Urine Routine and Microscopy Test: Normal Range and How to Read Your Report

A urine routine and microscopy test (also called urine R/M or urinalysis) checks the colour and clarity of urine, tests it with a chemical dipstick, and then examines a spun sample under a microscope. Normal urine is pale yellow and clear, has a pH around 5 to 7, has no protein, glucose, ketones, blood or nitrite, and under the microscope shows up to about 0 to 5 pus cells and 0 to 2 red cells per high-power field. Results outside these ranges point toward conditions such as urinary infection, kidney disease, diabetes or stones, but a single abnormal result rarely makes a diagnosis.

This guide walks through every section of the report, with typical normal values, what each abnormal finding can mean, how to collect a good sample and what usually happens next.

How to collect the sample

A poor sample gives misleading results, especially for infection.

1. Wash your hands. Clean the genital area with water (front to back for women).
2. Use a sterile container from the lab.
3. Begin urinating into the toilet, then collect the middle part of the stream (a "mid-stream clean catch"), then finish in the toilet.
4. Close the container without touching the inside.
5. Take it to the lab within one to two hours, or keep it refrigerated until it can be delivered.
6. The first morning sample is best, being more concentrated.

Women should try to avoid collecting during menstrual bleeding or note it for the lab, because blood and cells contaminate the sample. Tell the lab about any medicines, vitamin C supplements and recent exercise, which can affect results.

Part 1: Physical examination

| Item | Normal | Notes | |---|---|---| | Colour | Pale yellow to amber | Dark urine suggests dehydration; red or brown suggests blood or certain foods and medicines; very pale suggests overhydration or dilute urine | | Appearance | Clear | Cloudy urine can be due to pus, crystals (especially after standing), mucus or bacteria | | Volume | Not usually reported | Normal is roughly 800 to 2,000 mL a day | | Odour | Mild | Strong smells can follow food (such as asparagus), dehydration or infection |

Colour examples: pink or red (blood, beetroot, some medicines), brown or tea coloured (concentrated urine, bile pigments, liver disease, muscle breakdown), orange (dehydration, some medicines like rifampicin and phenazopyridine), green or blue (dyes, some drugs).

Part 2: Chemical examination (dipstick)

| Test | Normal | What abnormal can mean | |---|---|---| | Specific gravity | 1.005 to 1.030 | High: dehydration, glucose or protein in urine. Low: overhydration, diabetes insipidus, kidney concentration problems | | pH | About 4.6 to 8.0 (usually 5 to 7) | Alkaline: urinary infection with urea-splitting bacteria, vegetarian diet. Acidic: high protein diet, diabetes, dehydration | | Protein | Negative or trace | Kidney disease, fever, strenuous exercise, pregnancy complications, urinary infection | | Glucose | Negative | Diabetes, pregnancy, some kidney conditions | | Ketones | Negative | Fasting, vomiting, uncontrolled diabetes, low-carbohydrate diet | | Blood | Negative | Infection, stones, kidney or bladder disease, menstrual contamination, exercise | | Bilirubin | Negative | Liver or bile duct disease | | Urobilinogen | Normal or trace | High in haemolysis or liver disease; absent in complete bile duct obstruction | | Nitrite | Negative | Positive suggests bacteria, mostly in urinary infection | | Leukocyte esterase | Negative | Positive indicates white blood cells and likely infection or inflammation |

The dipstick is a screen. It can give false results, for example high vitamin C can mask glucose and blood, and dilute urine can hide protein.

Part 3: Microscopy

A small amount of urine is spun, and the sediment is examined. Results are reported as a count per high-power field (hpf).

| Finding | Typical normal | Meaning when raised | |---|---|---| | Pus cells (WBCs) | 0 to 5 per hpf | Urinary tract infection, inflammation, stones, contamination | | Red blood cells | 0 to 2 per hpf (up to about 3 in some labs) | Stones, infection, kidney disease, tumours, trauma, menstruation | | Epithelial cells | Few | Many squamous cells suggest a contaminated sample | | Casts | None, occasional hyaline | Many or abnormal casts suggest kidney disease (see below) | | Crystals | None to few | Many can signal stone tendency; usually harmless | | Bacteria | None to few | Many with pus cells suggests infection | | Yeast | None | Fungal infection, often in diabetes | | Mucus | Few | Usually harmless |

What pus cells mean

A count of 0 to 5 per hpf is normal. Higher numbers suggest inflammation of the urinary tract, most often infection. Women's samples can show more because of vaginal contamination, so a proper clean catch matters. "Sterile pyuria" (pus cells with a negative culture) can occur with tuberculosis of the urinary tract, stones, or recent antibiotics.

What red cells mean

A few red cells can be normal. Persistent blood in the urine (haematuria), visible or microscopic, needs evaluation, particularly in people over 40 or with risk factors such as smoking, because it can be the first sign of stones, infection, kidney disease or, less often, a tumour. Women should repeat the test when not menstruating.

Casts

Casts are moulds of kidney tubules.

• Hyaline casts: can be normal, especially after exercise or dehydration.
• Red cell casts: suggest glomerular disease (inflammation of the kidney filters).
• White cell casts: kidney infection (pyelonephritis) or inflammation.
• Granular and waxy casts: chronic kidney disease or acute tubular injury.

Crystals

Calcium oxalate and uric acid crystals are common and often harmless. Large numbers, with symptoms such as flank pain or blood in urine, can go along with stones. Some rarer crystals point to specific metabolic problems or drugs.

Common patterns

| Pattern | Likely explanation | |---|---| | Pus cells high, nitrite positive, bacteria seen, burning urine | Urinary tract infection; a urine culture confirms the organism and antibiotic choice | | Protein plus swelling and foamy urine | Possible kidney disease; needs urine protein quantification and kidney tests | | Glucose positive | Diabetes or high blood sugar; check blood glucose | | Ketones positive with high glucose | Diabetic ketoacidosis risk; urgent attention | | Red cells with flank pain | Kidney stone | | Red cells without pain | Needs evaluation; ultrasound and other tests | | Many epithelial cells, mixed findings | Contaminated sample; repeat | | Dark urine, bilirubin positive | Liver or bile duct problem; check liver function |

Urine culture: when it is needed

A routine and microscopy test suggests infection but cannot identify the organism or its antibiotic sensitivity. A urine culture, done on a clean sample before antibiotics, does. It is advised for:

• Recurrent urinary infections
• Infections in men, children and pregnant women
• Fever with urinary symptoms
• Treatment failure
• Hospital-acquired infections

Many urinary infections in healthy women are treated on symptoms with a short antibiotic course, and your doctor will decide. Avoid taking leftover antibiotics.

What can affect the result

• Dehydration or overhydration: changes colour, specific gravity and concentration
• Exercise: can cause temporary protein and red cells in urine
• Fever: can cause transient protein
• Menstruation: blood contamination
• Food and drugs: beetroot, vitamin C, rifampicin, antibiotics, contrast dye
• Standing time: old samples grow bacteria and change pH and crystals
• Collection technique: poor technique leads to contamination

What to do after an abnormal report

• Don't panic. Repeat the test with a proper clean-catch sample if the result is unexpected.
• Share symptoms with your doctor, such as burning, frequency, flank pain, fever, swelling and foamy urine.
• Get follow-up tests as advised: culture, blood sugar, kidney function, ultrasound, 24-hour urine protein or spot urine albumin-creatinine ratio.
• Drink enough fluids, unless restricted.
• Don't self-treat with antibiotics.

Frequently asked questions

What is a normal urine routine report?

Pale yellow, clear urine, pH about 5 to 7, specific gravity 1.005 to 1.030, no protein, glucose, ketones, blood, nitrite, with 0 to 5 pus cells and 0 to 2 red cells per hpf.

What do pus cells in urine mean?

More than 5 per hpf suggests infection or inflammation, usually a urinary tract infection. Contamination can also cause it.

What does protein in urine mean?

A trace can be harmless, but persistent protein suggests kidney disease and needs further tests.

Is the urine test done on an empty stomach?

No. The first morning sample is preferred, but fasting is not required.

Can drinking water change the result?

Yes. Excess water dilutes urine and can lower specific gravity and hide mild protein.

What is the difference between urine routine and urine culture?

Routine and microscopy looks for signs of infection and other abnormalities. Culture grows and identifies bacteria and tests antibiotic sensitivity.

Why is my urine foamy?

Occasionally from a strong stream, but persistent foam may signal protein in the urine and should be checked.

When to see a doctor

See a doctor for burning, frequent urination, fever, back pain, blood in the urine, foamy urine, swelling of the face or legs, or a report showing protein, blood or infection. Seek urgent care for fever with shivering and flank pain, vomiting, inability to pass urine or confusion.

Care at Prakash Hospital Noida

Whether you live in Sector 18, Sector 62, Greater Noida West, or anywhere nearby, Prakash Hospital Noida is a trusted name for urology, nephrology and diagnostic services in Noida. Our doctors explain your urine report clearly and arrange the follow-up it needs.

To book a consultation, call the number.

Sources: Standard clinical laboratory references for urinalysis reference ranges. Ranges vary slightly between laboratories; use your lab's printed range.

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