CKD: 10 Questions and 10 Answers
July 2, 2026
CKD: 10 Questions and 10 Answers Chronic Kidney Disease is a “silent” epidemic. In 2026, data suggests that over 9.5 million people in the UK are living with CKD, though many remain undiag...
A ‘urine test’ is one of the most common diagnostic tools used by healthcare professionals to monitor kidney function, detect infections, and screen for metabolic conditions like diabetes.
However, there is no single “urine test.” Depending on your symptoms, a doctor may order one of three primary types of analysis.
Below, we break down the Urinary Dipstick, Urinary ACR, and Midstream Specimen (MSU), including their normal values and what abnormal results might indicate.
The dipstick is a quick chemical test used for immediate bedside results. A plastic strip with chemical pads is dipped into the urine, changing color to indicate the presence of specific substances.
| Parameter | Normal Range/Value | Clinical Note |
| Colour | Straw / Pale Yellow | Darker urine usually indicates dehydration. |
| Turbidity | Clear | Cloudy urine may suggest infection or presence of salts. |
| pH | 4.5 – 8.0 | Naturally acidic (pH 5.5–6.5). A pH >9.0 often suggests a UTI. |
| Specific Gravity | 1.003 – 1.030 | Measures urine concentration; reflects hydration levels. |
| Protein | Negative | Presence (Proteinuria) can indicate chronic kidney disease (CKD). |
| Glucose | Negative | Common marker for uncontrolled Diabetes Mellitus. |
| Ketones | Negative | Indicates the body is burning fat for fuel (Ketosis/DKA). |
| Bilirubin | Negative | Presence may indicate liver or gallbladder issues. |
| Urobilinogen | 1.7 – 30 µmol/L | Higher levels can suggest liver disease or haemolysis. |
| Blood | Negative | Presence (Haematuria) requires clinical correlation. |
| Nitrites | Negative | Bacteria in the urinary tract often convert nitrates to nitrites. |
| Leucocytes | Negative | Presence of white blood cells (WBCs) suggests inflammation or infection. |
The Urinary ACR is a precise laboratory test used primarily to detect Albuminuria—the leaking of albumin (a protein) into the urine. This is a critical marker for chronic kidney disease (CKD).
ACR Reference Ranges
A1 (Normal): <3 mg/mmol. It is normal to excrete trace amounts of protein.
A2 (Mildly Increased): 3–30 mg/mmol. This indicates early-stage kidney involvement.
A3 (Moderately Increased): >30 mg/mmol. Often requires medication to protect the kidneys.
Nephrotic Range Proteinuria: >100 mg/mmol. At this level, a kidney biopsy is usually considered.
Nephrotic Syndrome: >220 mg/mmol. A serious clinical condition characterised by high protein loss, low blood albumin, and swelling (oedema).
An MSU involves collecting the “middle” portion of the urine stream to avoid contamination from skin bacteria. This sample is sent for microscopy, culture, and sensitivity (MC&S).
White Cells (WBC): <5. High counts (Pyuria) indicate infection.
Casts (Hyaline): 0–1. These are cylindrical structures formed in the kidney tubules.
Crystals: None seen. Presence may indicate a risk for kidney stones.
Bacteria: None seen. If bacteria are grown in a culture, it confirms a Urinary Tract Infection (UTI).
Understanding your urine test results is vital for monitoring your internal health.
Whether it is a rapid dipstick for infection, an ACR for kidney health, or an MSU for microscopic analysis, these tests provide a window into your metabolic and renal function.
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