A urinalysis report has three sections: a visual assessment of your urine’s appearance, a chemical dipstick panel, and a microscopic examination of the sediment. Each section tells a different part of the story. Once you understand what the terms mean and where the normal ranges fall, you can make sense of nearly every line on your report.
The Three Parts of a Urinalysis
The first part is the physical exam: color and clarity. Normal urine ranges from pale straw to deep amber, depending on how hydrated you are. “Clear” means transparent. “Cloudy” or “turbid” can signal infection, excess protein, or crystals. Unusual colors like red, brown, or orange may point to blood, liver problems, or medications.
The second part is the chemical analysis, done with a dipstick strip dipped into your sample. Each pad on the strip changes color based on the concentration of a specific substance. The lab reads those color changes and reports results as negative, trace, or on a scale from 1+ to 4+. This section covers pH, specific gravity, protein, glucose, ketones, bilirubin, blood, nitrites, and leukocyte esterase.
The third part is the microscopic exam. A technician spins your urine in a centrifuge, examines the sediment under a microscope, and counts cells, crystals, casts, and bacteria per high-power field (HPF). This is where subtle kidney disease and contamination issues show up.
Specific Gravity and pH
Specific gravity measures how concentrated your urine is. The normal range is 1.005 to 1.030. A reading near 1.005 means your urine is very dilute, which happens when you’re well-hydrated or drinking large amounts of fluid. A reading above 1.030 suggests dehydration, or that your kidneys are working hard to conserve water. Persistently low specific gravity can indicate a problem with the kidneys’ ability to concentrate urine.
Urine pH typically falls between 4.5 and 8.0. Most people land somewhere around 5.5 to 6.5, making urine mildly acidic. A consistently high (alkaline) pH can be caused by a vegetarian diet, certain medications, or a urinary tract infection from bacteria that produce ammonia. A low (acidic) pH is common with high-protein diets, dehydration, or metabolic conditions like diabetic ketoacidosis. On its own, pH rarely tells the whole story, but it adds context to other findings on the report.
Protein and Glucose
Protein in urine is reported as negative, trace, or 1+ through 4+. A negative or trace result is generally normal. Persistent protein at 1+ or higher can signal kidney damage, because healthy kidneys keep protein molecules in the bloodstream rather than letting them spill into urine. Temporary, harmless spikes can happen after intense exercise, fever, or emotional stress, so a single positive reading doesn’t automatically mean kidney disease. Repeat testing or a more precise lab measurement is usually the next step.
Glucose is normally undetectable in urine. Your kidneys reabsorb virtually all filtered glucose until blood sugar exceeds roughly 180 mg/dL, known as the renal threshold. Above that level, glucose spills into urine and shows up on the dipstick. This is most commonly seen in uncontrolled diabetes. It can also occur in pregnancy or in rare inherited conditions where the kidney’s sugar-reabsorbing machinery doesn’t work properly, even when blood sugar is normal.
Ketones and Bilirubin
Ketones appear in urine when your body burns fat for fuel instead of glucose. The most common trigger is simply not eating for an extended period. Ketones also show up during very low-carbohydrate diets, prolonged vomiting, and intense exercise. The concerning scenario is diabetic ketoacidosis, where high blood sugar combined with moderate to large ketones signals a dangerous metabolic emergency. If you have diabetes and your report shows ketones, that finding matters more than it would for someone on a keto diet.
Bilirubin should not appear in urine at all. A healthy liver processes bilirubin (a byproduct of red blood cell breakdown) and sends it into the intestines through bile. When the liver is damaged or a bile duct is blocked, bilirubin backs up into the bloodstream, gets filtered by the kidneys, and ends up in your urine. Bilirubinuria can actually be the earliest detectable sign of liver or bile duct disease, sometimes showing up before the skin or eyes turn yellow. Causes range from hepatitis and cirrhosis to gallstones and pancreatic tumors pressing on the bile duct.
Blood: What RBCs on the Report Mean
The dipstick detects blood and reports it as negative, trace, or 1+ through 3+. The microscopic exam gives a more precise count of red blood cells per high-power field. Current guidelines from the American Urological Association define microscopic hematuria as more than 3 red blood cells per high-power field on a properly collected specimen. Below that threshold, small numbers of red blood cells are considered normal.
Blood in urine has a wide range of causes. Menstruation, vigorous exercise, and urinary tract infections are common and usually harmless explanations. Kidney stones, enlarged prostate, and bladder or kidney cancers are less common but more serious possibilities. A single positive result often leads to repeat testing. Persistent microscopic hematuria, especially in people over 40 or with risk factors like smoking, typically warrants further imaging or evaluation.
Nitrites and Leukocyte Esterase: Infection Markers
These two dipstick results are the main screening tools for urinary tract infections. Leukocyte esterase is an enzyme released by white blood cells. A positive result means white blood cells are present in your urine, which points to inflammation or infection. Nitrites form when certain bacteria (especially E. coli and other common UTI-causing organisms) convert naturally occurring nitrates in urine into nitrites. A positive nitrite result strongly suggests a bacterial infection.
When both tests are positive together, the dipstick is about 90% sensitive for detecting bacteria in urine, meaning it catches roughly 9 out of 10 infections. However, specificity is lower, around 56%, so false positives do happen. A negative nitrite result doesn’t rule out infection either, because not all bacteria produce nitrites, and urine that hasn’t been in the bladder long enough (at least four hours) may not have had time for the conversion. That’s why a urine culture, where bacteria are actually grown and identified, remains the gold standard for confirming a UTI.
The Microscopic Exam: Cells, Casts, and Crystals
Cells
White blood cells above about 5 per high-power field generally indicate infection or inflammation somewhere in the urinary tract. Red blood cells are significant above 3 per high-power field, as described above. Squamous epithelial cells are flat skin cells from the outer genital area. Their presence on a report signals that the sample may be contaminated, meaning urine wasn’t collected with a proper clean-catch technique. If your report shows many squamous epithelial cells, other findings on that same test become less reliable, and a repeat collection may be needed.
Casts
Casts are tiny tube-shaped structures that form inside the kidney’s tubules. They’re essentially molds of the tubule interior, and the type of cast reveals where and how the kidney is being affected. Hyaline casts are the most innocent variety. They can appear after exercise or dehydration and are often clinically insignificant. Granular casts (sometimes described as “muddy brown”) suggest kidney tubule injury. Red blood cell casts point specifically to inflammation in the kidney’s filtering units and are a hallmark of glomerulonephritis. White blood cell casts indicate infection or inflammation within the kidney itself, not just the bladder. Waxy casts are associated with more advanced kidney damage and impaired kidney function. They rarely appear alone and are typically found alongside other cast types.
Crystals
Crystals form when minerals or other substances in urine become concentrated enough to solidify. Many are harmless. Calcium oxalate crystals (small envelope-shaped structures) and uric acid crystals are common and can appear in healthy people, particularly after certain foods or dehydration. Calcium phosphate crystals are also frequently benign.
Some crystals, however, are always pathological. Cystine crystals indicate cystinuria, a hereditary condition where the kidneys excrete too much of certain amino acids. Struvite crystals are almost always linked to infection by specific bacteria that produce an enzyme called urease, and they can form the basis of large “staghorn” kidney stones. Tyrosine and leucine crystals point to liver disease. Cholesterol crystals are associated with nephrotic syndrome, a condition where the kidneys leak large amounts of protein.
Putting the Results Together
No single line on a urinalysis tells the full story. The value of the test is in how the findings combine. Positive nitrites and leukocyte esterase together with bacteria on microscopy paint a clear picture of a UTI. Protein and red blood cell casts together raise concern for kidney disease. Glucose and ketones together in a person with diabetes suggest poor blood sugar control or developing ketoacidosis. Bilirubin without other abnormalities can be the first clue to investigate the liver.
Context matters too. A report that looks alarming after a marathon may look completely normal a week later. A contaminated specimen with many squamous epithelial cells may need to be repeated before anyone acts on the other findings. When reading your results, look at the reference range printed next to each value on your report, compare your number to that range, and pay attention to which results fall outside it. A single mildly abnormal value is often less meaningful than a pattern of several related abnormalities pointing in the same direction.