Urinalysis Results: Protein, Blood, and Other Findings Explained

Your urine test came back with words like "trace protein," "blood 1+," or "leukocytes positive." You may feel well and wonder why your urine shows anything at all. Small findings on a urinalysis are common. This guide explains what each part means and how clinicians decide what to do next.

What a urinalysis checks

A urinalysis is a test of a urine sample. It usually has up to three parts [1].

• Visual check: color and clarity.
• Dipstick: a strip with small pads that change color for different substances.
• Microscopy: looking at the urine under a microscope for cells, crystals, and casts.

A clean-catch, midstream sample gives the most accurate result. This means you clean the area first and collect urine partway through passing it.

What the dipstick measures

• Specific gravity: how concentrated your urine is. It is high when you are dehydrated.
• pH: how acidic your urine is. Diet affects it.
• Protein: mostly albumin. It can signal kidney stress or damage.
• Glucose: sugar, which appears when blood sugar is high.
• Ketones: made when the body burns fat for fuel, as in fasting or uncontrolled diabetes.
• Blood: red blood cells or hemoglobin.
• Leukocyte esterase: a sign of white blood cells, often from infection or inflammation.
• Nitrite: made by some bacteria. A positive result suggests infection.
• Bilirubin and urobilinogen: linked to the liver and red cell breakdown [1].

What microscopy shows

• Red blood cells (RBCs) per high power field (HPF).
• White blood cells (WBCs).
• Casts: tiny tube-shaped clumps formed in the kidney. Some types point to kidney disease.
• Crystals: often harmless, but some are linked to kidney stones.
• Squamous epithelial cells: skin cells. Many of them mean the sample was contaminated.

What your doctor looks at

Blood in the urine

Blood you can see is called gross hematuria. Blood found only on testing is called microscopic hematuria, or microhematuria.

A dipstick can be positive for reasons other than red blood cells, such as muscle breakdown. So clinicians confirm it with microscopy. The American Urological Association (AUA) defines microhematuria as 3 or more red blood cells per high power field on a single urine sample under the microscope [2].

Common harmless or temporary causes include menstruation, hard exercise, sex, and infection. Clinicians usually repeat the test once these causes have passed [2].

If blood persists, clinicians sort people into low, intermediate, or high risk of a urinary tract cancer. Risk is based on age, sex, smoking, the number of red cells, whether it persists, and past visible blood [2]. The 2025 AUA update revised this risk system and the guidance on follow-up [3].

• Low risk: often a repeat urinalysis.
• Intermediate risk: a discussion about cystoscopy (a camera look into the bladder) and kidney imaging.
• High risk: cystoscopy and imaging of the kidneys and urinary tract.

Visible blood in urine, even once, usually leads to a full evaluation.

Protein in the urine

A trace or 1+ protein can come from dehydration, fever, hard exercise, or standing for a long time. Persistent protein can be a sign of kidney disease, especially with diabetes or high blood pressure [5].

The dipstick is a rough screen. Clinicians confirm it with a urine albumin to creatinine ratio (ACR) on a fresh sample [4]. An ACR of 3 mg/mmol (30 mg/g) or higher, lasting more than 3 months, is a marker of kidney damage [5].

Signs of infection

Leukocyte esterase and nitrite together, plus symptoms such as burning or urgency, suggest a urinary tract infection. A urine culture can confirm which bacteria are present.

Bacteria in the urine without symptoms is called asymptomatic bacteriuria. It is common, especially in older adults, and usually should not be treated with antibiotics. The main exceptions are pregnancy and before some urologic procedures, where treatment is recommended in both Canada and the US.

Glucose and ketones

Glucose in urine suggests high blood sugar. Clinicians will check a blood glucose or A1C. Some medicines for diabetes, heart failure, and kidney disease (SGLT2 inhibitors) cause glucose in urine as part of how they work. Ketones can appear with fasting, low-carbohydrate diets, or vomiting, but high ketones with high blood sugar can be dangerous.

Canada and the US

The tests are the same. The main differences are units for ACR (mg/mmol in Canada, mg/g in the US) and which specialist groups write the guidance. The AUA guideline is widely used in the US, and Canadian urologists follow similar risk-based approaches.

Questions to ask your clinician

• Which results are abnormal, and are they confirmed by microscopy?
• Could my period, exercise, or an infection explain this result?
• Should we repeat the urine test, and when?
• Do I need a urine albumin to creatinine ratio?
• What is my risk group for blood in the urine, and do I need a cystoscopy or imaging?
• Do I need antibiotics, or is this bacteria without infection?

When to get care quickly

Go to the emergency department if you have:

• Fever, chills, and pain in your side or back, which can mean a kidney infection.
• Severe pain in your side that comes in waves, with nausea or vomiting.
• Large amounts of blood or clots in your urine, or you cannot pass urine.
• High blood sugar with ketones, vomiting, or fast breathing. Call 911 if you are confused or very drowsy.

Bottom line

A urinalysis is a quick screen for kidney, bladder, and metabolic problems. Many small findings are temporary and settle on repeat. Blood must be confirmed by microscopy, and persistent blood leads to a risk-based check. Protein is confirmed with an albumin to creatinine ratio. Bacteria without symptoms usually does not need treatment.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.