Urinalysis: What It Tests For and Why You Might Need One
Key takeaways:
A urinalysis is an easy and painless outpatient test on a sample of urine. It inspects urine visually, under a microscope, or with a dipstick.
A urinalysis can screen for health problems, diagnose diseases, or monitor treatments.
Early morning urine may be the most helpful for a urinalysis. This is when your urine is the most concentrated and any abnormalities are more likely to show up.
Believe it or not, your urine can be a window into your general health. Your kidneys make urine by filtering your blood and removing waste and extra fluid. If your kidneys or other organs in your body aren’t functioning properly, the first signs can be hidden in the urine. This is why a urinalysis can help in the early detection of many diseases.
What is a urinalysis?
A urinalysis is a simple test to look at the contents of a urine specimen. The test checks the urine in several ways to look for abnormalities. This includes changes in how the urine looks and its composition.
A urinalysis may be ordered as a screening test or when a provider is evaluating your symptoms to make a diagnosis.
Confirming a UTI: Symptoms alone can often tell you whether you have a UTI. But a test is sometimes necessary. Experts explain the differences between UTI tests and when you might need one.
Seeing red: Blood in your urine can be concerning. But the cause is often temporary and easily treatable. Discover why you might have blood in your urine and what you should do about it.
Finding out if you’re in the clear: Clear pee is usually a sign that you’re well hydrated — but not always. Learn about other potential causes of clear urine and when you should get it checked out.
What tests are included in a urinalysis?
A urinalysis can have three parts based on what your provider is looking for. These can include:
Visual inspection
Microscopic exam
Dipstick analysis
Visual
The color and clarity of your urine is checked first with the naked eye. This doesn’t require the assistance of any equipment or a machine.
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Urine has a typical yellow color from the urobilin pigment created during the digestive process. Any changes in the color of the urine may be significant. That’s because different conditions can affect the color of the urine.
Other colors for urine may include:
Clear: This may represent overhydration. Drinking too much water can be an issue if essential electrolytes like sodium drop too low.
Amber: This could suggest that your urine is concentrated. This can be a sign of mild dehydration.
Orange: This color might come from dehydration, medications, or liver or bile duct disease.
Brown: This color can be from severe dehydration. It may also be a symptom of serious conditions like jaundice, porphyria, or rhabdomyolysis.
Pink: This most commonly occurs after eating beets, blueberries, or certain food colorings. If you don’t have a history of eating dyed foods, it can be a sign of bleeding.
Red: This can be a worrisome sign of bleeding. It may occur from a urinary tract infection (UTI), kidney stones, a bladder tumor, an enlarged prostate, or metal poisoning.
Cloudy or foamy white: This can be due to kidney disease, too much protein or fat in the urine, or crystals in the urine.
Microscopic exam
Your urine may also need inspection for things that may not be visible. After being collected, your urine is placed in a machine that spins it at high speeds. This is to separate the various components of it. Those cells are then examined under a microscope.
In healthy people, the urine contains small numbers of cells from the urinary tract. With certain diseases, your urine may contain more of these cells or other substances.
A microscopic exam can shows the presence and amount of:
Bacteria and yeast: A certain amount of bacteria can be normal. But in large numbers, it could indicate an infection. Multiple organisms may indicate the specimen wasn’t collected correctly and needs repeating.
Epithelial cells: These are skin cells. If too many are present, the specimen likely wasn’t collected in a sterile way and should be redone.
Red blood cells: There should only be an occasional red blood cell in the urine. If there are more, it is an abnormal finding called hematuria. The number and shape of the cells will give your provider information to help make a diagnosis.
White blood cells: Normally, there are a few white blood cells in the urine. If more are present, it can be a sign of infection or inflammation in the urinary tract.
Casts: These are tiny particles of protein, cells, or debris made in the kidneys. Hyaline casts can appear in healthy patients or after strenuous exercise. Other types of casts may occur in kidney disease.
Crystals: These may be seen in healthy urine. Abnormal crystals can occur in infections, liver disease, or certain genetic conditions.
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Dipstick analysis
A dipstick is a thin plastic stick with patches of chemicals on it. It's dipped into the urine, and the patches will change colors if substances are present at high levels. The results are instant and available within 60 to 120 seconds of the testing.
A dipstick will report on the following:
Specific gravity: This will be abnormal if your urine is too concentrated or not concentrated enough. The specific gravity is a clue to how hydrated you are.
Urinary pH: Certain foods, medications, and illnesses can alter the urine pH. Vomiting, diarrhea, and kidney disease can affect the pH. It may be useful in predicting kidney stones.
Glucose: Glucose is normally reabsorbed by the kidneys and shouldn’t pass into the urine. It can be present with diabetes, pregnancy, or other kidney problems.
Ketones: These are products of body fat metabolism and are not normally in the urine. They can be seen in poorly controlled diabetes, starvation, excessive exercise, or vomiting.
Nitrites: If certain bacteria are present, the bacteria will produce nitrites. This can suggest a UTI.
Bilirubin: Bilirubin is a pigment found in bile, which is made by the liver. If present, it can be a sign of liver disease or hemolysis (red blood cells breaking down).
Protein: Small amounts of protein are normal. But if the kidneys aren’t filtering well, large amounts can seep into the urine. That can happen due to minor issues like standing too long or more serious conditions like diabetes or kidney disease.
Leukocyte esterase: White blood cells (WBCs) contain the enzyme leukocyte esterase. When there is a UTI, the numbers of WBCs in the urine increase and release leukocyte esterase.
Blood in the urine: If more than three red blood cells are present, the dipstick will be positive for blood. You will need further testing to determine the source of bleeding.
Why do I need a urinalysis?
Your healthcare provider may order a urinalysis for several reasons. It may be done for screening purposes, to help make a diagnosis, or to monitor any conditions that you have.
Since it’s not invasive, your provider may recommend it periodically for a routine exam. Some providers will do this if you have an underlying condition such as:
High blood pressure (hypertension)
Liver disease
Benign prostatic hypertrophy (an enlarged prostate)
Any conditions affecting the urinary system
The exception to this is in pregnancy. When you’re pregnant, you'll have a urinalysis to check for gestational diabetes, preeclampsia, and UTI. These are three common complications of pregnancy and are all detected by urinalysis.
Beyond screening, a urinalysis is always done if you have urinary symptoms. These might include:
Abdominal or flank pain
Urinary frequency
Burning with urination
Changes to the color or clarity of your urine
Foul odor to the urine
What’s the difference between a urinalysis and a urine culture?
A urinalysis and urine culture are different tests. They're collected in the same manner but ordered separately.
A urine culture is recommended if you have UTI symptoms or your urinalysis suggests a UTI is likely. A urine culture will take 1 to 3 days for the results to return. A urinalysis is a much more rapid test and can provide information immediately.
A urine culture is done in a microbiology lab to see if there are bacteria that grow in the urine. The culture will also reveal the type of bacteria present and what antibiotic it is sensitive to. This allows your provider to pick the correct medication to get rid of the infection.
How do I prepare for a urine test?
In general, you don’t have to prepare in advance for a urinalysis. But there are a few things you can do that may make the test easier or more reliable. Here are a few tips:
Drink water. It is good practice to be adequately hydrated. You may also want to avoid any foods or drinks that have food coloring and can change the color of your urine.
Take it easy. If possible, avoid any excessive physical exercise or long periods of standing for 24 hours prior to the urinalysis. This can lead to increased levels of protein or ketones.
Do it early. While you can usually collect a sample any time of day, it’s best if it’s your first morning urine. The urine is most concentrated at this point and more likely to show any abnormalities.
How do I collect urine for a urine sample?
The best test is a clean catch test. This is a way to collect the urine so it does not include the bacteria normally present on the skin, only the abnormal ones.
To do this, you’ll typically get a small, sterile container and an antiseptic wipe. Then you’ll follow these easy steps:
Make sure the sterile cup is labeled with your name.
Wash your hands with soap and water.
Remove the lid from the urine collection container and place it with the inner surface up.
Urinate into the container.
Screw the lid on tightly, making sure you don’t touch the inside of the cup.
Return the sample to your healthcare provider. If you are at home, place the cup in a plastic bag and put it in the refrigerator until you can take it to the lab or provider’s office.
Here are some tips for collecting the sample:
If you have a vagina:
Sit on the toilet with your legs spread apart and spread your vagina.
Clean from front to back with the sterile wipe. Clean the inner parts of the vagina and the opening where the urine flows.
Keeping the vagina open, urinate a bit and then pause your stream.
Place the urine cup just below where the urine flows and fill up the cup halfway. Do not touch the rim of the container to your genital area. If you’re not done, you can finish urinating into the toilet bowl.
If you have a penis:
Use the sterile wipe to clean the head of the penis. If you are not circumcised, pull back the foreskin, clean it, and keep the skin retracted.
Urinate a bit and then pause your stream.
Place the urine cup a few inches below the penis and fill the cup up halfway. Do not touch the rim of the container to your genital area. If you’re not done, you can finish urinating into the toilet bowl.
The bottom line
A urinalysis is a test of the urine that can provide helpful information about your health. It's useful if you have urinary complaints. But it can also be used as a screening test or to monitor progress for chronic diseases.
If you have noticed any changes in your urine, discuss this with your provider. They can decide which urine tests you may need to determine the source of your symptoms.
Why trust our experts?
References
Aycock, R.D., et al. (2012). Abnormal urine color. Southern Medical Journal.
Institute for Quality and Efficiency in Health Care. (2019). Understanding urine tests.
MedlinePlus. (2020). Clean catch urine sample.
MedlinePlus. (2021). Urine - abnormal color.
National Kidney Foundation. (n.d.). What is a urinalysis? (Also called a urine test).
Queremel Milani, D.A., et al. (2022). Urinalysis. StatPearls.
Simerville, J.A., et al. (2005). Urinalysis: A comprehensive review. American Family Physician.
Witte, E.C., et al. (2009). First morning voids are more reliable than spot urine samples to assess microalbuminuria. Journal of the American Society of Nephrology.
