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Urine Routine Test & Microscopy (R/M)

A urine routine test checks your urine for signs of infection, kidney disease, diabetes and other conditions. Here's what every value on your report means.

Written by Suman Konda, Clinical Pharmacist · Based on peer-reviewed sources · Editorial policy · Not medical advice

Last reviewed and updated: · How we check our content

Quick answer

A normal urine routine shows no protein, sugar, ketones, blood, or bacteria. Pus cells run 0 to 5 and red cells 0 to 2 per high power field, with pH 4.5 to 8.0 and specific gravity 1.005 to 1.030. Protein in urine is a warning sign of kidney disease. Pus cells above 5 per field suggest infection.

What is a Urine Routine test?

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A Urine Routine and Microscopy (R/M) test examines your urine in two ways: a dipstick chemical analysis (checking for protein, sugar, blood, pH etc.) and a microscopic examination of the urine sediment (looking at cells, casts and crystals). It is one of the cheapest and most informative tests available, often ordered as a first check for kidney disease, urinary tract infections (UTIs) and diabetes.

Urine Routine Normal Values

ParameterNormal ValueNotes
ColourPale yellow to amberClear, not cloudy
AppearanceClearCloudy may indicate infection
pH4.5 – 8.0Usually 6.0 (slightly acidic)
Specific Gravity1.005 – 1.030Measures urine concentration
ProteinNil / Negative<150 mg/day is normal
Glucose (Sugar)Nil / NegativeShould not be present
KetonesNegativeAbsent in healthy urine
Blood / RBCNegative / 0–2 per HPFHPF = high power field
Pus Cells (WBC)0 – 5 per HPF>5 suggests UTI or inflammation
Epithelial CellsFew / OccasionalMany may indicate contamination
CastsAbsent / Rare hyalineOther casts need investigation
CrystalsNone or rareDepends on type
BacteriaNil / NegativeAny bacteria may signal UTI
Key points
  • Normal: no protein, sugar, ketones, blood, or bacteria; pus cells 0-5, red cells 0-2 per high power field.
  • Protein in urine is a warning sign of kidney disease; a single positive after exercise or fever can be temporary.
  • The protein dipstick is a screening tool: it mainly detects albumin and can be normal despite early kidney damage.
  • Sugar in urine suggests diabetes; blood or casts need investigation.
  • Persistent protein needs a protein-to-creatinine ratio and kidney function tests.

What does PROTEIN in urine mean?

ABNORMAL Protein present (Proteinuria)

Protein in urine (proteinuria) is an important warning sign of kidney disease.1 The kidneys normally filter protein back into the blood. When they're damaged, protein leaks into urine. Causes include diabetic nephropathy, hypertensive kidney disease, glomerulonephritis and pre-eclampsia in pregnancy. A single positive result after heavy exercise or fever may be temporary: a repeat test confirms it. Persistent proteinuria needs further investigation with a urine protein-creatinine ratio and kidney function tests.

What the Protein Dipstick Cannot Tell You

The protein pad on a urine strip is a screening tool, and it is worth knowing what that means in practice: it is designed to be quick and cheap, not to be the final word, and it can be normal in someone who has kidney disease.

Two limitations explain most of the confusion. The strip reacts mainly to albumin at fairly high concentrations, so the small amounts that mark early kidney damage often do not register at all. And it measures concentration rather than quantity, so the same amount of protein looks worse in concentrated morning urine and can disappear in dilute urine after you have drunk a lot of water.

The accuracy has been measured. In a meta-analysis of dipstick testing for proteinuria in pregnancy, a reading of 1+ had a pooled sensitivity of 0.68 and specificity of 0.85, meaning roughly a third of women who genuinely had significant protein were missed by the strip. The authors concluded the dipstick performed poorly at ruling the problem out.2

The test that answers the questionAn albumin-to-creatinine ratio, done on a single urine sample, measures albumin against creatinine and so corrects for how dilute the urine is. It detects the small quantities the strip misses, and it gives a number that can be tracked over time rather than a row of plus signs. If you have diabetes, high blood pressure, or a reduced eGFR, this is the test that should be done.

That ratio matters more than most people are told. In pooled data from over a hundred thousand people, albuminuria predicted mortality independently of eGFR, with no threshold below which it ceased to count.3 A trace of protein on a strip is not something to be reassured about without a proper measurement behind it.

A positive strip is not automatically disease either. Fever, vigorous exercise in the previous day or two, standing for long periods and urinary infection all produce protein that resolves. A single positive result is a reason to repeat the test properly, not a diagnosis.

What does SUGAR (glucose) in urine mean?

ABNORMAL Glucose present (Glycosuria)

Glucose in urine usually means your blood sugar is very high: the kidneys are spilling the excess out. This is common in uncontrolled diabetes. Occasionally people have a low kidney threshold for glucose and spill it even with normal blood sugar (renal glycosuria). If you have glucose in urine, your doctor will check a blood sugar (fasting and post-meal) to rule out diabetes.

What do PUS CELLS in urine mean?

ABNORMAL Pus cells > 5 per HPF (Pyuria)

Pus cells are white blood cells that enter urine when there is infection or inflammation in the urinary tract. More than 5 pus cells per high-power field usually indicates a urinary tract infection (UTI). Common symptoms of UTI include burning on urination, frequent urge to urinate, cloudy or foul-smelling urine. Your doctor will usually order a urine culture to identify the bacteria and choose the right antibiotic.

What does BLOOD (RBC) in urine mean?

ABNORMAL RBC present (Haematuria)

Red blood cells in urine (haematuria) can be visible (red/brown urine: gross haematuria) or only detectable under microscope (microscopic haematuria). Causes range from kidney stones and UTI to glomerulonephritis and rarely kidney cancer. In women, menstrual contamination should be excluded. Any confirmed haematuria needs proper evaluation by your doctor.

What do CASTS in urine mean?

ABNORMAL Cellular or granular casts

Casts are cylindrical particles formed in the kidney tubules. Hyaline casts (few) can be normal. But granular casts, RBC casts, WBC casts and waxy casts all suggest significant kidney disease and need prompt investigation. RBC casts are a classic sign of glomerulonephritis.

Questions to ask your doctor

  • Is the abnormal finding confirmed or could it be a contaminated sample?
  • Do I need a urine culture to check for infection?
  • Should I have a kidney function test (KFT) alongside this?
  • Do I need a repeat urine test in a few weeks?

Pharmacist's practical notes

The sample matters as much as the test. A first-morning, midstream sample is the most concentrated and least contaminated. Vaginal discharge, menstrual blood or skin bacteria can all create false alarms for protein or red cells — a “dirty” sample is worth repeating before anyone acts on it.

Trace protein on a single dipstick is extremely common and usually meaningless. Dipsticks are screening tools, not diagnoses: if protein keeps showing up, the next step is a quantified test (such as a protein-to-creatinine ratio), not worry.

Dilute urine hides things and concentrated urine exaggerates them. Drinking litres of water before the test can wash out findings, while an early-morning sample gives the clearest read. Keep your fluid intake normal and let the lab note the sample's concentration.

Exercise, fever and even standing upright for long hours can cause transient protein or red cells in urine. An abnormal result after a marathon or a flu deserves a calm repeat in a week or two, not an immediate conclusion. Discuss the result with your doctor.

References

The clinical information on this page is drawn from peer-reviewed sources indexed by the US National Library of Medicine. Links go to the source so you can read it yourself.

  1. Proteinuria. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK564390
  2. Microalbuminuria. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK563255
  3. Teeuw HM, Amoakoh HB, Ellis CA, Lindsley K, Browne JL. Diagnostic accuracy of urine dipstick tests for proteinuria in pregnant women suspected of preeclampsia: a systematic review and meta-analysis. Pregnancy Hypertens. 2022;27:123–30. PMID 35051804 · doi:10.1016/j.preghy.2021.12.015
  4. Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375(9731):2073–81. PMID 20483451 · doi:10.1016/S0140-6736(10)60674-5

What each dipstick line can — and cannot — tell you

A urine routine is a screening test: each line on the strip is a clue, not a verdict. Here is how the main lines compare:

Dipstick lineWhat a positive screen suggestsWhy it needs confirmation
ProteinPossible kidney stress — but trace protein on a single strip is extremely common and usually meaninglessContamination, exercise and fever all cause transient positives; persistent protein needs a quantified test such as a protein-to-creatinine ratio
GlucoseBlood sugar high enough for the kidneys to spill the excess — common in uncontrolled diabetesSome people spill glucose at lower blood sugar (low renal threshold); blood sugar testing confirms
Blood / RBCRed cells in urine, from infection, stones or contaminationMenstrual blood or a poor clean-catch mimics it; microscopy distinguishes true RBCs
Pus cells (leukocytes)Possible urinary tract infection or inflammationVaginal discharge and skin bacteria contaminate samples; symptoms plus culture decide
pH and specific gravityHow acidic or concentrated the urine isDiet, fluids and time of day shift both — they describe the sample as much as the patient

No single line is read alone: your doctor interprets the whole pattern — dipstick plus microscopy — against your symptoms. The urine routine (R/M) is one of the cheapest tests in India, typically ₹100–₹250, available at virtually every lab with home collection; prices vary by city.

Urine routine myths vs facts

MYTH Trace protein on one dipstick means kidney disease.

Fact: Trace protein on a single dipstick is extremely common and usually meaningless. Dipsticks are screening tools, not diagnoses: if protein keeps showing up, the next step is a quantified test, not worry.

MYTH You must fast before a urine test.

Fact: No fasting is needed. What matters is the sample: a first-morning, midstream catch is the most concentrated and least contaminated, which makes small abnormalities easier to detect.

MYTH Pus cells always mean a UTI that needs antibiotics.

Fact: Contamination is common — vaginal discharge or skin bacteria can put white cells in the sample without any infection. A “dirty” sample is worth repeating as a clean catch before anyone acts on it; symptoms and culture guide treatment, not the strip alone.

MYTH Clear-looking urine means a normal result.

Fact: Appearance tells you very little. Significant findings — protein, glucose, microscopic blood — are invisible to the eye, which is exactly why the dipstick and microscopy exist.

Urine routine: what matters most

  • The sample matters as much as the test. First-morning, midstream, clean catch — get the collection right and half the false alarms disappear.
  • A dipstick screens; it does not diagnose. Persistent protein needs quantification (protein-to-creatinine ratio); suspected infection needs culture. The strip is the start of the workup, not the end.
  • Read the whole pattern. One abnormal line with an otherwise clean report and no symptoms usually means a repeat, not a verdict — your doctor interprets dipstick plus microscopy together.
  • Keep fluids normal beforehand. Drinking litres of water before the test can wash out findings, while an early-morning sample gives the clearest read.

Frequently Asked Questions

What is a Urine Routine test?
A Urine Routine and Microscopy (R/M) test examines your urine in two ways: a dipstick chemical analysis (checking for protein, sugar, blood, pH etc.) and a microscopic examination of the urine sediment (looking at cells, casts and crystals). It is one of the cheapest and most informative tests available, often ordered as a first check for kidney disease, urinary tract infections (UTIs) and diabetes.
What does PROTEIN in urine mean?
Protein in urine (proteinuria) is an important warning sign of kidney disease. The kidneys normally filter protein back into the blood. When they're damaged, protein leaks into urine. Causes include diabetic nephropathy, hypertensive kidney disease, glomerulonephritis and pre-eclampsia in pregnancy. A single positive result after heavy exercise or fever may be temporary: a repeat test confirms it. Persistent proteinuria needs further investigation with a urine protein-creatinine ratio and kidney function tests.
What the Protein Dipstick Cannot Tell You?
The protein pad on a urine strip is a screening tool, and it is worth knowing what that means in practice: it is designed to be quick and cheap, not to be the final word, and it can be normal in someone who has kidney disease.
What does SUGAR (glucose) in urine mean?
Glucose in urine usually means your blood sugar is very high: the kidneys are spilling the excess out. This is common in uncontrolled diabetes. Occasionally people have a low kidney threshold for glucose and spill it even with normal blood sugar (renal glycosuria). If you have glucose in urine, your doctor will check a blood sugar (fasting and post-meal) to rule out diabetes.
What do PUS CELLS in urine mean?
Pus cells are white blood cells that enter urine when there is infection or inflammation in the urinary tract. More than 5 pus cells per high-power field usually indicates a urinary tract infection (UTI). Common symptoms of UTI include burning on urination, frequent urge to urinate, cloudy or foul-smelling urine. Your doctor will usually order a urine culture to identify the bacteria and choose the right antibiotic.
How much does the Urine routine test cost in India?
There is no single fixed price — it varies by city, lab, and whether the test is ordered alone or as part of a panel. NABL-accredited labs usually publish their rates online, so it is worth comparing a couple near you. Whatever you pay, the reference range printed on your own report is what counts — discuss the result with your doctor.
Do I need to fast for a urine routine test?
No. But a first-morning sample is preferred because it is the most concentrated, which makes small abnormalities easier to detect. Your lab will advise on the container and timing.
Can exercise change my urine test result?
Yes. Strenuous exercise can cause temporary protein or red blood cells in urine, which usually clears within a day or two. If your result followed a hard workout, your doctor may simply repeat it after rest.
My report says “epithelial cells present” — should I worry?
Usually not. Epithelial cells are mostly skin or lining cells that wash into the sample during collection, especially if it was not a clean midstream catch. Large numbers alongside other findings are worth discussing with your doctor.
How soon should an abnormal urine result be repeated?
That depends on the finding: a trace abnormality is often rechecked with a first-morning sample in a couple of weeks, while red flags get faster follow-up. Your doctor sets the timing — do not delay seeking care for symptoms like burning, fever or visible blood.
Medical Disclaimer: This page is for general educational purposes only. Urine routine reference ranges may vary slightly between laboratories. The information here does not constitute medical advice and is not a substitute for consultation with a qualified doctor. Always discuss your reports with your physician before making any health decisions.
Written and medically reviewed by Suman Konda, Clinical Pharmacist · Sources linked to PubMed · Not medical advice: see our disclaimer