Urinalysis with Microscopic Examination of Urine Sediment (Elemental Urine Analysis)

When your urine sample is examined under a microscope, the laboratory looks for things too small to see with the naked eye, such as red blood cells, white blood cells, bacteria, yeast, crystals, and tiny cylinder-shaped particles called casts. Identifying these elements helps your doctor understand what may be happening in your kidneys, bladder, or urinary tract and guides the next steps in your care.

A trained technician will look for red blood cells (which may signal bleeding or kidney problems), white blood cells (often linked to infections), bacteria, crystals (like calcium or uric acid), or other particles that could point to conditions such as urinary tract infections, kidney stones, or glomerular diseases. The presence of casts (gel-like structures) may also be noted.

Common findings include red blood cells, which may point to infection, kidney stones, or irritation in the urinary tract; white blood cells, often a sign of inflammation or infection; bacteria or yeast, which can indicate a urinary tract infection; crystals, which may suggest a tendency to form kidney stones; and casts or protein, which can be linked to kidney conditions. Your doctor will read these results together with your symptoms, medical history, and other tests.

For example, red blood cells in urine might suggest kidney damage, bladder irritation, or urinary tract infections. White blood cells could indicate a urinary tract infection or inflammation. Crystals may point to kidney stones or metabolic issues. The technician will report these findings to help guide further testing or treatment.

Your doctor may order this test if you have symptoms such as pain or burning when you urinate, a frequent or urgent need to go, cloudy or strong-smelling urine, visible blood in your urine, or pain in your side, back, or lower belly. It is also often part of a routine checkup, used to monitor a known kidney or bladder condition, or ordered to follow up on abnormal findings from a standard urine dipstick test.

Your healthcare provider may recommend this test if you have symptoms like frequent urination, pain while urinating, blood in urine, cloudy or foul-smelling urine, or if you’re experiencing signs of kidney problems. It’s also used as part of routine check-ups or to monitor chronic conditions like diabetes or kidney disease.

The test is simple and painless. You will usually be asked for a clean-catch, midstream urine sample in a sterile cup after cleaning the genital area, though a catheter may be used in some situations. The sample is sent to a laboratory, where it is spun in a centrifuge so that the solid parts settle out, and that sediment is placed on a slide and examined under a microscope by a trained technician.

You’ll collect a midstream urine sample in a clean container. The sample is then examined under a microscope to identify and count specific elements in the urine sediment. No special preparation is needed, but drinking plenty of water beforehand can help ensure a representative sample.