# 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

1. Screening and monitoring:

   1. Diabetic patients: screen for kidney damage
   2. Renal disease: monitor progression
   3. Pregnancy: screen for preeclampsia and urinary tract infections

2. Diagnostic:

   1. Suspected urinary tract infections
   2. Suspected diabetic keto-acidosis
   3. Suspected kidney disease

## Contraindications

1. Patient refusal

## 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

1. Patient notes

### Equipment

1. Non-sterile gloves

2. Urine sample: midstream or catheter

3. Urine dipstick

4. Paper towel to blot the urine dipstick

5. Watch

## Procedure

Follow medical asepsis with non-sterile gloves.

1. Perform hand hygiene and don non-sterile gloves.

2. Inspect the urine dipstick container for the expiry date.

3. Inspect the urine colour and smell for an odour.

4. Dip a dipstick into the urine sample, covering all the squares with urine.

5. Blot the edge of the dipstick on a paper towel to remove excess urine.

6. Start reading the results between 30 seconds and 120 seconds from dipping (time indicated on the dipstick container).

7. Dispose of medical waste safely.

8. Record the results in patient notes.

## 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:

1. Dehydration

2. Glycosuria/proteinuria

3. Liver failure, heart failure, or nephrotic syndrome

If <1.002:

1. Excess fluid intake

2. Renal failure, diabetes insipidus, acute tubular necrosis, or pyelonephritis

### 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

1. Simerville JA, Maxted WC, Pahira JJ. Urinalysis: a comprehensive review. Am Fam Physician. 2005;71(6):1153-1162.

2. Olivier N. Routine Urine Testing. In: Mulder M, Joubert A, Olivier N, eds. Practical Guide for General Nursing Sciences. 2nd ed. Pearson; 2020.

3. Roberts JR. Urine Dipstick Testing. Emergency Medicine News. 2007;29(6):24-27 doi: 10.1097/01.EEM.0000279130.93159.d9