What it is: A urine acetone (ketone) test checks for ketones — byproducts of fat breakdown — in a urine sample, usually as part of a broader dipstick urinalysis.
Why it's ordered: Most often ordered to check for diabetic ketoacidosis in people with diabetes, or to evaluate starvation, very low-carbohydrate diets, prolonged vomiting, or illness affecting nutrition.
What it detects: Ketones aren't normally present in urine. They appear when the body burns fat for energy instead of glucose, which happens with inadequate insulin, inadequate carbohydrate intake, or significant illness.
Collection & prep: A urine sample collected in a clean container, tested with a dipstick that changes color based on ketone concentration. No special preparation is required.
Results:
Positive – ketones present; in someone with diabetes and high blood sugar, this raises concern for diabetic ketoacidosis, a medical emergency
Negative – no significant ketones detected
Possible complications of ketone buildup: In people with diabetes, a positive ketone result combined with high blood sugar and symptoms like nausea, abdominal pain, or rapid breathing needs urgent medical attention, since diabetic ketoacidosis can be life-threatening if untreated.
What it is: A urine bacteria check, seen on microscopic urinalysis or confirmed by urine culture, looks for bacteria in a urine sample as a sign of possible infection.
Why it's ordered: Ordered when symptoms suggest a urinary tract infection (painful or frequent urination, urgency, cloudy or foul-smelling urine) or as part of routine prenatal or pre-surgical screening.
What it detects: Bacteria in urine can indicate infection of the bladder, urethra, or kidneys; a urine culture identifies the specific bacteria and guides antibiotic selection, since bacteria are also frequently seen with sample contamination (especially with high squamous epithelial cells).
Collection & prep: A clean-catch, midstream urine sample is preferred to reduce contamination; the sample should be tested promptly, since bacteria can multiply in urine left standing at room temperature.
Results:
Positive with symptoms – supports a urinary tract infection diagnosis, especially alongside positive nitrites and white blood cells
Positive without symptoms – may reflect contamination or asymptomatic bacteriuria, which isn't always treated
Negative – no bacteria seen
Possible complications of an untreated UTI: An infection that spreads from the bladder to the kidneys can become more serious; when infection is suspected, a urine culture is typically ordered to confirm the organism and choose the right antibiotic.
What it is: A urine bilirubin test checks for bilirubin, a byproduct of red blood cell breakdown normally processed by the liver, in a urine sample as part of a dipstick urinalysis.
Why it's ordered: Ordered to help evaluate suspected liver or bile duct disease, especially when jaundice or other liver symptoms are present.
What it detects: Only conjugated (direct) bilirubin, which is water-soluble, appears in urine. Its presence suggests liver dysfunction or bile duct obstruction and should prompt further investigation of hepatobiliary disease.
Collection & prep: A urine sample collected in a clean container, tested with a dipstick. No special preparation is required.
Results:
Positive – suggests liver or bile duct dysfunction; typically prompts liver function blood tests
Negative – bilirubin not detected, which is the normal finding
Possible complications of liver/bile duct dysfunction: A positive urine bilirubin result is a useful early clue but isn't diagnostic on its own; it's typically followed up with blood-based liver function tests and imaging to identify the underlying cause.
What it is: A urine occult blood test checks for blood, whether visible or microscopic, in a urine sample using a dipstick that reacts to hemoglobin.
Why it's ordered: Ordered as part of routine urinalysis or to evaluate symptoms like flank pain, suspected kidney stones, urinary tract infection, or unexplained urinary symptoms.
What it detects: A positive dipstick can reflect actual red blood cells in the urine (from infection, kidney stones, trauma, or, rarely, cancer) or free hemoglobin/myoglobin without intact cells, which microscopic exam helps distinguish.
Collection & prep: A urine sample collected in a clean container, tested with a dipstick. No special preparation is required, though menstruation can cause a false-positive result.
Results:
Positive – warrants microscopic confirmation of red blood cells and further evaluation for the source
Negative – no significant blood detected
Possible complications of persistent blood in urine: Unexplained or recurring positive results are typically followed up with imaging or further urine testing, since causes range from minor infection to more serious kidney or bladder conditions.
What it is: A urine epithelial cells check, part of the microscopic portion of a urinalysis, looks at cells shed from the lining of the urinary tract (bladder, urethra) or, in women, the vagina.
Why it's ordered: Not ordered as a standalone test — it's part of routine microscopic urinalysis used to evaluate suspected urinary tract infection, inflammation, or to check whether a urine sample was properly collected.
What it detects: A small number of epithelial cells is normal. Squamous epithelial cells usually indicate the sample was contaminated during collection (from skin or vaginal tissue) rather than a urinary problem; elevated transitional or renal tubular epithelial cells can suggest infection, inflammation, or, rarely, malignancy.
Collection & prep: A urine sample collected in a clean container; a clean-catch, midstream technique reduces contamination and false findings. No special preparation is required.
Results:
High squamous cells – usually indicates sample contamination; may prompt a repeat, more carefully collected sample
High transitional/renal tubular cells – can suggest infection, inflammation, or a urinary tract problem needing further evaluation
Normal (few epithelial cells) – expected finding in a properly collected, healthy sample
Possible complications: Epithelial cell counts are mainly used to judge sample quality and support other urinalysis findings rather than to diagnose a condition on their own.
What it is: A urine glucose test checks for glucose (sugar) in a urine sample, as part of a dipstick urinalysis.
Why it's ordered: Ordered as part of routine urinalysis or to help evaluate suspected diabetes or gestational diabetes, though blood glucose and HbA1c tests are the primary tools for diagnosis today.
What it detects: Glucose isn't normally present in urine. It appears when blood glucose exceeds roughly 180–200 mg/dL, overwhelming the kidneys' ability to reabsorb it — most often from uncontrolled diabetes, though certain rare kidney disorders and SGLT-2 diabetes medications can also cause it.
Collection & prep: A urine sample collected in a clean container, tested with a dipstick. No special preparation is required.
Results:
Positive – suggests elevated blood glucose; typically prompts blood glucose or HbA1c testing to evaluate for diabetes
Negative – no significant glucose detected, which is the normal finding
Possible complications of uncontrolled diabetes: Persistent glucose in the urine reflects poorly controlled blood sugar, which over time raises the risk of nerve, kidney, eye, and cardiovascular damage if not addressed.
What it is: A urine nitrite test checks for nitrites in a urine sample, produced when certain bacteria convert urinary nitrates into nitrites, as part of a dipstick urinalysis.
Why it's ordered: Ordered to help screen for a urinary tract infection (UTI), typically alongside leukocyte esterase and urine microscopy, when symptoms like painful or frequent urination are present.
What it detects: A positive nitrite result suggests bacteria capable of this conversion (commonly E. coli) are present in the urinary tract, though not all UTI-causing bacteria produce nitrites, so a negative result doesn't rule out infection.
Collection & prep: A urine sample collected in a clean container, ideally a first-morning or held sample, since nitrites need time to form in the bladder. No special preparation is required.
Results:
Positive – suggests a bacterial urinary tract infection, especially alongside positive leukocyte esterase
Negative – doesn't rule out infection, since some bacteria don't produce nitrites
Possible complications of an untreated UTI: Left untreated, a lower urinary tract infection can spread to the kidneys, causing a more serious infection; a positive nitrite result combined with symptoms usually leads to a urine culture to confirm the bacteria and guide antibiotic choice.
What it is: A urine protein test checks for protein, particularly albumin, in a urine sample, either via dipstick or a more precise urine protein-to-creatinine ratio.
Why it's ordered: Ordered to screen for kidney disease, especially in people with diabetes or high blood pressure, or to evaluate swelling, foamy urine, or other symptoms suggesting kidney involvement.
What it detects: Healthy kidneys keep most protein in the blood rather than letting it pass into urine. Protein in the urine (proteinuria) suggests the kidney's filtering units aren't working properly, letting protein leak through.
Collection & prep: A urine sample collected in a clean container, or sometimes a 24-hour collection for a more precise quantitative measurement. No special preparation is typically required for a standard dipstick.
Results:
Positive – suggests kidney damage; dipstick becomes positive once protein exceeds roughly 300–500 mg/day
Negative – doesn't rule out smaller amounts of protein loss (microalbuminuria), which the standard dipstick isn't sensitive enough to detect
Possible complications of kidney damage: Ongoing significant proteinuria is associated with progressive kidney disease; positive results are usually followed by a more precise urine albumin-to-creatinine ratio and blood kidney function tests to assess severity.
What it is: A urine red blood cell (RBC) check, part of microscopic urinalysis, looks for red blood cells in urine sediment under a microscope, confirming true hematuria (blood in urine).
Why it's ordered: Ordered when a dipstick screen is positive for blood, or to evaluate symptoms like visible blood in urine, flank pain, or suspected kidney or bladder disease.
What it detects: If the dipstick is positive for blood but no RBCs are seen under the microscope, it may indicate myoglobin or hemoglobin in the urine rather than intact red cells (from muscle breakdown or a blood disorder) instead of true urinary bleeding.
Collection & prep: A urine sample collected in a clean container, centrifuged to concentrate the sediment before microscopic examination. No special preparation is required.
Results:
Elevated (typically >3 RBCs/high-power field) – confirms hematuria; can reflect infection, kidney stones, trauma, or, less commonly, cancer
Normal – few or no red blood cells seen
Possible complications of persistent hematuria: Ongoing or unexplained blood in the urine warrants further evaluation — such as imaging or cystoscopy — since causes range from benign (minor infection) to serious (kidney or bladder disease).
What it is: A urobilinogen test checks for urobilinogen, a breakdown product of bilirubin produced in the intestines, in a urine sample as part of a dipstick urinalysis.
Why it's ordered: Ordered as part of routine urinalysis or to help evaluate suspected liver disease or conditions causing excess red blood cell breakdown (hemolysis).
What it detects: A small amount of urobilinogen is normally present in urine. Elevated levels can suggest hemolysis or liver dysfunction, while notably decreased or absent urobilinogen can suggest bile duct obstruction preventing bilirubin from reaching the intestines.
Collection & prep: A urine sample collected in a clean container, tested with a dipstick. No special preparation is required.
Results:
Elevated – may indicate hemolysis or liver dysfunction
Absent/very low – may indicate bile duct obstruction
Normal (trace amounts) – expected finding
Possible complications of the underlying condition: Abnormal urobilinogen is usually interpreted alongside urine bilirubin and blood liver function tests, since urobilinogen alone doesn't distinguish between a liver, bile duct, or blood-related cause.
Statements made in the Clinical Manual have not been evaluated by the FDA. The products mentioned are not intended to diagnose, treat, cure or prevent any disease.
