What this test measures
A Routine Examination of Urine combines three tiers of analysis. (1) Physical: colour, appearance (clear or turbid), specific gravity. (2) Chemical (dipstick): pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leucocyte esterase. (3) Microscopic: red cells, white cells, epithelial cells, casts, crystals, bacteria, yeast.
Together the report gives a quick snapshot of urinary tract health, kidney function, hydration, diabetic control, and pregnancy-related issues — all from a single mid-stream urine sample.
Why it matters
A urine R/E is one of the most useful low-cost screening tests in clinical practice. It picks up urinary tract infections (the most common adult bacterial infection), early diabetic nephropathy (proteinuria before serum creatinine changes), diabetes itself (glycosuria), kidney stones (haematuria, crystalluria), pregnancy (specific gravity, hCG indirect cues), dehydration (high specific gravity), liver disease (urobilinogen, bilirubin), and uncontrolled diabetes (ketonuria). Annual urine R/E is standard during pregnancy, in diabetes, in hypertension, and as part of any health check.
How to prepare
Collect a clean mid-stream urine sample in the morning if possible (the first urine of the day is most concentrated and informative). Clean the genital area before collection to reduce contamination. Avoid testing during menstruation (blood interferes with the result). Mention any antibiotics in the past week — they can suppress UTI markers. Vitamin C supplements can interfere with dipstick chemistry.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Protein (Dipstick) (mg/dL)[1] | Negative or trace | Normal. | 1+ or higher: proteinuria. Causes: kidney disease (diabetic nephropathy, glomerulonephritis), urinary tract infection, dehydration, vigorous exercise, fever. Persistent proteinuria warrants a urine albumin-creatinine ratio (UACR) and KFT. |
| Glucose (Dipstick) (mg/dL) | Negative | Normal. | Glycosuria: uncontrolled diabetes (when blood glucose > 180 mg/dL the kidneys cannot reabsorb it all), rarely renal glycosuria (low renal threshold), pregnancy (lower threshold). Always pair with a blood glucose / HbA1c. |
| Ketones (Dipstick) (—) | Negative | Normal. | Ketonuria: fasting, vomiting, very low-carb diet, uncontrolled diabetes (particularly type 1 — diabetic ketoacidosis can be life-threatening), pregnancy with hyperemesis. Ketones with hyperglycaemia (>250) — urgent evaluation. |
| Nitrite + Leucocyte Esterase (—) | Negative | Normal. | Both positive — strongly suggests urinary tract infection (gram-negative organisms like E. coli convert nitrate to nitrite; white cells release leucocyte esterase). Pair with urine culture for organism + sensitivity if symptomatic. Leucocyte esterase positive with nitrite negative — sterile pyuria (consider TB, fastidious organisms, recent antibiotics). |
| Microscopy — RBCs (/HPF) | 0 – 2 per high power field | Normal. | > 5 RBCs/HPF: haematuria. Causes: urinary tract infection, kidney stones, glomerular disease, trauma, anticoagulants, bladder / kidney cancer, recent exercise, menstrual contamination. Persistent unexplained haematuria warrants ultrasound / cystoscopy. |
| Microscopy — WBCs (/HPF) | 0 – 5 per high power field | Normal. | > 5 WBCs/HPF: pyuria — usually urinary tract infection. Sterile pyuria (WBCs with negative culture) → consider TB, recent antibiotics, fastidious organisms, interstitial cystitis. |
Common Urine R/E patterns
| Pattern | Likely cause |
|---|---|
| Nitrite + LE + bacteria + WBCs | Bacterial urinary tract infection (most often E. coli) |
| Glucose +, ketones +/– | Uncontrolled diabetes; pair with HbA1c |
| Protein 1+/2+ persistent | Early diabetic nephropathy, glomerular disease; do UACR + KFT |
| RBCs only, no infection | Kidney stone, glomerular disease, trauma, anticoagulants, malignancy |
| High specific gravity, dark colour | Dehydration |
| Low specific gravity, pale colour | Over-hydration, diabetes insipidus, CKD |
| Bilirubin + / urobilinogen ↑ | Hepatobiliary disease — pair with LFT |
Frequently asked questions
How do I collect a urine sample correctly?
Use the mid-stream technique: clean the genital area with soap and water (or wet wipes), pass the first part of the urine into the toilet, then catch the middle of the stream in the sterile container provided by the lab. Aim for at least 30 mL. Morning urine (the first of the day) is most concentrated and informative.
Should I collect during menstruation?
No — menstrual blood contaminates the sample and produces false-positive haematuria. Reschedule for after the period ends, ideally 3 days after.
My urine has a faint trace of protein — should I worry?
Trace protein on a one-off dipstick can be normal (after exercise, dehydration, fever, or stress). Persistent protein on repeated tests warrants a Urine Albumin-Creatinine Ratio (UACR) and a KFT to check for early kidney disease.
I have UTI symptoms but my urine R/E is normal — what next?
If you have classic symptoms (burning, frequency, urgency, lower abdominal pain) but the dipstick is negative, do a urine culture anyway — some organisms (fastidious or partially treated) are missed by the dipstick. Hydrate well and contact your doctor.
What does "epithelial cells +++" mean?
Epithelial cells are normally present in small numbers from the bladder and urethra lining. A very high count suggests inadequate cleaning before collection (contamination from genital skin) rather than disease. Recollect a fresh mid-stream sample with proper cleaning.
Can Vitamin C affect the urine test?
Yes — high-dose vitamin C can give false-negative results for blood, glucose, nitrite and bilirubin on the dipstick. If you take vitamin C supplements, mention this; ideally stop them 24 hours before testing.
How often should I do a urine R/E?
Annually as part of a routine health check; every trimester in pregnancy; every 6 months if you have diabetes or hypertension; whenever symptoms (burning, frequency, abdominal pain, dark urine) appear.
Related Microbiology / Urine / Stool tests
Tests commonly ordered alongside Routine Examination Urine, or that help interpret an unexpected result.
Sources & references
- NIH MedlinePlus — Urinalysis · accessed 2026-05-29T00:00:00.000Z
- NCBI StatPearls — Urinalysis · accessed 2026-05-29T00:00:00.000Z
- American Family Physician — Urinalysis · accessed 2026-05-29T00:00:00.000Z
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