Understanding Urine Test

Most people have already had a urine sample taken at some point in their
life. A urine sample is needed for a urine test, which is used for instance to
check for a particular disease or to monitor its progress. Using a urine test
strip can already give an indication of a urinary tract infection, for example.
In this fact sheet we explain the different urine tests, what they can test,
and what the results can mean.

What does the quality of the urine tell us?

That urine is eliminated, is very important for different bodily functions.
On the one hand, it regulates the balance of water in the body. On the other,
substances are released along with the urine that are produced during
metabolism and are no longer needed by the body. These also include toxic substances,
which may have been absorbed from food, or medicines. You can read more about
how our urinary system works here. By examining urine, indications for diseases
of the urinary system can be detected. And a urine test can also provide
evidence of metabolic diseases like diabetes or liver disease.
The color, odor and amount of urine can already help to find out whether
something is wrong. If someone passes very little and very dark urine, it may
indicate that he or she has not had enough fluids – or that the kidneys no
longer function properly. Cloudy or flaky urine can indicate a urinary tract
infection. If the urine is reddish in color, blood in the urine may be the
reason. To find out more, laboratory testing is needed. But urine tests are
usually just one of several possible tests that can be done to diagnose or rule
out diseases.
How do you take a urine sample?
Because urine can easily be contaminated with bacteria, cells and other
substances it is a good idea to clean the genital area with water before the
test – but without soap. To get a good result and avoid contamination with
external bacteria, “clean” midstream urine is used for a urine test: urine is
considered to be midstream when the first portion of the urine stream is not
used, and only the middle part of the urine is caught in a cup. If there is
anything else to be careful about for your specific test your doctor will tell
What do the results tell us?
Where the results lie – inside of the reference range or abnormal – can be
determined using the package insert or the color chart on the package. The pH
value, for example, can be used to find out whether there is an increased risk
of developing urinary stones. This is the case for acidic values, meaning
values below 5. A pH value over 7 can indicate a bacterial urinary tract
infection. Other results can help find other problems:
  • High protein levels can indicate
    an inflammation of the kidneys,
  • Ketone and sugar in the urine are
    signs of uncontrolled diabetes mellitus and
  • Leukocytes and nitrite in the
    urine can indicate a bacterial infection.

If the results are abnormal you need to speak with a doctor. But as is the
case with all tests, urine tests do not always produce reliable results. For
this reason, it might be a good idea to have a more detailed test done at the
Rapid urine test – What is a rapid urine test?
A rapid urine test is – as the name says – the quickest way of examining
urine. A test strip that has small square color fields is dipped into the urine
for a few seconds. After that you will have to wait a little for the result.
Depending on the concentration of the particular substance, the fields on the
test strip change color. Then the resulting color of the fields is compared
with a color table. The color table is printed on the urine test package. It
shows which colors indicate normal and deviating values.
In a rapid urine test, a test strip is dipped into the urine and then
compared with the color fields on the packaging.
What can be tested with a rapid urine test?
“Reference: negative” means that a substance is not normally found in
urine. Other substances are usually found only in a certain amount, so a
different concentration indicates a deviation from the norm. The following
substances can be checked using a rapid urine test:
  • pH value – The pH is a measure of how acidic or alkaline (basic) the urine
    is. A urine pH of 4 is strongly acidic, 7 is neutral (neither acidic nor
    alkaline), and 9 is strongly alkaline. Sometimes the pH of urine is affected by
    certain treatments.  (reference : 5 to 7;
    depending on diet)
  • Protein – Protein is normally not found in the urine. Fever, hard exercise,
    pregnancy, and some diseases, especially kidney disease, may cause protein to
    be in the urine (reference: negative)
  • Glucose (Sugar) – Glucose is the type of sugar found in blood. Normally
    there is very little or no glucose in urine. When the blood sugar level is very
    high, as in uncontrolled diabetes, the sugar spills over into the urine.
    Glucose can also be found in urine when the kidneys are damaged or diseased (reference:
  • Nitrite – Bacteria that cause a urinary tract infection (UTI) make an
    enzyme that changes urinary nitrates to nitrites. Nitrites in urine show a UTI
    is present (reference: negative)
  • Ketone – When fat is broken down for energy, the body makes substances
    called ketones (or ketone bodies). These are passed in the urine. Large amounts
    of ketones in the urine may mean a very serious condition, diabetic
    ketoacidosis, is present. A diet low in sugars and starches (carbohydrates),
    starvation, or severe vomiting may also cause ketones to be in the urine (reference:
  • Bilirubin – Bilirubin is a product of red blood cell breakdown. Normally,
    bilirubin is carried in the blood and passes into your liver, where it’s
    removed and becomes part of bile. Bilirubin in your urine may indicate liver
    damage or disease. (reference: negative)
  • Urobilinogen – This is a substance formed by the breakdown of bilirubin. It
    is also passed from the body in stool. Only small amounts of urobilinogen are
    found in urine. Urobilinogen in urine can be a sign of liver disease (cirrhosis, hepatitis) that the flow
    of bile from the gallbladder is blocked (reference: 0.1 – 1)
  • Red blood cells – Blood cells are not found in urine normally.
    Inflammation, disease, or injury to the kidneys, ureters, bladder, or urethra
    can cause blood in urine. Strenuous exercise, such as running a marathon, can
    also cause blood in the urine.
  • Leukocytes (White blood cells) – WBCs in the urine may mean a UTI is
    present, a sign of infection or kidney disease (reference: negative)
  • Specific gravity – This checks the amount of substances in the urine. It
    also shows how well the kidneys balance the amount of water in urine. The
    higher the specific gravity, the more solid material is in the urine. When you
    drink a lot of fluid, your kidneys make urine with a high amount of water in it
    which has a low specific gravity. When you do not drink fluids, your kidneys
    make urine with a small amount of water in it which has a high specific gravity
    (reference: 1.000)

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