A urinalysis (UA) report has three sections: a visual exam, a chemical dipstick test, and a microscopic exam. Each section tells a different part of the story, from basic hydration status to signs of infection, kidney problems, or metabolic conditions like diabetes. Once you understand what each line means and what “normal” looks like, the report is straightforward to interpret.
The Three Parts of a UA Report
Every standard urinalysis follows the same structure. The visual exam describes what the urine looks like to the naked eye: its color, clarity, and sometimes odor. The dipstick test uses a chemically treated strip to measure about ten different substances at once. The microscopic exam puts a drop of urine under a microscope to look for cells, bacteria, crystals, and other sediment. Your report may list all three sections together or break them into labeled groups.
Visual Exam: Color and Clarity
The first few lines on your report describe the urine’s appearance. Normal urine is pale yellow to amber and clear. A result that says “cloudy” or “turbid” can point to infection, excess minerals like phosphates or calcium, or simply a sample that sat too long before testing. Pink, red, or brown urine suggests blood is present, though certain foods (beets, blackberries) and medications can cause the same color shift. Foamy urine sometimes indicates protein is spilling into the urine, which the dipstick section will confirm or rule out.
The Dipstick Results
The dipstick section is the longest part of most UA reports. Each line represents a different chemical test, and results are typically reported as “negative,” “trace,” or on a scale from 1+ to 4+. Here’s what each one means.
pH
Urine pH measures how acidic or alkaline your urine is. The normal range is 4.5 to 8. A lower number means more acidic, a higher number more alkaline. Diet is the biggest influence: meat-heavy diets push pH lower, while vegetarian diets push it higher. Persistently acidic urine can encourage uric acid crystals, while consistently alkaline urine can promote different types of crystals. On its own, pH rarely signals a serious problem, but it adds context to other findings on the report.
Specific Gravity
This number tells you how concentrated the urine is, which is essentially a measure of hydration. It’s reported as a decimal, typically between 1.001 and 1.030. A value under 1.013 generally reflects well-hydrated urine. Values at or above 1.020 suggest the urine is concentrated, often from not drinking enough fluids. A reading around 1.028 or higher points toward significant dehydration. Very dilute urine (close to 1.001) can mean you drank a large amount of water before the test, which can also dilute other results and make them harder to interpret.
Protein
The normal result is negative. A trace amount can show up after intense exercise or during a fever and isn’t always cause for concern. Persistent protein in urine, especially at 1+ or higher, may indicate kidney damage, since healthy kidneys keep protein in the blood and out of the urine. If protein shows up on a routine UA, a repeat test or a more specific follow-up test is common.
Glucose
Normal is negative. Glucose appears in urine when blood sugar exceeds the kidneys’ ability to reabsorb it, which typically happens when blood sugar rises above roughly 180 mg/dL. Finding glucose in your urine is a red flag for diabetes or poorly controlled blood sugar. It doesn’t diagnose diabetes on its own, but it prompts a blood glucose test.
Ketones
Normal is negative. Ketones are byproducts your body produces when it burns fat for energy instead of sugar. Small amounts can appear during fasting, low-carb diets, prolonged vomiting, or intense exercise. In someone with diabetes, ketones in the urine are more concerning because they can signal diabetic ketoacidosis, a dangerous condition where the blood becomes too acidic.
Bilirubin and Urobilinogen
Bilirubin is a waste product from the normal breakdown of red blood cells. It should not be present in urine at all. A positive bilirubin result suggests a liver or bile duct problem, because bilirubin normally gets processed by the liver and excreted through the intestines, not the kidneys.
Urobilinogen is a related substance that forms when intestinal bacteria break down bilirubin. A small amount in urine is normal. Elevated urobilinogen can indicate liver disease (hepatitis, cirrhosis) or a condition where red blood cells are being destroyed faster than usual, called hemolytic anemia. Very low or absent urobilinogen may signal a bile duct blockage preventing bilirubin from reaching the intestines at all.
Leukocyte Esterase and Nitrites
These two lines are the infection indicators, and they’re often the reason a UA was ordered in the first place. Leukocyte esterase is an enzyme released by white blood cells. A positive result means white blood cells are present in the urine, which usually signals inflammation or infection. Nitrites appear when certain bacteria convert naturally occurring nitrates in urine into nitrites. A positive nitrite result is a strong indicator of a bacterial urinary tract infection.
When both leukocyte esterase and nitrites are positive, the likelihood of a UTI is high. When both are negative, the chance of a significant infection is low, with a negative predictive value above 93% in studies. However, not all bacteria produce nitrites, so a negative nitrite result alone doesn’t completely rule out infection. If leukocyte esterase is positive but nitrites are negative, infection is still possible.
Blood
Normal is negative. The dipstick detects even microscopic amounts of blood you can’t see with the naked eye. Blood in urine can come from a UTI, kidney stones, vigorous exercise, menstrual contamination, or, less commonly, kidney disease or bladder cancer. A positive blood result almost always prompts further testing to identify the source.
The Microscopic Exam
This section reports what a lab technician actually sees under the microscope, counted per “high-power field” (HPF), which is one view through the microscope lens.
White and Red Blood Cells
A small number of white blood cells (typically 0 to 5 per HPF) is normal. Higher counts support the dipstick finding of leukocyte esterase and suggest infection or inflammation in the urinary tract. Red blood cells follow a similar scale. A few may be normal, but elevated counts need investigation, especially when paired with a positive blood result on the dipstick.
Bacteria and Yeast
Ideally, urine is sterile, and the report should show no bacteria. When bacteria are present, the report may say “few,” “moderate,” or “many.” Combined with positive leukocyte esterase and nitrites, bacteria in the microscopic exam build a strong case for a UTI. Yeast in the urine is less common and may indicate a fungal infection, particularly in people with diabetes or weakened immune systems.
Epithelial Cells
Squamous epithelial cells are skin cells from the outer genital area. The normal range is 0 to 5 per HPF. More than 15 to 20 per HPF is a sign the sample was contaminated during collection, meaning skin cells (and potentially skin bacteria) got into the cup. A contaminated sample can make other results unreliable, and you may be asked to provide a new specimen using a clean-catch technique.
Crystals
Crystals form when minerals in urine become concentrated enough to solidify. The report will name the type. Calcium oxalate and calcium phosphate crystals are the most common and are the same minerals that make up the majority of kidney stones. Uric acid crystals tend to form in acidic urine and are associated with gout or type 2 diabetes. Struvite crystals are linked to repeated urinary tract infections. A few crystals on a single UA don’t necessarily mean you’ll develop kidney stones, but recurring or large amounts may warrant further evaluation.
Casts
Casts are tiny tube-shaped structures that form inside the kidney’s filtering tubes. They take the shape of the tube they formed in, which is why they look like cylinders under the microscope. The type of cast tells you what’s going on in the kidneys.
Hyaline casts are the most common and often harmless. They can show up after dehydration or strenuous exercise. Granular casts are a general sign of kidney disease. White blood cell casts point to kidney infection or inflammation. Red blood cell casts indicate bleeding inside the kidney itself, not just the bladder or urethra. Waxy casts suggest chronic, advanced kidney disease. If your report mentions any cast type other than hyaline, it typically warrants follow-up.
Why Sample Collection Matters
Many confusing UA results come down to a poorly collected sample. The standard method is a “clean-catch midstream” collection. You wash the genital area with a sterile wipe, begin urinating into the toilet, then catch the middle portion of the stream in the cup. The first part of the stream flushes away bacteria and cells that live on the skin’s surface. If you skip the cleaning step or catch the initial stream, skin bacteria and squamous epithelial cells contaminate the sample, potentially producing a false-positive result for infection.
Collecting urine that has been in the bladder for two to three hours gives a more concentrated, reliable sample. First-morning urine is ideal for this reason. If you’re well hydrated and producing very dilute urine, low concentrations of protein, glucose, or bacteria may not register on the dipstick even if they’re present.