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Urinalysis in the diagnosis of kidney disease

Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Albert Q Lam, MD


The urinalysis is an informative and noninvasive diagnostic tool that is readily accessible to the clinician. Performance and interpretation of the urinalysis are practical skills for clinicians in both the ambulatory and hospital settings. In conjunction with the history, physical examination, and serum chemistries, the urinalysis plays a central role in evaluating acute and chronic kidney disease. In addition, abnormal findings on a routine urinalysis, often in an otherwise asymptomatic patient, may be the first evidence of underlying kidney disease. The urinalysis can also be used in some patients to monitor the course of kidney diseases.

Interpretation of the urinalysis in patients with established or suspected kidney disease will be presented in this topic. Assessment of kidney function, a general approach to the patient with kidney disease, an overview of the indications for kidney biopsy, and the differential diagnosis and evaluation of glomerular disease are discussed separately. (See "Assessment of kidney function" and "Diagnostic approach to the patient with subacute kidney injury in an outpatient setting" and "Indications for and complications of renal biopsy" and "Differential diagnosis and evaluation of glomerular disease".)


A complete urinalysis consists of three components: gross evaluation, dipstick analysis, and microscopic examination of the urine sediment. These components are discussed in detail below. (See 'Gross assessment' below and 'Urine dipstick' below and 'Urine sediment' below.)

A complete urinalysis should be performed in the following settings:

In a patient with evidence of kidney disease, such as someone with albuminuria or an acute or chronic reduction in the glomerular filtration rate.


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Literature review current through: Sep 2016. | This topic last updated: Sep 15, 2016.
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  1. Rabinovitch A, Arzoumanian L, Curcio KM, et al. Urinalysis-approved guideline, 3rd ed. Clinical and Laboratory Standard Institute, 29(4), 2009 Wayne, PA. http://www.clsi.org/source/orders/free/gp16-a3.pdf (Accessed on March 07, 2012).
  2. Graff L. A Handbook of Routine Urinalysis, Lippincott, Williams and Wilkins, Philadelphia 1983.
  3. Rose BD. Pathophysiology of Renal Disease, 2nd ed, McGraw-Hill, New York 1987. p.10.
  4. Pimstone NR. Renal degradation of hemoglobin. Semin Hematol 1972; 9:31.
  5. Sakata S, Yoshioka N, Atassi MZ. Human haptoglobin binds to human myoglobin. Biochim Biophys Acta 1986; 873:312.
  6. Adornato BT, Kagen LJ, Garver FA, Engel WK. Depletion of serum hemopexin in fulminant rhabdomyolysis. Evidence for an interaction of hemopexin with myoglobin-derived heme. Arch Neurol 1978; 35:547.
  8. Thompson WG. Things that go red in the urine; and others that don't. Lancet 1996; 347:5.
  9. Tunnessen WW, Smith C, Oski FA. Beeturia. A sign of iron deficiency. Am J Dis Child 1969; 117:424.
  10. Crane DB, Wheeler WE, Smith MJ. Chyluria. Urology 1977; 9:429.
  11. Cheng JT, Mohan S, Nasr SH, D'Agati VD. Chyluria presenting as milky urine and nephrotic-range proteinuria. Kidney Int 2006; 70:1518.
  12. Nates J, Avidan A, Gozal Y, Gertel M. Appearance of white urine during propofol anesthesia. Anesth Analg 1995; 81:210.
  13. Mills F, Jeffery J, Ayling R. A cause of pink urine. BMJ 2013; 347.
  14. Stern AB, Stewart HD, Singh HK, Kshirsagar AV. Pink urine after propofol anesthesia. Kidney Int 2010; 78:1193.
  15. Stratta P, Barbe MC. Images in clinical medicine. Green urine. N Engl J Med 2008; 358:e12.
  16. Lepenies J, Toubekis E, Frei U, Schindler R. Green urine after motorcycle accident. Nephrol Dial Transplant 2000; 15:725.
  17. Blakey SA, Hixson-Wallace JA. Clinical significance of rare and benign side effects: propofol and green urine. Pharmacotherapy 2000; 20:1120.
  18. Bernante P, Francini F, Zangrandi F, et al. Green urine after intragastric balloon placement for the treatment of morbid obesity. Obes Surg 2003; 13:951.
  19. Gillett MJ, Burnett JR. Medications and green urine. Intern Med J 2006; 36:64.
  20. Leclercq P, Loly C, Delanaye P, et al. Green urine. Lancet 2009; 373:1462.
  21. Slotki IN, MacIver JE, Mallick NP, Palmer HM. Acute intravascular hemolysis with minimal renal impairment in Clostridium perfringens infection. Clin Nephrol 1976; 6:451.
  22. Massoud OI, Yousef WI, Mullen KD. Hemoglobinuria with ribavirin treatment. J Clin Gastroenterol 2003; 36:367.
  23. Fogazzi GB, Verdesca S, Garigali G. Urinalysis: core curriculum 2008. Am J Kidney Dis 2008; 51:1052.
  24. Mazouz B, Almagor M. False-positive microhematuria in dipsticks urinalysis caused by the presence of semen in urine. Clin Biochem 2003; 36:229.
  25. Cohen RA, Brown RS. Clinical practice. Microscopic hematuria. N Engl J Med 2003; 348:2330.
  26. Daum GS, Krolikowski FJ, Reuter KL, et al. Dipstick evaluation of hematuria in abdominal trauma. Am J Clin Pathol 1988; 89:538.
  27. Schröder FH. Microscopic haematuria. BMJ 1994; 309:70.
  28. Brigden ML, Edgell D, McPherson M, et al. High incidence of significant urinary ascorbic acid concentrations in a west coast population--implications for routine urinalysis. Clin Chem 1992; 38:426.
  29. Nagel D, Seiler D, Hohenberger EF, Ziegler M. Investigations of ascorbic acid interference in urine test strips. Clin Lab 2006; 52:149.
  30. Nicot GS, Merle LJ, Charmes JP, et al. Transient glomerular proteinuria, enzymuria, and nephrotoxic reaction induced by radiocontrast media. JAMA 1984; 252:2432.
  31. Cheng KH, Chu CS, Lee KT, et al. Evaluation of microalbuminuria after non-ionic radiocontrast medium exposure in patients undergoing coronary angiography. Int J Cardiol 2008; 127:126.
  32. Tonelli M, Muntner P, Lloyd A, et al. Using proteinuria and estimated glomerular filtration rate to classify risk in patients with chronic kidney disease: a cohort study. Ann Intern Med 2011; 154:12.
  33. Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375:2073.
  34. Chapter 1: Definition and classification of CKD. Kidney Int Suppl (2011) 2013; 3:19.
  35. Haque SK, Ariceta G, Batlle D. Proximal renal tubular acidosis: a not so rare disorder of multiple etiologies. Nephrol Dial Transplant 2012; 27:4273.
  36. Vasilakou D, Karagiannis T, Athanasiadou E, et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med 2013; 159:262.
  37. Tsai JJ, Yeun JY, Kumar VA, Don BR. Comparison and interpretation of urinalysis performed by a nephrologist versus a hospital-based clinical laboratory. Am J Kidney Dis 2005; 46:820.
  38. Wald R, Bell CM, Nisenbaum R, et al. Interobserver reliability of urine sediment interpretation. Clin J Am Soc Nephrol 2009; 4:567.
  39. Daudon M, Hennequin C, Boujelben G, et al. Serial crystalluria determination and the risk of recurrence in calcium stone formers. Kidney Int 2005; 67:1934.
  40. Daudon M, Cohen-Solal F, Barbey F, et al. Cystine crystal volume determination: a useful tool in the management of cystinuric patients. Urol Res 2003; 31:207.
  41. Vivante A, Afek A, Frenkel-Nir Y, et al. Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA 2011; 306:729.
  42. Birch DF, Fairley KF. Haematuria: glomerular or non-glomerular? Lancet 1979; 2:845.
  43. Pollock C, Liu PL, Györy AZ, et al. Dysmorphism of urinary red blood cells--value in diagnosis. Kidney Int 1989; 36:1045.
  44. Köhler H, Wandel E, Brunck B. Acanthocyturia--a characteristic marker for glomerular bleeding. Kidney Int 1991; 40:115.
  45. Tesser Poloni JA, Bosan IB, Garigali G, Fogazzi GB. Urinary red blood cells: not only glomerular or nonglomerular. Nephron Clin Pract 2012; 120:c36.
  46. Wise GJ, Schlegel PN. Sterile pyuria. N Engl J Med 2015; 372:1048.
  47. Nolan CR 3rd, Anger MS, Kelleher SP. Eosinophiluria--a new method of detection and definition of the clinical spectrum. N Engl J Med 1986; 315:1516.
  48. Muriithi AK, Leung N, Valeri AM, et al. Biopsy-proven acute interstitial nephritis, 1993-2011: a case series. Am J Kidney Dis 2014; 64:558.
  49. Ruffing KA, Hoppes P, Blend D, et al. Eosinophils in urine revisited. Clin Nephrol 1994; 41:163.
  50. Muriithi AK, Nasr SH, Leung N. Utility of urine eosinophils in the diagnosis of acute interstitial nephritis. Clin J Am Soc Nephrol 2013; 8:1857.
  51. Fogazzi GB, Ferrari B, Garigali G, et al. Urinary sediment findings in acute interstitial nephritis. Am J Kidney Dis 2012; 60:330.
  52. Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med 2002; 137:744.
  53. ZIMMER JG, DEWEY R, WATERHOUSE C, TERRY R. The origin and nature of anisotropic urinary lipids in the nephrotic syndrome. Ann Intern Med 1961; 54:205.
  54. Streather CP, Varghese Z, Moorhead JF, Scoble JE. Lipiduria in renal disease. Am J Hypertens 1993; 6:353S.
  55. Duncan KA, Cuppage FE, Grantham JJ. Urinary lipid bodies in polycystic kidney disease. Am J Kidney Dis 1985; 5:49.
  56. Braden GL, Sanchez PG, Fitzgibbons JP, et al. Urinary doubly refractile lipid bodies in nonglomerular renal diseases. Am J Kidney Dis 1988; 11:332.
  57. Chawla LS, Dommu A, Berger A, et al. Urinary sediment cast scoring index for acute kidney injury: a pilot study. Nephron Clin Pract 2008; 110:c145.
  58. Perazella MA, Coca SG, Kanbay M, et al. Diagnostic value of urine microscopy for differential diagnosis of acute kidney injury in hospitalized patients. Clin J Am Soc Nephrol 2008; 3:1615.
  59. Perazella MA, Coca SG, Hall IE, et al. Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients. Clin J Am Soc Nephrol 2010; 5:402.
  60. Bagshaw SM, Haase M, Haase-Fielitz A, et al. A prospective evaluation of urine microscopy in septic and non-septic acute kidney injury. Nephrol Dial Transplant 2012; 27:582.
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