gravity) can indicate high fluid intake, diabetes insipidus, or kidney disease 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2022).Diagnosis of Bladder Infection in Adults.Role of urinalysis in detecting white blood cells, protein, glucose, and blood in urine; use in diagnosing UTI, kidney problems, and diabetes. pH reflects acidity; this is used mainly in the context of kidney stone evaluation and certain infections.

What does the microscopic analysis show?

When a microscopic urinalysis is performed, the report may list:

• WBCs per high-power field (hpf): Higher numbers reinforce the dipstick finding of infection or inflammation
• RBCs per hpf: Confirms whether hematuria is truly present and at what level; the 2020 AUA/SUFU Microhematuria Guideline defines clinically significant microscopic hematuria as ≥3 RBCs/hpf on a properly collected specimen 3Ref 3Barocas DA, Boorjian SA, Alvarez RD, et al. (2020).Microhematuria: AUA/SUFU Guideline.Definition of clinically significant microscopic hematuria (≥3 RBCs/hpf); risk-stratified workup including imaging and cystoscopy for persistent hematuria
• Bacteria: Presence of bacteria (especially combined with WBCs) supports a diagnosis of UTI
• Casts: Cylindrical structures formed in the kidney tubules; certain types (RBC casts, granular casts) suggest specific kidney diseases
• Crystals: Some crystal types can indicate kidney stone risk (calcium oxalate, uric acid)

What should you do with your results?

A single abnormal finding on a urinalysis rarely tells the whole story. Results are interpreted alongside your symptoms, medical history, and sometimes additional tests. For example:

• Positive leukocytes and nitrites with burning urination and frequency in an otherwise healthy woman most likely represent an uncomplicated UTI 1Ref 1Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE (2011).International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.Role of leukocyte esterase and nitrites in UTI dipstick diagnosis; interpretation in the clinical context of uncomplicated UTI
• Persistent microscopic blood in urine warrants risk stratification and possible urology referral for cystoscopy and imaging per current guidelines 3Ref 3Barocas DA, Boorjian SA, Alvarez RD, et al. (2020).Microhematuria: AUA/SUFU Guideline.Definition of clinically significant microscopic hematuria (≥3 RBCs/hpf); risk-stratified workup including imaging and cystoscopy for persistent hematuria
• Protein in urine on multiple tests may lead to nephrology evaluation 2Ref 2National Institute of Diabetes and Digestive and Kidney Diseases (2022).Diagnosis of Bladder Infection in Adults.Role of urinalysis in detecting white blood cells, protein, glucose, and blood in urine; use in diagnosing UTI, kidney problems, and diabetes

A Gale primary care clinician can review your specific urinalysis results, put them in context, and decide with you whether further testing or a specialist referral is needed.

Tips for a reliable sample

A clean-catch midstream specimen reduces contamination that can cause false-positive leukocyte or bacteria readings. Drink a normal amount of fluid — very concentrated or very dilute urine can affect readings. Avoid vigorous exercise for 24 hours before collecting a sample, since strenuous activity can temporarily cause blood to appear in urine.