What can be read up in my pee? Test for UTI at home
Urinalysis, also called Routine Urine Analysis, is a set of tests on your urine (pee). In addition to the complete blood count (CBC) and comprehensive metabolic panel (CMP) blood tests, a urinalysis is the third important test in your routine yearly check-up. Your urine can tell you a lot about the state of your health as it contains waste produced by your kidneys. Certain diseases and disorder conditions can be discovered in their early stages by detecting certain substances that normally are not present in your urine. Generally, your urine does not include high levels of glucose, bilirubin, certain proteins, and bacteria. A routine urine analysis is an excellent way to detect kidney diseases, test for UTI at home (urinary tract infections=UTI), and diabetes.
If you ask yourself—"How to test for a UTI at home? Or, How to read UTI test or a urinalysis test?” There are two main methods of detection of your urine. Chemistry + microscopy analyzers that read directly from your urine sample and by dipping sticks (dipsticks) into your urine sample. A dipstick is a thin, plastic stick with strips of chemicals on it — when it is placed in urine, the chemical strips change color if certain substances are present or if their levels are above typical levels. The strips read up can be done by either a lab technician's visual exam or yourself at home or by using an automated strip reader to reduce subjective readings1. Lab analyzers normally include more tests options. There are also some differences in the number of chemical strips on each manufacturer’s dipstick. Check what analytes are included to compare.
What are the most common tests/strips in a Urinalysis test?
Urine nitrite, also called Nitrite (urine): (nitrite can also be detected in blood, but this is a different test, so labs normally add in parentheses if this is a nitrite was measured in your urine or in your blood). This test detects if nitrites, a byproduct of nitrogen waste, are present in your urine. Normal urine contains chemicals called nitrates. If bacteria enter the urinary tract, nitrates can turn into different, similarly named chemicals called nitrites. Nitrites in the urine are often the result of certain bacteria that, when growing in the bladder, ureters, or kidneys, can be a sign of a urinary tract infection (UTI).
Occult Blood: the presence of hemoglobin (a protein that carries oxygen from your lungs to your tissues) usually indicates the presence of a microscopic amount of blood in your urine. It is called occult because it is hidden and cannot be seen by your eyes. Having hidden hemoglobin in your urine is also called hematuria.
Ketones: the level of ketones in your urine tells if your liver produces these chemicals in response to your body burning fat for energy instead of glucose.
Protein (Urine): This test measures the level of albumin in the urine. Albumin is a protein found in your blood. It is made by your liver which takes proteins from the foods you eat and turns them into new proteins that circulate to various organs and tissues in your body. A healthy kidney doesn't let albumin pass from your blood into your urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better. The presence of small amounts of albumin in the urine is called microalbuminuria. As kidney damage progresses and the amount of albumin in the urine increases, the name of the condition changes from microalbuminuria to albuminuria (macroalbuminuria) or proteinuria.
pH: Measures your urine acidity or alkalinity. Monitoring your urine pH can tell if your kidney develops stones (deposit of minerals and salts that stick together and form a hard material – it can be painful when passing through the urinary tract). Some types of kidney stones are more likely to develop in alkaline urine (urine pH high) and others are more prone to form in acidic urine (urine pH low).
Specific Gravity: Measuring urine specific gravity is a more precise way to tell what your urine’s overall concentration is, and it is a better way than looking at the color of your urine. This test compares the density of urine to the density of water and evaluates your hydration level.
Urobilinogen: This test measures the level of urobilinogen, a colorless byproduct of bilirubin. Urobilinogen is formed from the reduction of bilirubin which has an orange-yellow pigment and is released as part of your red blood cells’ normal breakdown. Normal urine contains some urobilinogen but urine urobilinogen high level is a red flag. If there is little or no urobilinogen in your urine, it can mean your liver isn't working correctly. On the other side, too much urobilinogen in your urine can indicate liver diseases such as hepatitis or cirrhosis.
Additional strips that may be included in some dipsticks
Calcium: Some dipsticks measure the levels of calcium in your urine. Almost all of your body's calcium is stored in your bones. A small amount circulates in the blood, and the remainder is filtered by the kidneys and passed into your urine. If urine calcium levels are too high or too low, it may mean you have a medical condition, such as kidney disease or kidney stones.
Creatinine (urine): Creatinine is a waste product from the normal breakdown of your muscle tissue. At the time your body makes it, it's immediately filtered through your kidneys and flushed out through your urine. The creatinine urine test measures the amount of creatinine in urine. This test is done to see how well your kidneys are working. Creatinine can also be measured by a blood test as part of the comprehensive metabolic panel (CMP).
Leukocytes: White Blood Cells (WBC) are a part of the immune system and fight infections. WBCs are also called Leukocytes. A strip on a dipstick cannot count the number of WBC in your urine. A qualitative level of Leukocytes in your urine is measured by leukocyte esterase, an enzyme found in most white blood cells and indicates the presence of white blood cells in urine. A high level of leukocyte esterase in your urine might indicate a urinary tract infection.
Additional tests that are measured by a microscopy analyzer
The tests cannot be measured by dipsticks and require that your urine will be sent as a liquid to the analyzing lab. There are several tests that offer urinalysis with microscopic test
White Blood Count: detects the number of white blood cells in your urine. Red Blood Count: detects the number of red blood cells (erythrocytes). Red blood cells contain hemoglobin, a protein that transfers oxygen from your lungs throughout the body. Epithelial Cells (renal): A measure of the number of epithelial cells in urine. Epithelial cells line the surfaces of your body and are found on your skin, urinary tract, and organs. Results are often reported as an approximate amount, such as "few," moderate," or "many" cells. "Few" cells are generally considered in the normal range. "Moderate" or "many" cells may indicate some infections like Urinary tract infection (UTI) or Yeast infection.
Epithelial Cells (non-renal): It's normal to have a small number of epithelial cells (non-renal) in your urine. A large amount may indicate an infection, kidney disease, or other serious medical condition. Epithelial Cells (non-renal): It's normal to have a small number of epithelial cells (non-renal) in your urine. A large amount may indicate an infection, kidney disease, or other serious medical condition.
Your urine appearance and color can also tell about your health and what you have eaten or drunk lately. Normal urine color ranges from pale yellow to deep amber — the result of a pigment called urochrome and how diluted or concentrated the urine is. Pigments and other compounds in certain foods and medications can change your urine color. Beets, berries and fava beans are among the foods most likely to affect the color. Also, sometimes blood in the urine can make it look red or brown. Urine is typically clear. Cloudiness or an unusual odor can indicate a problem, such as an infection. Protein in the urine can make it appear foamy. If you complete the urine test by yourself at home, your visual examination should be part of your checklist. When your urine is sent to a lab, the analysis can be done by a technician or by an analyzer. A urinalysis lab report normally includes:
Urine Appearance: your urine’s physical appearance, which includes assessing color, clarity, or cloudiness. Urine Color: a classification of your urine’s color. Urine Crystals: abnormal crystals may appear in the urine as a result of pathology or due to normal catabolism, like urine Uric Acid Crystals. Other urine crystals are: Calcium Oxalate Crystals: urine crystals calcium carbonate is a chemical compound that forms envelope-shaped crystals. A major constituent of human kidney stones. Triple Phosphate Crystals or Struvite stones (triple phosphate/magnesium ammonium phosphate) - about 10–15% of urinary calculi are composed of struvite Struvite stones also known as "infection stones".
Albumin/Creatinine Ratio (ACR)
We discussed albuminuria (the increased excretion of urinary albumin) earlier and Urinalysis, which can be enough in most cases. However, a routine dipstick is sometimes not sensitive enough to detect very small amounts of urine protein. Therefore, it is recommended that screening in adults with Chronic kidney disease (CKD) or at risk for CKD be done by testing for albuminuria. Albumin/Creatinine Ratio or ACR is a more sensitive test for many types of kidney diseases. A persistent increase of protein in the urine (two positive tests over a period of 3 or more months) can detect it early. ACR is calculated by dividing albumin concentration in milligrams by creatinine concentration in grams. Although the 24-hour collection has been the "gold standard," alternative methods for detecting protein excretion such as urinary albumin-to-creatinine ratio (ACR) correct for variations in urinary concentration due to hydration as well as provide more convenience than timed urine collections. Some labs are offering ACR tests online. In general, a moderately increased albuminuria, also known as microalbuminuria, refers to albumin excretion above the normal range but below the level of detection by tests for total protein. A severely increased albuminuria, also known as macroalbuminuria, refers to a higher elevation of albumin associated with a progressive decline in glomerular filtration rate (eGFR). So, if you do see some signs in your urinalysis test, adding CAR and eGFR tests would be the right thing to do. An eGFR test is part of the CMP blood test but can be purchased online also separately.
Urinalysis test for pregnancy
Urinalysis is not the same as a drug screening or pregnancy test, although all three tests involve a urine sample. A quick urinalysis during each prenatal checkup gives you and your practitioner a heads-up if you potentially have a condition that requires treatment. There is no specific urinalysis test for pregnancy, but five tests in the regular urinalysis test are important for your pregnancy. These tests include glucose to detect Gestational diabetes (GD)—see more in our previous diabetes blog, protein to detect potential Preeclampsia (a pregnancy complication characterized by high blood pressure), Red or white blood cells in your urine, which can be a sign of a UTI, the urine color to make sure you are not dehydrated. Two common causes for preterm contractions include dehydration and UTI. Make sure you are reading up your pee!
Urinalysis with reflex to culture
A urinalysis with reflex to culture means that if there are signs of urinary tract infections (UTI) e.g. bacterial infections the lab will subsequently take a sample of your urine and try to see bacterial growth in culture. Urine culture is designed to quantitate the growth of significant bacteria. This test has a reference range of less than 1,000 bacteria per mL. More than 95% of UTIs are caused by a single type of bacterium. The benefit of a reflex test is the automatic subsequent testing without the need to recollect a new sample which enables to complete the lab analysis in one visit. Make sure to collect your midstream urine to enable the reflex to bacterial culture.
Are at home urine tests accurate?
Urinalysis dipsticks are qualitative by nature. Their chemical strips provide a range. Though, for initial screening, they are accurate enough to give you red flags, especially if results repeat over time. It is also recommended to use automated strip readers at home to eliminate subjective reading. For quantitative results, a lab analyzer will be better but you can still order urine lab tests without doctor and have an in-person visit to a lab service station and take your pee sample there.
A routine urine analysis test at home – urinalysis is a simple and affordable test to track your kidney health and ensure you do not have any urinary tract infection or some signs of diabetes. Multiple dipsticks are available for initial screening at home. Several labs are offering urinalysis test online without the need for a prescribing physicians a more sensitive analysis using chemistry and microscopy analyzers, which normally require an in-person visit. To avoid your subjective reading, some providers also offer automated strip readers of their dipsticks. If you see some changes in your albumin level that remain over time (two positive tests over 3 or more months), it is recommended to dig further as this can be an early red flag for your kidney health and that may be treated early and prevented. Finally, if you have urinary tract infection symptoms but negative tests, you’d need additional tests like urine culture (the lab will try to grow bacteria from your urine). In rare cases, repeated negative cultures (meaning they don't show a bacterial infection) but persistent UTI symptoms may, in fact, be bladder cancer.
Do you find urinalysis as an affordable way to test for UTI at home?
1. Van Delft S., Goedhart A., Spigt M., van Pinxteren B., de Wit N., and Hopstaken R., Prospective, observational study comparing automated and visual point-of-care urinalysis in general practice, BMJ Open 2016; 6:e011230. DOI:10.1136/bmjopen-2016-011230