Complete Urine Analysis (CUE)

What is the Urine routine test?

Urine routine parameters18 measured

1. Colour

   Pale yellow

   The shade of the urine, paler with good hydration, darker when dehydrated, and orange, red or brown with bile, blood or certain foods and medicines

2. Appearance

   Clear

   Whether the urine is clear or cloudy, turning hazy with infection, pus, crystals or mucus

3. pH

   5–8

   How acidic or alkaline the urine is, more acidic with a meat-heavy diet or dehydration and more alkaline with vegetarian diets or some urinary infections

4. Specific gravity

   1.005–1.03

   How concentrated the urine is, high when dehydrated and low when drinking plenty or when the kidneys lose their ability to concentrate

5. Protein (dipstick)

   Nil

   Checks for protein leaking into the urine, normally absent, appearing with kidney damage, high blood pressure, infection or after heavy exercise

6. Glucose (dipstick)

   Nil

   Checks for sugar spilling into the urine, normally absent, appearing when blood sugar climbs high enough that the kidneys cannot hold it back

7. Ketones

   Nil

   Checks for ketones, the by-products of burning fat for fuel, appearing with fasting, low-carbohydrate diets or poorly controlled diabetes

8. Bilirubin (urine)

   Nil

   Checks for bilirubin in the urine, normally absent, appearing when bile is blocked or the liver is inflamed, often before jaundice is visible

9. Urobilinogen

   Normal

   A breakdown product of bilirubin normally present in small amounts, rising with liver disease or red cell breakdown and absent when bile is fully blocked

10. Nitrite

    Negative

    Checks for nitrite, which many bacteria produce in the bladder, a positive result pointing to a urinary tract infection

11. Leukocyte esterase

    Negative

    Checks for an enzyme released by white cells, a positive result suggesting the body is fighting infection somewhere in the urinary tract

12. Blood (dipstick)

    Nil

    Checks for blood in the urine, normally absent, appearing with infection, kidney stones, menstruation, heavy exercise or kidney disease

13. Pus cells

    up to 5 /hpf

    White cells seen under the microscope, few in healthy urine and rising with urinary infection or inflammation of the kidneys or bladder

14. RBCs (urine)

    up to 2 /hpf

    Red blood cells seen under the microscope, rising with stones, infection, kidney inflammation or contamination from a period

15. Epithelial cells

    up to 5 /hpf

    Cells shed from the lining of the urinary tract, a few being normal and many suggesting the sample was contaminated or the lining is inflamed

16. Casts

    Nil

    Tiny moulds of protein or cells formed inside the kidney tubules, usually absent and appearing with kidney inflammation or damage

17. Crystals

    Nil

    Mineral crystals in the urine, often harmless after concentrated or cooled samples, but recurring types point to a tendency to kidney stones

18. Bacteria

    Nil

    Germs seen under the microscope in the urine, normally absent and appearing with a urinary tract infection or a contaminated sample

Reference ranges are the lab's defaults for adults and are printed on the report beside every value

How to prepare

• No fasting is needed.
• Give the first urine of the morning if you can; it is the most concentrated and most informative.
• Wash your hands and the genital area, pass a little urine into the toilet, then collect the middle of the stream in the container.
• If you are menstruating, tell the phlebotomist; blood from the period will show up in the sample, so the test may be postponed.

Who should take it

Anyone with burning, urgency, frequent urination, lower abdominal or flank pain, or cloudy or foul-smelling urine. People with diabetes or high blood pressure, at least once a year. Pregnant women at each antenatal visit. Anyone who has seen blood in the urine, or has a history of kidney stones. Children with unexplained fever. People with swelling of the feet or face, which can mean protein loss. It is part of most pre-surgery and annual health checks.

Before the visit

Tell your doctor if you have taken antibiotics in the past few days, as they can mask an infection. Vitamin C, beetroot, rifampicin and some painkillers change the colour or dipstick readings.

Why take the Urine routine test?

• Burning or frequent urination: The commonest reason, and the test usually settles whether it is an infection.
• Diabetes or high blood pressure: Protein in the urine is the earliest sign the kidneys are affected.
• Pregnancy: Checked at every antenatal visit for infection, protein and sugar.
• Blood in the urine: Even a single episode needs a microscopy to count red cells and look for casts.
• Before surgery or as part of a health check: A cheap, wide screen of kidney and metabolic health.

Questions about the Urine routine test