Urinalysis, Complete, with Reflex to Culture

The Urinalysis, Complete, with Reflex to Culture test contains 1 test with 27 biomarkers.

Breif Description: The Urinalysis with Reflex to Culture test is a comprehensive examination of a urine sample to assess the presence of various substances and indicators of urinary tract health. It combines a standard urinalysis with the option for further testing if certain abnormalities are detected. This reflex approach ensures that potential infections can be identified and treated promptly.

NOTE: Only measurable biomarkers will be reported.

Also Known As: Urine Test, Urine Analysis Test, UA Test, urine microscopic examination, Urine Culture Test, Urine Culture and Sensitivity test, Urine C and S test, UTI test, Culture Urine test

Collection Method: Urine Collection

Specimen Type: Urine

Test Preparation: No preparation required

IMPORTANT - If initial testing results in a Reflex to Culture, the lab will add and charge for Culture, Urine, Routine #395.

If you need just a Urinalysis, Complete test, order Urinalysis (UA), Complete #5463.

Culture, Urine, Routine #395 can Reflex to additional testing and charges, detailed below, if Culture is positive.

If culture is positive, CPT code(s): 87088 (each isolate) will be added with an additional charge.  Identification will be performed at an additional charge (CPT code(s): 87077 or 87140 or 87143 or 87147 or 87149).

Antibiotic susceptibilities are only performed when appropriate (CPT code(s): 87181 or 87184 or 87185 or 87186).

  • ORG ID 1. $ 12.45

  • ORG ID 2. $ 23.95

  • PRESUMPTIVE ID 1. $ 12.45

  • PRESUMPTIVE ID 2. $ 23.95

  • SUSC-1  $14.95

  • SUSC-2  $30.90

When is a Urinalysis with Reflex to Culture test ordered?

A Urinalysis with Reflex to Culture test is commonly ordered in the following situations:

  1. Urinary Tract Infection (UTI) Symptoms: If a patient presents with symptoms of a UTI, such as frequent urination, burning sensation during urination, cloudy or foul-smelling urine, or pelvic pain, a urinalysis with reflex to culture is often performed to determine the presence of infection and guide appropriate treatment.

  2. Preventive Screening: In some cases, a urinalysis with reflex to culture may be ordered as part of routine preventive screening, such as during a regular check-up or before certain medical procedures or surgeries.

  3. Monitoring Chronic Conditions: Patients with chronic kidney disease, recurrent UTIs, or other urinary tract-related conditions may undergo periodic urinalysis with reflex to culture to assess kidney function, detect any signs of infection, or monitor treatment effectiveness.

What does a Urinalysis with Reflex to Urine Culture test check for?

A urinalysis is a series of examinations done on urine that are physical, chemical, and microscopic. The tests identify and/or measure a number of elements in the urine, including cells, cellular fragments, and microbes. These elements include byproducts of healthy and unhealthy metabolism.

Urine is produced by the kidneys, two fist-sized organs located on either side of the spine near the base of the rib cage. The kidneys help the body regulate its water balance, filter wastes from the blood, and store proteins, electrolytes, and other molecules for later use. To get rid of everything unnecessary, urine travels from the kidneys to the ureters, bladder, and urethra before exiting the body. The color, amount, concentration, and content of urine will change slightly every time a person urinates due to the varied elements in urine, despite the fact that pee is normally yellow and clear.

By screening for components in the urine that aren't typically present and/or monitoring aberrant levels of specific substances, many illnesses can be caught early on. Glucose, bilirubin, protein, red and white blood cells, crystals, and germs are among examples. They could be present because of the following reasons:

  • The body responds to an elevated amount of the substance in the blood by attempting to remove the excess through urine.
  • There is a problem with the kidneys.
  • As with bacteria and white blood cells, there is a urinary tract infection present.

Three separate phases make up a full urinalysis:

  • The color and clarity of the urine are assessed using a visual examination.
  • Chemical examination, which determines the concentration of urine and tests for roughly 9 chemicals that provide useful information about health and disease.
  • Microscopic inspection that identifies and counts the different types of cells, casts, crystals, and other components found in urine, such as bacteria and mucus.

When abnormal results are found, or if a healthcare provider requests it, a microscopic analysis is usually performed.

It may be essential to repeat the test if the findings of a urinalysis are abnormal, and further other urine and blood tests may be needed to help establish a diagnosis, if the results are abnormal.

Urine culture is a test that detects and identifies bacteria and yeast in the urine that could be the source of a urinary tract infection.

A small amount of urine is placed on one or more agar plates and incubated at body temperature for a urine culture. Any bacteria or yeast present in the urine sample will grow into little circular colonies during the next 24 to 48 hours. The number of colonies and the size, shape, and color of these colonies assist identify which bacteria are present in the urine sample, and the number of colonies shows the amount of bacteria that were initially present in the urine sample. A laboratory technician counts the total number of colonies on the agar plate and determines how many types have grown. If a good, clean catch sample was taken for the test, the only bacteria found should be from an infection. Typically, there will be only one variety of bacterium present in relatively significant quantities. More than one type of bacteria may be present at any given time. This could be the result of a multi-pathogen infection, although it's more likely owing to contamination from the skin picked up during the urine collection.

A gram stain will be performed on a colony from each type by the laboratory technician. The bacteria are examined under a microscope by the laboratory technician. Different species of bacteria will have distinct colors and forms. Under a microscope, the bacterium Escherichia coli, which is responsible for the majority of urinary tract infections, will appear as gram-negative rods. Lactobacillus, a frequent vaginal contaminant found in women's urine, will show up as gram-positive rods. Some bacteria, such as Lactobacillus, are easy to detect by a skilled lab technician, are nonpathogenic, and do not require additional research. Others, such as gram-negative rods, represent clusters of identical bacteria that will necessitate extra testing to determine which bacteria are present.

After 24 to 48 hours of incubation, if there is no or little growth on the agar, the urine culture is declared negative for pathogens and the culture is complete. If one or more pathogens are found, more testing is done. Testing is performed to determine which bacteria are present, as well as susceptibility testing to determine which antibiotics are most likely to cure the infection.

Lab tests often ordered with a Urinalysis with Reflex to Culture test:

When a Complete Urinalysis with Reflex to Culture is ordered, it's often part of a broader evaluation of urinary or systemic health. Here are some tests commonly ordered alongside it:

  1. Complete Blood Count (CBC):

    • Purpose: Provides a broad picture of overall health, including white and red blood cells.
    • Why Is It Ordered: To detect signs of infection or other health issues, such as anemia, which might be related to or affect urinary health.
  2. Blood Urea Nitrogen (BUN) and Creatinine:

    • Purpose: To assess kidney function.
    • Why Is It Ordered: To evaluate the kidneys' ability to filter waste products, especially if the urinalysis suggests kidney involvement.
  3. Electrolyte Panel:

    • Purpose: To measure electrolytes such as sodium, potassium, and chloride.
    • Why Is It Ordered: To assess the body's electrolyte balance, which can be affected by kidney function and urinary disorders.
  4. C-Reactive Protein (CRP) or Erythrocyte Sedimentation Rate (ESR):

    • Purpose: Non-specific markers of inflammation.
    • Why Is It Ordered: To assess the presence and extent of inflammation, which can accompany UTIs or other kidney disorders.
  5. Glucose Test:

    • Purpose: To measure blood sugar levels.
    • Why Is It Ordered: High levels of glucose in the urine can be a sign of diabetes, which can increase the risk of UTIs and kidney problems.
  6. STD Testing (such as Chlamydia and Gonorrhea):

    • Purpose: To test for sexually transmitted infections.
    • Why Is It Ordered: Some STDs can cause urinary symptoms similar to UTIs.

These tests, when ordered alongside a Complete Urinalysis with Reflex to Culture, provide a comprehensive view of urinary tract health and can assist in diagnosing, monitoring, and managing conditions related to the urinary system, kidneys, and metabolic disorders. The specific combination of tests will depend on the individual’s symptoms, medical history, and initial urinalysis results.

Conditions where a Urinalysis with Reflex to Culture test is recommended:

A Urinalysis with Reflex to Culture test is commonly performed in the following conditions or diseases:

  1. Urinary Tract Infections (UTIs): Symptoms suggestive of a UTI, such as frequent urination, pain or burning during urination, or lower abdominal discomfort, may prompt the need for a urinalysis with reflex to culture.

  2. Kidney Infections: Suspected cases of pyelonephritis, a severe kidney infection, often require a urinalysis with reflex to culture to confirm the diagnosis and guide appropriate antibiotic treatment.

  3. Monitoring Chronic Kidney Disease: Patients with chronic kidney disease may undergo regular urinalysis with reflex to culture to monitor for signs of infection or assess kidney function.

How does my health care provider use a Urinalysis with Reflex to Culture test?

A urinalysis is a series of tests that can diagnose a variety of disorders. It can be used to screen for and/or diagnose a variety of illnesses, including urinary tract infections, renal abnormalities, liver diseases, diabetes, and other metabolic disorders, to name a few.

Urinalysis may be used in conjunction with other tests, such as urine albumin, to monitor the progress of treatment in patients with diseases or conditions like diabetes or kidney disease.

The urine culture is often used to diagnose a urinary tract infection and to identify the bacteria or yeast that is causing it. It can be used in conjunction with susceptibility testing to discover which drugs will stop the infection-causing bacterium from growing. The findings will aid a doctor in determining which treatments are most likely to be beneficial in treating a patient's infection.

The kidneys, a pair of bean-shaped organs positioned near the bottom of the ribcage on the right and left sides of the back, produce urine. To transport wastes out of the body, the kidneys filter waste from the blood and generate urine, a yellow fluid. Urine goes from the kidneys to the bladder, where it is briefly stored, and then via the urethra to be emptied. Urine is normally sterile, but bacteria or, more rarely, yeast can migrate up the urinary tract from the skin outside the urethra and produce a urinary tract infection.

The majority of UTIs are considered simple and treatable. The infection may spread up through the ureters and into the kidneys if they are not treated. A kidney infection is more hazardous and can result in renal damage that is irreversible. In some situations, a urinary tract infection can escalate to a life-threatening infection in the bloodstream.

People with renal disease or other illnesses that impact the kidneys, such as diabetes or kidney stones, as well as people with compromised immune systems, may be more susceptible to UTIs.

What do my Urinalysis test results mean?

There are numerous ways to interpret the results of a urinalysis. Unusual results are a warning sign that something isn't right and needs further testing.  To connect the urinalysis results with an individual's symptoms and clinical findings and to look for the causes of aberrant findings, other targeted tests must be done, such as a complete blood count, metabolic panel, or urine culture.

It is more likely that a problem must be addressed the higher the concentration of the atypical component, such as noticeably increased levels of protein, glucose, or red blood cells. On the other hand, the outcomes do not inform the medical professional as to what led to the finding or whether it is a transient or ongoing sickness.

A normal urinalysis does not rule out the possibility of disease. Early in a disease process, some persons will not release elevated amounts of a drug, and others will release them irregularly throughout the day, which means they could be overlooked by a single urine sample. Small amounts of substances may be undetectable in very dilute urine.

What do my Urine Culture test results mean?

Urine culture results are frequently interpreted in conjunction with urinalysis results, as well as how the sample was taken and whether symptoms are present. Because certain urine samples may contain bacteria that are ordinarily found on the skin, some culture results must be interpreted with caution.

A positive urine culture is usually defined as the presence of a single kind of bacteria growing at high colony counts. Cultures containing more than 100,000 CFU/mL of one species of bacteria in clean catch samples that have been correctly collected usually indicate infection. Even if an infection is present, there may not be a large number of germs present in some circumstances. Lower levels can sometimes suggest infection, particularly if symptoms are present. Similarly, values of 1,000 to 100,000 CFU/mL may be deemed significant for samples acquired using a technique that reduces contamination, such as a sample collected with a catheter.

Although UTIs can be caused by a variety of bacteria, the majority are caused by Escherichia coli, a kind of bacteria that is widespread in the digestive tract and frequently detected in stool. Proteus, Klebsiella, Enterococcus, and Staphylococcus are among the bacteria that can cause UTIs. A yeast infection, such as Candida albicans, can cause a UTI, but urethritis is more commonly caused by a sexually transmitted illness, such as herpes, chlamydia, or gonorrhea.

When a culture says "no growth in 24 or 48 hours," it usually means there isn't an infection. If the symptoms persist, a urine culture on a new sample may be performed to test for bacteria with reduced colony numbers or other microorganisms that could be causing the symptoms. Acute urethral syndrome is defined as the presence of white blood cells and low quantities of bacteria in a sick person's urine.

If multiple different species of bacteria thrive in a culture, the growth is almost certainly due to contamination. This is notably true in urine samples containing Lactobacillus and/or other prevalent nonpathogenic vaginal bacteria in women. If the symptoms persist, the healthcare provider may order a second culture on a more thoroughly collected sample. However, if one species of bacteria has considerably larger colony counts than the others, such as 100,000 CFUs/mL versus 1,000 CFUs/mL, further testing to determine the dominating bacterium may be required.

Susceptibility testing may be used to guide treatment if a culture is positive. Any bacterial infection can be dangerous and, if left untreated, can spread to other parts of the body. Pain is frequently the first sign of infection. Treatment as soon as possible, generally with antibiotics, will help to relieve the pain.

Most Common Questions About the Urinalysis with Reflex to Culture test:

Understanding the Urinalysis with Reflex to Culture Test

What is the Urinalysis with Reflex to Culture test?

The Urinalysis with Reflex to Culture test is a two-step process. Initially, a routine urinalysis is performed, which involves checking the appearance, concentration, and content of the urine. If certain abnormalities are found, then a urine culture is reflexively done to identify any bacteria or yeast present.

Why would a Urinalysis with Reflex to Culture test be ordered?

This test is often ordered when a person has symptoms of a urinary tract infection (UTI), such as pain during urination, frequent urination, lower abdominal pain, back pain, or the presence of blood in the urine.

Interpreting Urinalysis with Reflex to Culture Test Results

What does a positive Urinalysis with Reflex to Culture result mean?

A positive result indicates the presence of an infection in the urinary tract. The reflex to culture part of the test will provide additional information about the specific type of bacteria or yeast causing the infection.

What does a negative Urinalysis with Reflex to Culture result mean?

A negative result suggests there's no significant bacterial growth in the urine, indicating that a urinary tract infection is unlikely. However, it doesn't completely rule out an infection.

Urinalysis with Reflex to Culture Test and Medical Conditions

Can a Urinalysis with Reflex to Culture test detect kidney problems?

Yes, the initial urinalysis can reveal abnormalities such as protein or blood in the urine that may suggest kidney disease. If these are found, additional testing would typically be done to investigate further.

Can the Urinalysis with Reflex to Culture test help in diagnosing diabetes?

While the test is not typically used to diagnose diabetes, the urinalysis part of the test can identify glucose in the urine, which can be an indicator of poorly controlled or undiagnosed diabetes.

Can a Urinalysis with Reflex to Culture test detect sexually transmitted infections (STIs)?

While a urinalysis can indicate an infection, it does not specifically identify STIs. Specialized tests are needed for diagnosing STIs.

General Queries about the Test

Can I take medications before a Urinalysis with Reflex to Culture test?

Yes, but it's essential to inform your healthcare provider about all medications you're taking, as certain drugs may interfere with the test results.

How is a Urinalysis with Reflex to Culture test different from a regular urinalysis?

A regular urinalysis and a Urinalysis with Reflex to Culture test start the same way, by examining the urine's appearance and concentration, and testing it for various substances. The difference is that if the initial urinalysis shows signs of an infection, the sample will automatically ("reflexively") be cultured to identify the specific bacteria or yeast causing the infection.

Can a Urinalysis with Reflex to Culture test determine the severity of a urinary tract infection (UTI)?

The test can identify the type and amount of bacteria present, which can give some indication of the severity of an infection. However, the severity is more typically judged by the patient's symptoms and whether the infection has spread beyond the bladder.

Can a Urinalysis with Reflex to Culture test be used for drug testing?

While a urinalysis can detect certain drugs in the urine, the Urinalysis with Reflex to Culture test is not designed or used for drug testing. There are specific urine drug tests for that purpose.

Why does the urine need to be cultured in the Urinalysis with Reflex to Culture test?

Urine culture is an essential part of the Urinalysis with Reflex to Culture test because it allows for the identification of the specific type of bacteria or yeast causing a UTI. This information can help guide the choice of antibiotics for treatment.

Why might a Urinalysis with Reflex to Culture test be repeated?

The test might be repeated if the first one was not clear, if the symptoms persist despite treatment, or if there is a need to confirm that a UTI has been successfully treated.

Can a Urinalysis with Reflex to Culture test detect a yeast infection?

Yes, if yeast is present in significant quantities in the urine, the urine culture part of the test can identify it.

What does it mean if there are 'traces of leukocytes' in my Urinalysis with Reflex to Culture test?

Leukocytes, or white blood cells, are part of the immune system and fight infections. Their presence in the urine often suggests a urinary tract infection. 'Traces' means there are leukocytes in the urine, but not in large quantities.

Can a Urinalysis with Reflex to Culture test be used to diagnose conditions other than UTIs?

Yes, a urinalysis can provide information related to several other conditions apart from UTIs, including kidney disease, diabetes, and bladder stones, among others. However, further diagnostic tests would typically be done to confirm these conditions.

What is the significance of the 'reflex to culture' part of the Urinalysis with Reflex to Culture test?

The 'reflex to culture' part is done only if the initial urinalysis indicates an infection. It's significant because it identifies the specific type of bacteria or yeast causing the infection, which is essential for guiding treatment.

Can a Urinalysis with Reflex to Culture test differentiate between bacterial and viral infections?

Yes, a urine culture, which is part of the reflex test, can identify bacterial and yeast infections. However, it does not identify viral infections as viruses do not grow in standard culture conditions.

Are there any factors that can affect the results of a Urinalysis with Reflex to Culture test?

Yes, several factors can affect the results. These include the method of urine collection, the time between collection and testing, and certain medications. That's why it's important to follow your healthcare provider's instructions closely.

Can a Urinalysis with Reflex to Culture test be performed during menstruation?

Yes, but menstrual blood can contaminate the urine sample, leading to inaccurate results. It's usually recommended to wait until after your period to collect a urine sample, if possible.

Can I take a Urinalysis with Reflex to Culture test if I'm pregnant?

Yes, the test is safe to take during pregnancy. In fact, it's a routine part of prenatal care because UTIs can lead to complications if left untreated during pregnancy.

How does the Urinalysis with Reflex to Culture test help in managing UTIs?

The test helps in several ways. It can confirm a suspected UTI, identify the bacteria or yeast causing the infection, and monitor the effectiveness of treatment. If the UTI recurs, the test can also help determine whether the cause is the same as or different from the initial infection.

What's the next step if my Urinalysis with Reflex to Culture test shows I have a UTI?

If the test shows you have a UTI, your healthcare provider will usually prescribe antibiotics to treat the infection. The specific medication will depend on the type of bacteria identified in the urine culture.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

The following is a list of what is included in the item above. Click the test(s) below to view what biomarkers are measured along with an explanation of what the biomarker is measuring.

Also known as: UA, with Reflex to Culture, Urinalysis Complete with Reflex to Culture, Urine Analysis, with Reflex to Culture

Amorphous Sediment



Bacteria are living things that have only one cell. Most bacteria won't hurt you - less than 1 percent of the different types make people sick. Many are helpful. Some bacteria help to digest food, destroy disease-causing cells, and give the body needed vitamins. But infectious bacteria can make you ill. They reproduce quickly in your body. Many give off chemicals called toxins, which can damage tissue and make you sick. Examples of bacteria that cause infections include Streptococcus, Staphylococcus, and E. coli.


Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. A small amount of older red blood cells are replaced by new blood cells every day. Bilirubin is left after these older blood cells are removed. The liver helps break down bilirubin so that it can be removed from the body in the stool.

Calcium Oxalate Crystals

Calcium oxalate is a chemical compound that forms envelope-shaped crystals. A major constituent of human kidney stones.


Urinary casts are cylindrical structures produced by the kidney and present in the urine in certain disease states. They form in the distal convoluted tubule and collecting ducts of nephrons, then dislodge and pass into the urine, where they can be detected by microscopy.



Abnormal crystals may appear in urine as a result of pathology or due to normal catabolism


A blood glucose test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of the body, including those in the brain. The hormones insulin and glucagon help control blood glucose levels.

Granular Cast

The second-most common type of cast, granular casts can result either from the breakdown of cellular casts or the inclusion of aggregates of plasma proteins (e.g., albumin) or immunoglobulin light chains. Depending on the size of inclusions, they can be classified as fine or coarse, though the distinction has no diagnostic significance. Their appearance is generally more cigar-shaped and of a higher refractive index than hyaline casts. While most often indicative of chronic renal disease, these casts, as with hyaline casts, can also be seen for a short time following strenuous exercise

Hyaline Cast

Urinary casts are tiny tube-shaped particles. Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. The most common type of cast, hyaline casts are solidified Tamm-Horsfall mucoprotein secreted from the tubular epithelial cells of individual nephrons. Low urine flow, concentrated urine, or an acidic environment can contribute to the formation of hyaline casts, and, as such, they may be seen in normal individuals in dehydration or vigorous exercise. Hyaline casts are cylindrical and clear, with a low refractive index,


Ketones are substances produced in the liver when fat cells break down in the blood. A serum ketone test is a measurement of how many ketones are in the blood.

Leukocyte Esterase


Occult Blood

The test looks for hidden (occult) blood in a specimen sample. It can find blood even if you cannot see it yourself.


Level of acid


Body fluids contain many different proteins that serve diverse functions such as transport of nutrients, removal of toxins, control of metabolic processes, and defense against invaders. Protein electrophoresis is a method for separating these proteins based on their size and electrical charge. When body fluids are separated by electrophoresis, they form a characteristic pattern of bands of different widths and intensities, reflecting the mixture of proteins present. This pattern is divided into five fractions, called albumin, alpha 1, alpha 2, beta, and gamma. In some cases, the beta fraction is further divided into beta 1 and beta 2. Albumin, which is produced in the liver, accounts for about 60% of the protein in the blood. "Globulins" is a collective term used to refer to proteins other than albumin. With the exception of the immunoglobulins and some complement proteins, most of the globulins are also produced in the liver. Immunofixation electrophoresis (IFE) is a method used to identify abnormal bands seen on serum, urine, or CSF protein electrophoresis, as to which type of antibody (immunoglobulin) is present.


RBCs contain hemoglobin, which carries oxygen. How much oxygen your body tissues get depends on how many RBCs you have and how well they work.

Reducing Substances

Renal Epithelial Cells

Specific Gravity

Squamous Epithelial Cells

Transitional Epithelial

Triple Phosphate Crystals

Struvite stones (triple phosphate/magnesium ammonium phosphate) - about 10–15% of urinary calculi are composed of struvite (ammonium magnesium phosphate, NH4MgPO4·6H2O).[44] Struvite stones (also known as "infection stones", urease or triple-phosphate stones), form most often in the presence of infection by urea-splitting bacteria

Uric Acid Crystals

Abnormal crystals may appear in urine as a result of pathology or due to normal catabolism


WBCs help fight infections. They are also called leukocytes. There are five major types of white blood cells: basophils, eosinophils, lymphocytes (T cells and B cells), monocytes and neutrophils


Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in your body. Usually, your immune system keeps yeast under control. If you are sick or taking antibiotics, it can multiply and cause an infection.
*Process times are an estimate and are not guaranteed. The lab may need additional time due to weather, holidays, confirmation/repeat testing, or equipment maintenance.

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