How to read a urinalysis
Other platforms explain it with text and video. In VMS you practice it on the patient.
A urinalysis is cheap and fast and can point to infection, kidney disease, diabetes and dehydration. The key is reading it together with the patient's symptoms.
Step by step
Check how it was collected
A midstream clean-catch sample is best. Many skin cells (squamous epithelial cells) mean the sample is contaminated. [1]
Look at color and concentration
Dark urine with a high specific gravity suggests dehydration. Red or brown urine needs a check for blood or muscle breakdown. [2]
Read the dipstick
Protein can mean kidney damage. Glucose suggests high blood sugar. Ketones suggest fasting or ketoacidosis. [2]
Check blood
A positive blood test with no red cells on microscopy suggests myoglobin from muscle breakdown or free hemoglobin. [2]
Check for infection signs
Leukocyte esterase shows white cells. A positive nitrite suggests bacteria such as E. coli. [2]
Look at microscopy and casts
Red cell casts suggest glomerulonephritis, white cell casts suggest pyelonephritis or kidney inflammation, and muddy brown casts suggest acute tubular injury. [2]
Match to symptoms
Treat a urinary infection when there are symptoms. Bacteria without symptoms usually need no antibiotics, except in pregnancy or before some urologic procedures. [1]
Common errors
- Treating bacteria in the urine of a patient with no symptoms.
- Ignoring a contaminated sample full of skin cells.
- Missing a positive blood dipstick with no red cells (possible muscle breakdown).
Typical adult results; use your lab's ranges [2]
| Test | Typical normal | Abnormal can suggest |
|---|---|---|
| Specific gravity | 1.005 to 1.030 | High: dehydration; fixed low: kidney concentrating problem |
| pH | 4.5 to 8 | Persistently high: some infections or stones |
| Protein, glucose, ketones, blood | Negative | Kidney disease, diabetes, ketosis, bleeding |
| Nitrite and leukocyte esterase | Negative | Urinary infection |
| White cells | 0 to 5 per high-power field | Infection or inflammation |
| Red cells | 0 to 2 per high-power field | Stones, infection, tumor, kidney disease |
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); NCCPA PANCE Content Blueprint. VMS is not affiliated with these organizations. Updated: 2026-10-11.