Urine routine test — what it detects and how to read it

The urine routine is the unsung workhorse of pathology. It costs ₹200, takes 30 minutes, and screens for problems in the kidneys, bladder, and urinary tract — plus catches early diabetes complications and dehydration. Most patients glance at the report and miss what it actually says.

What the test does

The urine routine has two parts:

1. Chemical analysis — a strip dipped into urine changes colour for various markers.
2. Microscopic examination — a drop of urine is examined under a microscope to count cells, casts, and crystals.

Together they take 20–30 minutes once the sample is in the lab.

How to collect a proper sample

The single biggest factor in a reliable urine test is the collection technique. Common errors:

• Contamination from skin or genital area — gives false positives for blood, white cells, bacteria
• First-stream sample (urethral cells)
• Sample sitting too long — cells degrade after 1 hour at room temperature
• Sample collected during periods — menstrual blood contaminates

The right way:

1. Wash hands. Clean the genital area with water (no soap).
2. Start urinating into the toilet.
3. Stop briefly midstream.
4. Collect about 30 mL into the sterile cup.
5. Cap immediately and deliver to the lab within 1 hour (or refrigerate).

At our centre, we provide sterile cups and a clean toilet. Collecting on-site is usually the most reliable.

Chemical strip results

Colour

Normal: pale yellow to amber.

• Dark yellow: dehydration
• Red or brown: blood (or beetroot, certain medications)
• Cloudy: infection or crystals
• Foamy: protein

pH

Normal: 4.5–8.0 (highly variable through the day).

Persistently very acidic urine may suggest dietary issues; very alkaline urine may suggest UTI or kidney problems.

Specific gravity

Measures urine concentration. Normal: 1.005–1.030.

• Low (under 1.010): overhydration or kidney concentrating problem
• High (over 1.025): dehydration

Glucose

Should be negative in normal urine. Positive glucose usually means blood sugar is significantly elevated (above 180 mg/dL). Always follow up with a fasting blood sugar or HbA1c.

Ketones

Should be negative. Positive ketones can mean:

• Prolonged fasting or low-carb diet
• Severe vomiting
• Diabetic ketoacidosis (medical emergency — usually with high glucose)

Protein

Should be negative or trace. Positive protein needs evaluation:

• Transient: after fever, heavy exercise, or stress — usually nothing to worry about. Repeat after a week.
• Persistent: can indicate kidney damage. Follow up with microalbumin and KFT.

Blood

Should be negative. Positive blood can mean:

• UTI
• Kidney stones
• Menstrual contamination (in women)
• Trauma
• Kidney or bladder disease

Needs evaluation if persistent or unexplained.

Nitrites and leukocyte esterase

These two together suggest UTI. If both are positive with symptoms, antibiotics are usually started while waiting for culture results.

Bilirubin and urobilinogen

These flag liver problems. Positive bilirubin suggests obstructive jaundice; abnormal urobilinogen suggests liver or red-cell disorders.

Microscopic findings

White cells (Pus cells)

Normal: 0–5 per high-power field (HPF).

• Raised (over 10/HPF): UTI most likely. Severe elevation (over 50/HPF) strongly suggests active infection.

Red cells

Normal: 0–2 per HPF.

• Raised: stones, infection, trauma, kidney disease. Needs evaluation if persistent.

Epithelial cells

A few squamous epithelial cells are normal (from the lining of urethra and external genitalia). Many suggest a contaminated sample — collect again.

Casts

Microscopic cylinders formed in kidney tubules. Different types suggest different problems:

• Hyaline casts — normal in small numbers
• Granular casts — kidney injury
• Red cell casts — bleeding from the kidney itself
• White cell casts — kidney infection (pyelonephritis)

Crystals

Several types occur normally; some flag specific problems:

• Calcium oxalate — may suggest stone formation tendency
• Uric acid — sometimes seen in gout
• Cystine — rare metabolic disorder

Bacteria

A small number is often contamination. Many bacteria with raised white cells confirm UTI — proceed to urine culture for identification.

When this test matters

Standard situations:

• UTI symptoms: burning, frequency, urgency — first test always.
• Annual screening in diabetics: catches both UTI and early kidney damage.
• Investigation of unexplained fever: UTI is a common silent cause.
• Pre-operative workup.
• Pre-employment medicals.
• Pregnancy: urinary infections are common and need prompt treatment.
• Suspected kidney stones: blood + crystals are clues.

When you need urine culture instead

A urine routine is a screening test. If it shows infection, the next step is urine culture and sensitivity — which identifies the exact bacteria and tells your doctor which antibiotic will work. Always do a culture before starting antibiotics for:

• Recurrent UTIs (3 or more in a year)
• UTIs that haven't responded to first-choice antibiotics
• UTIs in pregnancy
• UTIs in diabetics

Bottom line

The urine routine is cheap, fast, and surprisingly informative. Pay attention to glucose, protein, blood, white cells, and nitrites — these five lines catch the most important things. Repeat any positive in a clean re-collection before concluding it's a real abnormality.

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Urine Routine & Microscopy

Same day₹300₹200

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Urine Culture & Sensitivity

48-72 hours₹700₹500

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Kidney Function Test (KFT)

Same day₹900₹600