# Dipstick Urinalysis

## Overview

This module describes how to perform and interpret dipstick urinalysis. Usually it is performed on a midstream urine sample, which is also sent away for culture. However, for dipstick urinalysis alone, a midstream sample may not be necessary.

## Indications

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“Clues to many conditions show up in one’s urine. We can test your urine by dipping a paper stick into it.”

### What can my patient expect?

“This will take only a few minutes and the results will be available immediately.”

### What is my patient’s role?

“I need you to give me a midstream urine sample.”

## Preparation

### Documentation

### Equipment

## Procedure

Follow medical asepsis with non-sterile gloves.

## Interpretation

### Colour, clarity & odour

Urine is normally clear, light yellow to medium yellow (straw coloured) with an aromatic odour.

- Dark yellow may indicate dehydration or bilirubinuria.
- Light yellow may indicate diabetes insipidus.
- Red/orange may indicate blood, pigments from food (beetroot), or rifampicin use.
- Frothiness suggests proteinuria.
- A foul (ammonia) or fishy smell may indicate urinary tract infection.
- A sweet apple odour may indicate diabetes mellitus.
- Cloudy urine may indicate urinary tract infection.

### Specific gravity (SG)

A measure of the concentration of the urine. Normally 1.002-1.035.

If >1.035:

If <1.002:

### pH

A measure of the acidity of urine. Normally 4.5-8.0.

- Drugs, diet, and many disease states may cause abnormal pH values.
- Generally, systemic alkalosis causes alkaline urine (high pH) and systemic acidosis causes acidic urine (low pH).

### Protein

Normally negative or only trace.

If elevated, proteinuria indicates:

- Renal: glomerulonephritis, nephrotic syndrome, pyelonephritis
- Cardiovascular: hypertension, heart failure, pre-eclampsia
- Drugs: antibiotics, amphotericin, NSAIDs
- Physical stress such as fever, cold exposure, standing for a long time, or exercise.

Causes of false positives: Concentrated urine or alkaline urine

Causes of false negatives: Dilute urine or acidic urine

### Leukocytes

Should normally be negative. If positive, suggests a urinary tract infection.

### Nitrites

Should normally be negative. If positive, strongly suggests a urinary tract infection.

### Blood

Should normally be negative. If positive, haematuria indicates:

- Trauma, infection, inflammation, kidney stones, tumours in the urinary tract, long-standing urinary tract infections, or clotting disorders.
- Exclude menstruation in females.

### Ketones

Should normally be negative. If positive, ketonuria indicates:

- A starvation state, such as keto diets or maternal exhaustion during labour.
- In diabetics: diabetic ketoacidosis or an insulin overdose.

### Glucose

Should normally be negative. If positive, glycosuria indicates:

- Hyperglycaemia
- Kidney damage

### Urobilinogen

Should normally be negative. If positive, urobilinogen indicates:

- Conjugated hyperbilirubinaemia, which is a sign of liver disease or haemolysis.

## References