Interpretation of results
Leukocytes
Leukocytes (white blood cells) are the cells of the immune system that are involved in protecting the body against both infectious diseases and foreign invaders. A few white blood cells are normally present in urine and generally yield negative results. When the number of WBCs in urine increases significantly, this screening test will become positive. The presence of leukocytes (>10 cacells/uL) in urine may indicate infections in the urinary tract or kidneys.
Leukocytes in urine signify inflammation in the urinary tract. Clinical studies show that the leukocyte counts in urine increase when the body is fighting an infection.
The leukocyte reagent pad is nearly white or a shade of cream for a negative result.
For trace levels of leukocytes in urine, the reagent pad changes to a beige/brown color.
The reagent pad changes to a shade of purple for a positive result. The color strength is proportional to the concentration of leukocytes in urine, as shown in the image below.
Click on this link to learn more about Leukocytes in Urine in this blog.
Nitrite
Normal urine contains chemicals called nitrates. If bacteria enter the urinary tract, nitrates can turn into different, similarly named chemicals called nitrites. Nitrites in urine may be a sign of a urinary tract infection (UTI). To detect UTI, the presence of leukocytes in urine is also considered. UTI can be present despite a negative Nitrite test (not all bacteria reduce nitrate to nitrite).
Nitrite in urine test is used to check bacteriuria, i.e., bacterial activity in the urine caused by nitrate-reducing bacteria.
The nitrite reagent pad yields a white to off-white color for a negative result. If the nitrite test is positive, the color changes to pink. Any shade of pink is considered a positive result for bacteria in the urine.
Click on this link to learn more about nitrite in urine.
Urobilinogen
Urobilinogen is formed from the reduction of bilirubin. Bilirubin is a yellowish substance found in the liver that helps break down red blood cells. Normal urine contains some urobilinogen (up to 1.0 mg/dL). If there is little or no urobilinogen in urine, it can mean the liver isn't working correctly. Too much urobilinogen (> 2 mg/dL) in urine may indicate liver diseases such as hepatitis or cirrhosis.
The color of the reagent pad will produce a light cream/peach to peach color for normal urobilinogen levels in the urine. Higher levels of urobilinogen in urine will produce a pink color on the reagent pad. Higher the level, the brighter the shade of pink, as shown in the image below.
Click this link to learn about urobilinogen in urine and its relationship to liver health.
Protein
A protein in urine test measures how much protein is in your urine. Proteins are substances that are essential for the body to function properly. Protein is normally found in the blood. If there is a problem with the kidneys, protein can leak into the urine. While a small amount is normal, a large amount of protein in the urine may indicate kidney disease. When urine protein is elevated, a person has a condition called proteinuria. Persistently elevated protein levels in urine can result from urological or nephrological disorders and require medical intervention.
Protein in the urine can be caused by several factors – follow this link to learn about the causes of protein in the urine.
The reagent pad changes to a light green color for a negative result.
For a positive urine protein result, the color of the reagent pad changes into darker shades of green. The intensity of the color is proportionate to the protein concentration in the urine (darker shades of green correspond to the higher concentration of protein).
Protein in urine is linked to several diseases. Lifestyle changes can help manage protein in the urine.
pH
A urine pH test measures the level of acid in urine. Normal urine is slightly acidic, with pH values ranging from 5 to 8. A high urine pH (>8) indicates alkaline urine and may be due to kidneys that do not properly remove acids from the body or due to kidney failure, stomach pumping (gastric suction), urinary tract infection, or vomiting. A low urine pH may be due to diabetic ketoacidosis, diarrhea, starvation, and too much acid in the body fluids (metabolic acidosis). Urinary pH is a vital indicator of kidney, gastrointestinal, respiratory, and metabolic health.
Urine pH can also help determine how effectively kidneys regulate the pH balance in the body. It is vital to know that pH alone cannot provide all answers to bodily function; when combined with other urine parameters, it helps diagnose several health conditions.
The reagent pad changes from orange for acidic urine to shades of green for alkaline urine, as shown in the color key below.
Learn about what to make of the pH of urine in this blog.
Blood
Blood in the urine is also known as hematuria and may be a sign of possible kidney damage, infection, kidney or bladder stones, kidney or bladder cancer, or blood disorders. Blood is often, but not always, found in the urine of menstruating females.
Blood in the urine is not a normal finding, but it is not uncommon and not necessarily a cause for alarm for acute episodes. Persistently elevated blood in urine requires professional evaluation. To devise a proper treatment plan, your healthcare practitioner will determine the source and underlying cause.
The test pad for blood will produce a yellow color for a negative result. The reagent pad will turn a shade of green for a positive result. Higher the concentration of blood in urine, the deeper the color on the reagent pad. If you see green spots on a yellow pad, it represents intact blood cells. Learn more about green spots on the blood test pad here.
Specific Gravity
Urine specific gravity is a measure of the concentration of all chemical particles in the urine.
Healthy adults have urine specific gravity ranging from 1.003 to 1.030. Reduced specific gravity may indicate diabetes and other renal disorders, while elevated levels indicate liver disease, excessive loss of free water, or congestive heart failure. A higher-than-normal concentration often is a result of not drinking enough fluids. In addition to knowing the body's hydration status, by monitoring the specific gravity of urine, you can learn how effectively kidneys regulate the fluid and electrolyte balance in the body.
The reagent pad changes to a dark green color for dilute urine. The urine pad color changes to yellowish green for higher urine concentrations.
Ketones
Ketones are chemicals (a type of acid) made in our liver. Everyone has them, but they are more prevalent in people who fast or are on low-carb/high-fat diets or individuals with chronic conditions like diabetes that inhibit the body's ability to produce sufficient insulin. The presence of ketones in urine can mean very different things to people with different conditions.
Ketones are produced when the body burns fat for energy or fuel. They are also produced when you lose weight or if there is not enough insulin to help your body use sugar for energy. Ketones are not normally found in the urine. They can form when a person does not eat enough carbohydrates (for example, in cases of fasting, starvation, or high-protein diets) or when a person's body cannot use carbohydrates properly. When carbohydrates are not available, the body metabolizes fat instead to get the energy it needs to keep functioning.
If you are on a ketogenic diet, detecting ketones in the urine is indicative of a metabolic state called ketosis which leads to weight loss and fat burning.
Increased ketone levels are a sign of insufficient insulin and are found in diabetes, starvation, vomiting, digestive disorders, pregnancy, and febrile states. Ketones in urine in diabetes require prompt medical intervention to prevent complications, such as diabetic ketoacidosis (DKA).
The reagent pad on the urine test strip yields a peach color for a negative ketone result. The color of the reagent pad changes to deeper shades of pink and purple depending on the concentration of ketones in the urine, as shown in the color key below.
Learn more about ketones in urine and ketone test strips in this blog.
Bilirubin
Bilirubin is a yellowish pigment found in bile, a fluid produced by the liver. Bilirubin is not present in the urine of normal, healthy individuals. Increased bilirubin levels ((Bilirubinuria) indicate different forms of liver disease, e.g., cirrhosis, hepatitis, gallstone, biliary tract disease, and is an early indicator of jaundice development. Even trace amounts of bilirubin are sufficiently abnormal to require further investigation.
For a negative bilirubin in urine result, the reagent pad will yield a cream to light-yellow color.
Any shade of peach, pink, purple, or brown indicates a positive result for bilirubin in urine. The color intensity of the reagent pad increases with the concentration of bilirubin in urine.
Learn more about bilirubin in the urine and how it relates to liver health in this blog.
Glucose
Glucose is normally not present in urine. When glucose is present, the condition is called glucosuria. This often happens if there is an abnormally high level of glucose present in the blood. The normal glucose range in urine is 0 to 0.8 mmol/l (0 to 15 mg/dL). Higher values may occur with diabetes, renal glycosuria, or during pregnancy (due to gestational diabetes).
A negative result for glucose in the urine is indicated by a bright blue or aqua-green color. Trace to small amounts of glucose in urine yields a dull green color, whereas higher concentrations change the pad color to brown.
Learn more about glucose in urine in this blog.
What factors can affect urine test results?
Factors such as medications, supplements, vitamins, and diets, can interact with the reagent pads and affect the readings.
It is essential to know that urinalysis strips are semi-quantitative, which means the colors produced by the strip may not be a 100% match with the color key. In such cases, find the closest color possible for colors that fall in-between two color blocks.
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Use the Urinox app on Apple App Store or Google Play Store to record, track, and share your urinalysis data easily. You can view trends in your data in graphical format and share them with your medical professional if required.
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