Urinalysis Interpretation

A urinalysis is evidence, not a diagnosis. Before interpreting the strip, ask why the test was ordered, whether the patient has localizing urinary symptoms, whether the specimen was collected and handled properly, and what decision the result is expected to change. Pyuria can reflect inflammation without infection, while bacteriuria in a patient without symptoms usually represents asymptomatic bacteriuria (ASB) and should not trigger antibiotics. This distinction is particularly important in long-term care. Cloudy or malodorous urine, an isolated fall, or confusion without localizing urinary symptoms does not establish a UTI and should not prompt reflex urine culture or treatment. The recognized exceptions are screening and treatment during pregnancy, beginning with an early-pregnancy urine culture, and treatment before an invasive urologic procedure in which mucosal bleeding is expected. When symptoms do point to the urinary tract, interpret the physical appearance, dipstick chemistry, and microscopic sediment as one pattern. Leukocyte esterase supports pyuria but does not prove infection; nitrite positivity supports nitrate-reducing bacteria, but a negative nitrite result is not an exclusion test. Once the indication and specimen quality are clear, the...