Dr. Prabhat AryaMD · Internal Medicine
ConditionsKnow your condition

Your urine report, line by line.

A urine routine test looks at the colour, the chemistry (a dipstick) and, under a microscope, the cells in your urine. Many “abnormal” lines come from a sample that was not collected cleanly. A few point to infection, diabetes or the kidneys.

Reviewed by Dr. Prabhat Arya, MBBS, MD (Internal Medicine)

Reviewed · Next review · Sources: MedlinePlus, NHS, Testing.com

Send your report for ₹199See every value

Read this first.

Go by the range printed on your own report. Most lines should read “Nil”, “Negative” or “Absent”; a few cells are normal. The ranges below are typical adult ranges.

The sample matters. Urine should be a clean-catch midstream sample (wash, pass the first part into the toilet, then collect), tested within about an hour. Plenty of epithelial cells or bacteria usually means the sample picked up skin cells, not that you have an infection. A sample during or just after a period often shows blood.

A urine report is read with your symptoms. Pus cells and bacteria without burning, frequency or fever usually do not need antibiotics, except in pregnancy. A urine culture is the test that confirms an infection.

If you have diabetes or high blood pressure, the urine routine is not enough to check the kidneys: ask for a urine albumin-to-creatinine ratio (ACR) once a year.

Every value, one by one.

Colour

How the urine looks

Typical adult range pale yellow to amber

What it means
Dark yellow usually means concentrated urine: you need more water. Orange-red is normal while taking the TB medicine rifampicin. Red or pink can be blood, beetroot or some food colours. Dark brown or “cola” urine can be bilirubin (a liver problem) or, rarely, muscle breakdown.
Usually nothing to worry about when
It is dark yellow and goes pale when you drink more, or it is orange-red while you take rifampicin.
See a doctor when
It is red, pink or cola-coloured without an obvious food or medicine cause: see a doctor this week, and the same day if you also have yellow eyes, pain or fever.

Appearance (clarity)

Clear or cloudy (turbid)

Typical adult range clear

What it means
Cloudy urine can be pus cells (infection), crystals or mucus, or simply a sample that was left to stand and cool before testing.
Usually nothing to worry about when
It is slightly turbid and the rest of the report (pus cells, nitrite, protein) is normal.
See a doctor when
It is cloudy with burning, frequency, fever or a bad smell: see a doctor within a day or two.

pH (reaction)

How acidic or alkaline the urine is

Typical adult range about 4.5–8.0 (usually 5–7)

High usually means
Alkaline urine: common with a vegetarian diet, after meals, a sample left standing, and some urine infections and stones.
Low usually means
Acidic urine: a high-protein diet, fasting, uncontrolled diabetes, and some kidney stones (uric acid).
Usually nothing to worry about when
It is anywhere in the 5–8 range on a single test. pH on its own rarely means anything.
See a doctor when
You keep getting kidney stones: your doctor may use your urine pH to choose how to prevent them, at your next check-up.

Specific gravity

How concentrated the urine is compared with water

Typical adult range about 1.005–1.030

High usually means
Concentrated urine: not enough water, fever, sweating, or sugar in the urine.
Low usually means
Dilute urine: drinking lots of water. When it stays low all day even when you drink little, the kidneys may not be concentrating well.
Usually nothing to worry about when
It matches how much you drank before the test.
See a doctor when
It stays very low (around 1.005 or below) with constant thirst and passing large amounts of urine: see a doctor this week for sugar and kidney tests.

Protein (albumin)

Protein leaking through the kidney filters; normally almost none

Typical adult range Nil / Negative

High usually means
“Trace” or “1+” is often temporary: fever, hard exercise, dehydration, stress, or a concentrated sample. It is also seen with a urine infection. Protein that stays on repeat tests is a sign of kidney damage, most often from diabetes or high blood pressure.
Usually nothing to worry about when
It is trace or 1+ once, during a fever or after exercise, and is nil on a repeat a week or two later.
See a doctor when
It is present on two tests, or you have diabetes or high blood pressure: see a doctor this month for a urine ACR and kidney blood test. It is 2+ or more, or you have swollen eyes, face or legs or frothy urine: this week.

Glucose (sugar)

Sugar spilling into the urine

Typical adult range Nil

High usually means
Usually high blood sugar: sugar spills into urine when blood sugar is above about 180 mg/dL, so it often means undiagnosed or uncontrolled diabetes. It is expected with the diabetes medicines dapagliflozin, empagliflozin and similar, which work by passing sugar out in urine. It can appear in pregnancy, and rarely with normal blood sugar (a harmless kidney trait).
Usually nothing to worry about when
You take dapagliflozin, empagliflozin or a similar tablet: sugar in the urine is how it works.
See a doctor when
You are not known to have diabetes: have a fasting sugar and HbA1c this week. See the blood sugar page.

Ketones

Made when the body burns fat for fuel instead of sugar

Typical adult range Nil

High usually means
Fasting (including religious fasts), a very low-carbohydrate diet, vomiting, or not eating during an illness. In someone with diabetes, ketones with high sugar can be a sign of diabetic ketoacidosis, a dangerous condition.
Usually nothing to worry about when
You do not have diabetes and you were fasting, dieting or vomiting before the test.
See a doctor when
You have diabetes and ketones are present: check your blood sugar and speak to your doctor the same day. Large ketones with vomiting, tummy pain or fast breathing: go to hospital (see below).

Bilirubin

The yellow pigment the liver clears into bile; it appears in urine when bile flow is blocked or the liver is inflamed

Typical adult range Nil / Negative

High usually means
A liver or bile duct problem: hepatitis or a blocked bile duct. Often seen with dark urine and yellow eyes.
Usually nothing to worry about when
A faint positive with normal blood liver tests (LFT) is often a false reading, from some medicines or a very dark, concentrated sample.
See a doctor when
It is positive: have a liver blood test this week. See the liver tests page. With yellow eyes, fever or pain: the same day.

Urobilinogen

A breakdown product of bilirubin made in the gut; a small amount in urine is normal

Typical adult range Normal (about 0.2–1.0 mg/dL)

High usually means
More bilirubin being made or handled: red cells breaking down faster than usual (haemolysis), or a liver problem such as hepatitis.
Low usually means
Absent urobilinogen can mean bile is not reaching the gut (a blocked bile duct). Antibiotics can also lower it.
Usually nothing to worry about when
It is just above normal and your blood count and liver tests are normal.
See a doctor when
It is raised with anaemia, dark urine or yellow eyes: see a doctor this week for a blood count and LFT.

Blood (haemoglobin)

The dipstick test for blood; it reacts to red cells and also to free haemoglobin or muscle protein

Typical adult range Nil / Negative

High usually means
Very often a period or the days around it. Also a urine infection, a kidney stone, hard exercise, an enlarged prostate in older men, and kidney filter inflammation. If the dipstick is positive but the microscope shows no red cells, it may be free haemoglobin or muscle protein, or a false reading.
Usually nothing to worry about when
You were on or near your period, or had very hard exercise the day before, and a repeat test a week or two later is clear.
See a doctor when
Blood stays on a repeat test with no period or infection to explain it: see a doctor this month. You can see the blood, with no clear cause, especially if you are over 40 or smoke: this week. With high blood pressure, swelling or protein in the urine: this week.

Nitrite

Made when certain bacteria in the bladder change nitrate to nitrite

Typical adult range Negative

High usually means
Positive nitrite strongly suggests bacteria in the urine, usually a urine infection, especially with burning or frequency. A sample left standing for hours can turn positive falsely.
Usually nothing to worry about when
Negative nitrite is normal. A negative result does not rule out infection, because some bacteria do not make nitrite.
See a doctor when
It is positive and you have burning, frequency or lower tummy pain: see a doctor within a day or two. Positive in pregnancy, even without symptoms: within a few days.

Leucocyte esterase

A dipstick test for white blood cells (pus cells)

Typical adult range Negative

High usually means
White cells in the urine: usually infection or inflammation. In women, a sample that is not midstream often picks up white cells from the vagina.
Usually nothing to worry about when
It is trace or 1+, the microscope shows few pus cells, and you have no symptoms.
See a doctor when
It is positive with nitrite or with burning or frequency: see a doctor within a day or two.

Pus cells (WBCs)

White blood cells counted under the microscope, per high-power field (/hpf)

Typical adult range about 0–5 /hpf (a few more is common in women)

High usually means
Infection or inflammation in the urinary tract. With burning, frequency or fever it is usually a urine infection. Pus cells without symptoms are common and usually not treated, except in pregnancy. Pus cells that persist when the urine culture shows no bacteria can be a stone, a recent course of antibiotics, a sexually passed infection, or, in India, TB of the urinary tract.
Usually nothing to worry about when
It is 5–10 /hpf, epithelial cells are plenty (a contaminated sample), and you have no symptoms. Repeat with a clean midstream sample.
See a doctor when
It is above about 10 /hpf with symptoms: see a doctor within a day or two, and give a urine culture before starting antibiotics. Pus cells on repeated tests with a negative culture: see a doctor this month.

Red blood cells (RBCs)

Red cells counted under the microscope, per high-power field

Typical adult range about 0–2 /hpf

High usually means
The same causes as a positive blood test: a period, infection, a stone, hard exercise, an enlarged prostate, or kidney filter inflammation. Red cells that look misshapen (“dysmorphic”) or red cell casts point to the kidney filters.
Usually nothing to worry about when
It is 3–5 /hpf during or near a period, or after hard exercise, and clear on a repeat.
See a doctor when
Red cells on two tests with no clear reason: see a doctor this month. With red cell casts, protein, swelling or high blood pressure: this week.

Epithelial cells

Cells from the lining of the urinary tract and the skin around it

Typical adult range few (“occasional”)

High usually means
“Plenty” of squamous (flat) epithelial cells almost always means the sample picked up skin cells and was not a clean midstream catch. It makes the rest of the report less reliable. Renal tubular epithelial cells, if named, come from the kidney itself.
Usually nothing to worry about when
They are squamous cells and you have no symptoms. Repeat with a clean midstream sample if anything else was abnormal.
See a doctor when
The report names renal tubular epithelial cells: see a doctor this week with a kidney blood test.

Casts

Tube-shaped clumps formed inside the kidney’s tiny tubes and washed out in urine

Typical adult range Nil (a few hyaline casts can be normal)

High usually means
Hyaline casts are common after exercise, fever or dehydration and are usually harmless. Granular casts can be non-specific or a sign of kidney injury. Red cell casts point to inflammation of the kidney filters; white cell casts to a kidney infection or inflammation.
Usually nothing to worry about when
They are a few hyaline casts after exercise or a fever.
See a doctor when
Red cell or white cell casts: see a doctor this week, and the same day with fever and back pain. Granular casts with a raised creatinine: this week.

Crystals

Minerals that have formed crystals in the urine

Typical adult range Nil or few

High usually means
Calcium oxalate, uric acid and amorphous phosphates or urates are very common, especially in concentrated urine or a sample that cooled before testing. They are usually harmless. Many crystals, again and again, in someone with kidney stones suggest a higher chance of more stones.
Usually nothing to worry about when
A few calcium oxalate or amorphous crystals and you have never had a stone. Drink more water.
See a doctor when
You have had kidney stones before and crystals keep showing: see a doctor at your next check-up about preventing stones. Crystals with side or back pain and blood in urine: within a day or two.

Bacteria

Germs seen under the microscope

Typical adult range Nil

High usually means
Bacteria with pus cells and symptoms usually mean a urine infection. Bacteria alone, with many epithelial cells and no symptoms, are usually contamination or a sample left standing. A urine culture is the only reliable test for infection.
Usually nothing to worry about when
You have no symptoms, pus cells are few, and epithelial cells are plenty.
See a doctor when
Bacteria with symptoms or in pregnancy: see a doctor within a day or two and give a urine culture first.

Results that go together.

PatternsTypical, not certain
When you seeIt usually means
Pus cells, nitrite and leucocyte esterase positive, with burning or frequencyA urine infection. Give a urine culture, then treatment. See the urine infection page.
Plenty of epithelial cells, bacteria, a few pus cells, no symptomsUsually a contaminated sample. Repeat with a clean midstream sample; antibiotics are not needed.
Blood, protein and red cell casts, with swelling or high blood pressureInflammation of the kidney filters. Needs a doctor and a kidney blood test this week.
Glucose and ketones together, in someone unwellCan be diabetic ketoacidosis. See the danger signs below.
Blood positive on the dipstick but no red cells under the microscopeFree haemoglobin, muscle protein, or a false reading. Repeat the test; if it stays, see a doctor this week.
Pus cells again and again, urine culture always negativeA stone, recent antibiotics, or TB of the urinary tract. Needs a doctor this month.

Get help today if

  • Burning urine with high fever, shivering, pain in the back or side under the ribs, or vomiting: see a doctor today; this can be a kidney infection.
  • A urine infection with confusion, drowsiness, fast breathing or feeling faint, especially in an older person: go to hospital now, or call 112.
  • Diabetes with ketones in the urine plus vomiting, tummy pain, fast breathing or drowsiness: go to hospital now, or call 112.
  • You cannot pass urine at all, or pass clots of blood with severe pain: go to hospital today.
  • Burning or blood in urine during pregnancy, or with fever: see a doctor today.

Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).

Read more.

Questions people ask.

  1. Pus cells 6–8 in urine: do I need antibiotics?

    Only if you have symptoms such as burning, frequency or fever, or you are pregnant. A few pus cells without symptoms are common, especially in women and in samples that were not midstream. Repeat with a clean-catch sample, and if treatment is needed, give a urine culture first.

  2. What does protein “trace” in urine mean?

    Often nothing serious: fever, exercise, dehydration or a concentrated sample can all show a trace. Repeat the test in a week or two. If it stays, or you have diabetes or high blood pressure, ask for a urine albumin-to-creatinine ratio (ACR), which measures it properly.

  3. Are calcium oxalate crystals in urine dangerous?

    Usually not. They are common in concentrated urine and in samples that cooled before testing. They matter mainly if you have had kidney stones. Drink enough water to keep your urine pale.

  4. Why does my urine report show blood when I feel fine?

    The commonest reasons are a period, hard exercise or a mild infection. Repeat the test away from your period. If blood keeps showing, see a doctor this month; if you can see the blood yourself, this week.

  5. How do I give a proper urine sample?

    Wash your hands and the genital area with water, pass the first few drops into the toilet, collect the middle part in the sterile container, and give it to the lab within about an hour. Avoid testing during a period if you can.

Where this can be checked

These are trusted general sources. The advice on this page is Dr. Arya’s, written for patients in India. Ranges differ between labs: go by the range printed on your own report.

Your whole report, read by your doctor.

Send every page, old reports too. He reads them himself and tells you what changed and what to do.

Send your report for ₹199

Dr. Prabhat Arya · MBBS, MD (Internal Medicine)