Urine Routine Test Explained: Pus Cells, Protein, Sugar, Ketones and What's Normal

Quick answer: A urine routine and microscopy test has three parts: physical (colour, clarity, specific gravity), chemical (pH, protein, glucose, ketones, bilirubin, urobilinogen, nitrite, leukocyte esterase, blood) and microscopic (pus cells, red cells, epithelial cells, casts, crystals, bacteria). Normal urine typically shows no protein, no glucose, no ketones, no nitrite, 0–5 pus cells and 0–2 red cells per high-power field. Abnormal results can point to urinary infection, kidney disease, diabetes, dehydration or stones. Give a first-morning, midstream clean-catch sample in a sterile container.

A urine test is simple, painless and inexpensive — and yet it gives early clues about the kidneys, bladder, blood sugar and hydration. It's part of every Aarvak full body checkup.

Physical Examination

Colour

• Pale to dark yellow: normal, depending on hydration
• Very dark yellow or amber: dehydration, or bilirubin
• Red or brown: blood, certain foods (beetroot) or medicines
• Cloudy: infection, crystals or mucus

Specific Gravity

Reflects how concentrated urine is. High in dehydration; persistently low may suggest the kidneys aren't concentrating urine well.

Chemical Examination

• pH: usually 4.5–8. Very acidic or alkaline urine can relate to diet, stones or infection
• Protein: normally absent or trace. Persistent protein suggests kidney involvement — follow up with a urine albumin-to-creatinine ratio. See kidney function tests
• Glucose: normally absent. Sugar in urine usually means blood sugar is high — check HbA1c. Some diabetes medicines (SGLT2 inhibitors) cause glucose in urine intentionally
• Ketones: appear with fasting, very low-carb diets, vomiting or uncontrolled diabetes. Ketones with high blood sugar need urgent attention
• Bilirubin and urobilinogen: clues to liver conditions — see LFT guide
• Nitrite: positive with certain bacterial UTIs
• Leukocyte esterase: suggests white cells — infection or inflammation
• Blood: may be due to infection, stones, menstruation contamination, intense exercise or kidney conditions

Microscopic Examination

• Pus cells (WBC): 0–5 per high-power field is usually normal; higher suggests infection or inflammation
• Red blood cells: 0–2 per high-power field is usually normal; more needs evaluation
• Epithelial cells: many squamous cells suggest the sample was contaminated by skin — repeat with a clean-catch sample
• Casts: some (hyaline) can be normal; others (red cell, white cell, granular) suggest kidney involvement
• Crystals: often harmless; certain types with symptoms may suggest stones
• Bacteria and yeast: may indicate infection or contamination

When Is a Urine Test Ordered?

• Burning, frequency or urgency — see UTI tests
• Back or flank pain, suspected stones
• Diabetes and high BP monitoring
• Pregnancy check-ups — see pregnancy tests
• Fever without a clear cause — see fever panel
• Before surgery
• Routine health checkups

How to Give a Good Sample

• Use the sterile container from the lab
• Collect first-morning urine if possible
• Wash hands; clean the genital area with water
• Pass the first stream into the toilet, then collect the midstream portion
• Close tightly; deliver within one hour (refrigerate if delayed, don't freeze)
• Women: avoid testing during menstruation unless advised; tell the lab if you are menstruating
• Tell the lab about antibiotics, vitamin C supplements (can affect some readings) and medicines

Frequently Asked Questions

What is a normal pus cell count in urine?

Generally 0–5 pus cells per high-power field is considered normal. Higher counts suggest infection or inflammation.

What does protein in urine mean?

Persistent protein in urine may indicate kidney involvement, especially in people with diabetes or high blood pressure. A urine albumin-to-creatinine ratio test helps confirm.

Why is there sugar in my urine?

Sugar in urine usually means blood sugar is high, as in uncontrolled diabetes. Some diabetes medicines also cause sugar in urine intentionally.

What does ketone in urine mean?

Ketones appear during fasting, low-carbohydrate diets, vomiting or uncontrolled diabetes. Ketones with high blood sugar need urgent medical attention.

Do I need to fast for a urine test?

No fasting is needed, but a first-morning sample is preferred.

How long does a urine routine report take?

Urine routine and microscopy results are usually available the same day.

Book a Urine Test in Gurugram

Urine routine is included in every Aarvak health package, starting with the ₹1,000 ADC Basic Swasthya Panel. Book at our Sector 67 lab or at home — call +91 92663 33711.

This article is for general information only. Please consult your doctor for interpretation of results.