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urine dipstick

Notes: Dipstick: - specific gravity: 1.005-1.031 - urobilinogen - nitrite* (none) - leukocyte esterase* (none) - blood (none) - bilirubin (none) - ketones (none) - glucose (none) - protein: protein by dipstick detects albumin (none to trace) - pH: 5-9 (5.0-6.5) [2] * presence of leukocyte esterase + nitrites suggests urinary tract infection (UTI) vs asymptomatic bacteriuria [2] * absence of both leukocyte esterase & nitrites has high negative predictive value for UTI or asymptomatic bacteriuria [2] Nitrites: - normal: none - detects nitrites converted from dietary nitrate by bacteria within the urinary tract - negative in urinary tract infections caused by Enterococcus, Streptococcus, Staphylococcus or Haemophilus [2] Leukocyte esterase: 1) dipstick detects > 3-4 leukocytes/hpf 2) sensitivity 92% Blood: 1) dipstick detects > 5 RBC/hpf 2) dipstick detects hemoglobin & myoglobin 3) false positives a) ascorbate > 5 mg/dL b) contamination with povidone-iodine 3) positive dipstick alone insufficient for diagnosis of microhematuria [6] Ketones - detects acetoacetic acid - does not detect acetone or beta-hydroxybutyrate Glucose: - positive when urine glucose > 180 mg/dL - lower threshold in pregnancy & Fanconi syndrome [2] Protein: - dipstick detects only albumin [2,4] {good reliability} a) given dipstick value represents greater protein excretion in dilute than concentrated urine b) for specific gravity of 1.020, the chance of overt proteinuria for a reading of: 1] 0 mg/dL = 2% 2] 300 mg/dL = 98% c) quantify positive protein on urine dipstick with albumin/creatinine ratio, protein/creatinine ratio or 24 hour urine protein [7] d) moderately increased albumin in urine may be undetected by dipstick - obtain albumin/creatinine ratio, protein/creatinine ratio or 24 hour urine protein if high-risk patient [2] e) dipstick does not detect immunoglobulin light chains associated with multiple myeloma [2]

Related

urine culture urine discoloration

Specific

urine ketone test strip

General

urinalysis (UA)

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 620
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Prescriber's Letter 9(5):28 2002
  4. Journal Watch 25(13):105, 2005 Constantiner M, Sehgal AR, Humbert L, Constantiner D, Arce L, Sedor JR, Schelling JR. A dipstick protein and specific gravity algorithm accurately predicts pathological proteinuria. Am J Kidney Dis. 2005 May;45(5):833-41. PMID: 15861348 A calculator may be found at http://www.metrohealthresearch.org/schelling/
  5. Brown RS. Has the time come to include urine dipstick testing in screening asymptomatic young adults? JAMA. 2011 Aug 17;306(7):764-5. PMID: 21846861
  6. Bankhead C Guideline Clarifies Work-up for Microhematuria - Positive dipstick test alone insufficient for diagnosis. MedPage Today July 1, 2020 https://www.medpagetoday.com/meetingcoverage/aua/87364
  7. Xu Y, Shin JI, Wallace A et al. Shortfalls in follow-up albuminuria quantification after an abnormal result on a urine protein dipstick test. Ann Intern Med 2024 Oct 1; [e-pub] PMID: 39348706 https://www.acpjournals.org/doi/10.7326/ANNALS-24-00549

Components

albumin in urine by test strip bilirubin in urine by test strip glucose in urine by test strip hemoglobin in urine by test strip ketones in urine by test strip leukocyte esterase in urine by test strip nitrite in urine by test strip pH in urine by test strip protein in urine by test strip specific gravity in urine by test strip urine blood urobilinogen in urine by test strip