Urine Analysis and urinary Tests

bacteria in urine testing report in absence of pus cells

Bacteria in The Urine Testing in the Absence of Pus Cells, what does that mean?

Bacteria in urine without pus cells, do I have UTI inflammation or not?

Do I have a urinary tract infection if I have no pus cells in the urine testing, or I am ok?

Such questions are sent to the official page every day, and we can conclude the reasons here, be patient…

There are many reasons behind the existence of bacteria in urine in the absence of inflammation cells called “pus cells”.

  1. Unwashed pubic area: not cleaning the pubic area well in women before dribbling the urine sample into the urine sample jar can lead to accumulation of dirt and microorganisms which falsly appear positive in the urine results.
  2. Proloned changing of women’s pants: Also, if a woman changes her underwear after long periods after wearing it, this will lead to more accumulation of dirt, secretions and microorganisms, which causes a false positive for bacteria in urine analysis in women in particular.
  3. Unsterile urine cup: If the urine sample collection cups and tools are not sterilized well in the laboratory, this may lead to a false positive appearance of bacteria and microorganisms in the result of the complete urine examination.
  4. Asymptomatic bacteriuria: If all the above reasons are well-checked, then you can exclude the poor cleaning and sanitation from the possible reasons of false bacteruria, now we can call it bacteria in urine without symptoms which does nor require a course of antibiotics, it is not false but doesn’t need treatment.

Suggestions and recommendations:

Redo urinanalysis after washing and sanitizing your pubic area and replaced your underwear pants with cleaned one.

Midstream urine is the best urine sample of testing: so you may discard the first drops of urine and collect the later urine for testing.

Also, treating asymptomatic bacteriuria can promote antibiotic-resistant organisms, however, pregnant women may need treatment with antibiotics in asymptomatic bacteriuria after doctor consultation.

What can be detected in a urine test?

In a brief, urine tests or urine analysis can detect up to 25 parameters which help evaluate your urinary system health and other body functions.

The tests included in the routine urine analysis are classified into three main groups;

  1. Physical examination of a urine sample by naked eyes, also called “macroscopic examination, this exam including the Aspect, color, volume, and if there is blood or worms by our eyes without microscope magnification.
  2. Chemical Examinations of a urine sample by the urine strips, a kind of strips contain special chemicals each of which is a chemical urine test, that include proteins; glucose; ketone; bilirubin; urobilinogen; nitrite; ascorpic acid; blood hemolysis; leucocytes; specific gravity; and urine reaction
  3. Microscopic examination of the urine sample sediment to detect and count pus cells; red blood cells; epithelial cells; casts; crystals; ova; larvae; bacteria; fungi; and amorphous materials.

Later we will add full description for each test in the urine analysis and why doctors need such tests to evaluate many health issues.

You can learn more about:

The 5 test drug panel in urine

Ketone bodies in urine

Sugar in urine

Urine blood explanation

The report of a urine analysis shows all tests inside the urine analysis
The report of a urine analysis shows all tests inside the urine analysis

What Does Ketone Levels in Urine and Blood mean?

What is ketones?

Ketones are end products of burning fatty-acids (fats) in the body, the medical term is (fatty acid metabolism).
Ketone bodies in urine are Acetone, acetoacetate and beta-hydroxybutyric acid.
Ketones in the body urine and blood come from liver and completely processed and only negligible amount appear in urine, but when carbohydrates in unavailable or he body unable to use Carbs. then the fatty acids become the predominant source of body fuel.
As the body increases its usage of fatty acids, the burning product increased, I mean ketones of course, and liver will leave excess amounts to go out by urination, that’s why you have plus ketone in urine.

What does ketonuria mean?

The disease in which ketones are present in urine is called “ketonuria”
Ketonuria is a medical condition in which ketone bodies are present in our urine
How do you know you have ketone in urine?
Simply by smelling fruit-like odor from the breath and on the urine sample especially children with type 1 diabetes, this is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid.
ACETONE is often described as smelling like fruit or like some nail polish remover that contains acetone.
Sometimes the odor is more subtle due to lower concentrations of acetone.

Ketone Levels

Presence of ketones may be considered a healthy sign and may be a harm indicator, just learn how to know the relationship between ketone levels and your health.
Optimal ketone levels offer many health benefits, also used as health indicators for who doing weight loss, physical and mental performance.

Normal Ketone levels

Normal healthy person will not show ketone bodies in his/her urine test.
The normal human body uses carbohydrates to make energy units that fuel brain, muscles, and other cells, in some unusual cases the body uses fats instead carbohydrates to produce energy, burning fats will produce more acetone and ketonic bodies.
Low ketone level in urine is insignificant and can’t considered as a disease or anything.
Diabetes patient with type 2 may not show ketone in urine unless urinary sugar become highly elevated
Please read: urine sugar levels chart

Urine Ketone Levels Chart

Ketone bodies finding in urine is a direct measure of ketone level.

  1. Trace ketone in urine is less than +1 and lower than 20 mg/dl, considered negative ketonuria.
  2. A mild Ketone (Plus one +1)  is a value 20 – 29 mg/dl.
  3. A moderate high ketone (plus two ++2) is a value of 30–40 mg/dl.
  4. A marked high ketone Plus three +++3) is a finding of 80 mg/dl or greater.

urine ketone levels chat

urine ketone levels chat

High ketone levels in urine

Urine test usually seen positive for ketone in patients with sever diabetes mellitus, so that urine results show high glucose and high ketone, but there are some unusual cases whereas urine has only ketone high levels without glucose in urine, such cases include:
Keto Diet or Ketogenic diet
Applying “high fats low carbs diet” will lead to high ketone levels in urine, urine ketone test used as a monitor test for keto diet.
Read more at: what is ketogenic diet?
Fasting for long period:
Presence of ketones in a healthy fasting person is a good indicator, as his body uses its alternative sources of fuel.
Very long period of fasting can aggressively consume and deplete all sources of energy and ketonic bodies in the urine will be a very important indicator when a starved person starts to heal.
Losing weight:
What happens when you start a weight loss program?
Weight loss means carbohydrate burning more than usual, so the body compensates for a lack of energy source by burning fat instead of carbohydrates, the accumulated fats will be reduced and carbohydrates stopped accumulation, thus the body loses weight, but burning fats will produce acetone in blood and urine.
Measuring ketone in urine will help you make decision about your Weight Loss Diet, read about Keto Diet Plan
Presurgical patients and Acutely ill patients
These people receive many IV solution bottles (glucose), thus ready-glucose enters the blood without using much insulin, body response is made by burning fats and may be proteins, thus ketones come to the scene.
Also a patient stay for longtime in hospital can develop ketone bodies in his urine as a result of increased fatigue and reduced nutrient led by the course of the disease.
Pregnant women
Pregnant females have an additional fuel machine, the fetus of course, so that you may find acetone-like in urine of some pregnant females not all of them of course.

Diabetes without ketone in urine

There is a case where there’s glucose in urine but no Ketone in urine is present, called hyperosmolar hyperglycemic nonketotic syndrome (HHNS).
Also know as Hyperosmolar Hyperglycaemic State (HHS): when glucose in blood being high it usually seen in urine, and ketone as well as a result of alternative usage of carbs, therefore the urine of a diabetes patient has a relative amount of both glucose and ketone.
However, after glucose in blood exceeds 1000 it might be a doubt when lab technician can’t find positive ketone in urine.
So that, HHNS is a medical syndrome following extremely high glucose levels and doesn’t show a ketone value in the urine.
You can explore: Blood Glucose Levels Chart
Acetone and ketone bodies in urine come from excessive burning fats due to diabetes, ketogenic diet, or other stress situation made to the body organs, common characteristics are fruity-breath and fruit-like-odor urine. Also urine test is enough to detect the ketone level in your urine.

What Does a 5 Panel Drug Test tests for? What's inside urine drug test?

If your employer spot-checks staff using a 5 panel drug test or 10-panel drug test, this means that technology is used which can test for different illegal substances and abuse drugs.
The most commonly consumed street drugs are cocaine, marijuana, amphetamines, basic opiates such as heroin, and PCP. The traditional standard urine test tests for these 5 health Street’s most basic drug.

  • The following drugs are included in most available 5 panel urine drugs test:
  1. Cocaine, Crack.
  2. Marijuana, THC, cannabinoids, pot, weed.
  3. Phencyclidine, PCP, angel dust.
  4. Amphetamines, methamphetamines, meth, crystal meth.
  5. Heroin, codeine, morphine.

Drug screen is for pre-employment screen and drugs of abuse
Specimen: 30ml random urine
There are commercially available 4 Parameter Multiline Cassette Drugs of Abuse Test, Multi Panel Drugs of Abuse RapiCard™ (Cassette), SureStep™ Drug Screen Cassette – Alere, and others
Medical codes for abuse drugs in 5-Panel Drug Tests are: THC-COC-OPI-AMP-mAMP
The medical code of drugs of abuse test is “DOA”

A common multi panel drug test in urine tests for:

  1. Amphetamines: Amphetamine is a potent central nervous system stimulant that is used in the treatment of attention deficit hyperactivity disorder, narcolepsy, and obesity. So that it can be used as abuse drug.
  2. Barbiturates: Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, hypnotics, and anticonvulsants.
  3. Benzodiazepines: Benzodiazepines or “benzos”, are a class of psychoactive drugs.
  4. Cannabinoids: substances acts on cannabinoid receptors in cells that alter neurotransmitter release in the brain.
  5. Cocaine: also known as coke, is a strong stimulant mostly used as a recreational drug. It is commonly snorted, inhaled, or injected into the veins
  6. Opiates: Opioids are substances that act on opioid receptors to produce morphine-like effects. Opioids are most often used medically to relieve pain.
  7. phencyclidine (angel dust):  is a dissociative drug. PCP was brought to market in the 1950s as an anesthetic pharmaceutical drug but was taken off the market in 1965. Other drugs in same class: Ketamine, Memantine, Nitrous oxide, Amantadine, Riluzole. Drug class is NMDA receptor antagonist.cassette THC-COC-OPI-AMP-mAMP

Read about: drugs cause liver pain and damage at: 33 drugs cause high liver enzymes and liver pain.

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Benzodiazepines and the same class drugs:

Diazepam, Alprazolam, Clonazepam, Lorazepam, Midazolam, Chlordiazepoxide, Oxazepam, Flunitrazepam, Temazepam, Bromazepam, Flumazenil, Triazolam, Nitrazepam, Clobazam, Clorazepate, Flurazepam, Phenazepam, Estazolam, Lormetazepam, Brotizolam, Ethyl loflazepate, Tetrazepam, Nordazepam, Prazepam, Chlordiazepoxide/clidinium bromide, Medazepam, Tofisopam, Clotiazepam, Delorazepam, Loprazolam, Cloxazolam, Ketazolam, Meclonazepam, Mexazolam, Quazepam, Nimetazepam, Ro15-4513, Halazepam, Fludiazepam, Gidazepam, Flutoprazepam, Adinazolam, Oxazolam, Rilmazafone, Clorazepate Dipotassium, Pinazepam, Bretazenil, Chlordiazepoxide hydrochloride, Cinolazepam, Haloxazolam

Barbiturates and drugs in the same class include:

Phenobarbital, Sodium thiopental, Methohexital, Thiamylal, Butalbital/Acetaminophen/Caffeine, Butalbital/Acetaminophen, Butalbital/Aspirin/Caffeine, Methohexital sodium, Thiobarbital, Thiobutabarbital, Thialbarbital, Codeine/Butalbital/Caffeine/Aspirin, Codeine anhydrous/Butalbital/Caffeine/Acetaminophen

Cocaine and Other drugs in same class:

Cocaine classes: Dermatological – Topical Local Anesthetic Esters, Local anesthetic. Other is the same class:
Tetracaine hydrochloride
Proparacaine hydrochloride

Opiates include:

Morphine, Tramadol, Oxycodone, Fentanyl, Methadone, Naloxone, Hydrocodone/paracetamol, Hydromorphone, Oxycodone/paracetamol, Loperamide, Meperidine, Tapentadol, Oxymorphone, Propoxyphene, Remifentanil, Sufentanil, Alfentanil, Levorphanol, Oxycodone/aspirin, Morphine/naltrexone, Hydrocodone/ibuprofen, Morphine Sulfate, Oxycodone Hydrochloride, Fentanyl Citrate, Hydromorphone Hydrochloride, Methadone hydrochloride, Tramadol/Acetaminophen, Hydrocodone/Homatropine, Oxymorphone Hydrochloride, Propoxyphene Napsylate, Codeine/Guaifenesin, Propoxyphene/Acetaminophen, Hydrocodone/Chlorpheniramine, Loperamide Hydrochloride, Oxycodone/ibuprofen, Tapentadol hydrochloride, Meperidine Hydrochloride, Sufentanil citrate, Remifentanil hydrochloride, Levorphanol tartrate, Alfentanil Hydrochloride, Propoxyphene Hydrochloride, Hydrocodone/Pseudoephedrine, Acetaminophen/Caffeine/Dihydrocodeine, Dihydrocodeine/Aspirin/Caffeine, Hydrocodone/Homatropine methylbromide, Hydrocodone/Pseudoephedrine/Chlorpheniramine, Dihydrocodeine/Guaifenesin, Dihydrocodeine/Brompheniramine/Pseudoephedrine, Dihydrocodeine/Phenylephrine/Pyrilamine.

5 panel drug test results

Results are reported as +ve or -ve using internationally recognised cut-off limits.
Serum is not used for screening durgs of abuse.
If alcohol is required a blood (serum) specimen should be collected to give a quantitative result which will separate the prospective employee who had a health-giving glass of wine the night before from the chronic alcoholic with a sustained high alcohol level.
Pre-employment screens, common for some years in the USA, are being used more often now in New Zealand and in some occupations, for example in public transport, random checks may be used.
When results are to be used medico-legally, there has to be a secure audit trail beginning with direct observation of specimen collection.

When drugs seen in the urine drug test?

The half-life (t½) is the time for a serum level to drop by 50%. When a drug is started, or the dosage changed, the time to reach a new steady state = t½ x 5.

Reasons for drug monitoring include:

  1. check compliance
  2. guide dose adjustment
  3. check for toxicity
  4. monitor interactions if a new drug is added
  5. the choice of rehabilitation at clinics

Other types of drugs of abuse according to pharmacies:

Drug Scheduling in five categores:

Schedule I
Schedule II
Schedule III
Schedule IV
Schedule V

V. Narcotics


VI. Stimulants


VII. Depressants


VIII. Hallucinogens

Peyote & Mescaline
IX. Marijuana/Cannabis
X. Steroids
XI. Inhalants
XII. Drugs of Concern
Bath Salts or Designer Cathinones
Salvia Divinorum

It is impossible to cheat these drug tests. so that urine test are accurate enough.
5 panel urine drug test acts as an intervention if an addict is found to have excessive levels of alcohol or abuse drugs in his urine. For more interpretations follow up.

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