Discrepant results you may see with Urinalysis data and possible causes

Dipstick result

Microscopic
finding
Bacteria
Squamous Epith
Mucus

Explanation/additional
results

Leukocyte Esterase: Positive

Nitrites: Negative

WBCs, Bacteria

UTI

Blood: Negative

RBCs

All bacteria do not

reduce nitrates;
Look for yeast
Look for yeast
Look for interference
from Vit C (ascorbic
acid)
RBCs have lysed so lots
of free hemoglobin;
look for pink/red urine
color and specific
gravity to be low (dilute
urine will lyse RBCs)

False negative blood reaction

Leukocyte Esterase: Negative

Nitrites: Negative

Blood: Positive

Few or no RBCs

Blood:
Negative
Bilirubin
or
Nitrites
Lower than
Glucose:
expected
Bilirubin: Negative
Urobilinogen: Increased
Bilirubin: Variable
Urobilinogen: Variable
Bilirubin: Increased
Urobilinogen: Negative
Protein: Minimal

RBCs, bacteria

Protein: Moderate to large

Pathology

May be contaminant
(likely not midstream
clean catch urine)

Vitamin C interference

Only conjugated
bilirubin found in urine

Yeast infection?
Yeast misidentified as RBCs?

Glucose and bilirubin do not

have cellular components, but
a diabetic or liver patient
should be further evaluated
Hemolytic disease (prehepatic)
Liver damage/disease (hepatic)
Obstructive disease
(post hepatic)
Could be exercise induced or
non-pathologic
Pathology/infection in kidney

Hyaline and/or
granular casts
Granular,
cellular, waxy
casts

Glucose: Negative
Clinitest: Positive

Dipstick specific for

glucose

Glucose: Positive
Clinitest: Negative

Dipstick more sensitive

than Clinitest

No glucose is present, but

reducing substance such as
galactose or Vit C (ascorbic
acid) may be present
Glucose is present

Glomerulonephritis: Proteinuria, hematuria, RBC casts in urine

Nephrotic syndrome: Proteinuria (much more than glomerulonephritis: greatest amount of protein found in urine);
likely will see lipids in urine (free fat globules, fatty casts, oval fat bodies); waxy casts (severe urine stasis)
Cystitis (lower UTI such as bladder infection): leukocyte esterase, nitrite; WBCs, bacteria and possible
transitional epithelial cells; LACK significant casts (hyaline casts may be present)
Pyelonephritis (upper UTI kidney infection): proteinuria, leukocyte esterase, nitrite; WBCs and bacteria
present; WBC casts, granular casts; possible renal tubular epithelial cells present
CLS 500 Application and Interpretation of Clinical Laboratory Data
Discrepant Results: Urinalysis