Urine FEME
Urine Full Examination and Microscopic Examination
What it is
Urine Full Examination and Microscopic Examination (FEME) is a two-part urinalysis panel. The first part is a dipstick examination: a chemically treated strip dipped in fresh urine that detects the presence of protein, glucose, blood (haemoglobin), leukocyte esterase (an enzyme from white cells), nitrites (a bacterial metabolite), ketones, bilirubin, urobilinogen, and measures urine pH and specific gravity (concentration). The second part is microscopic examination of the urine sediment after centrifugation, identifying cellular elements and casts: red blood cells (erythrocytes), white blood cells (leucocytes), renal tubular epithelial cells, granular and cellular casts (formed in the kidney tubules and diagnostic of specific renal pathologies), crystals (uric acid, calcium oxalate, and others), bacteria, and yeast. Together, the dipstick and microscopy provide a comprehensive survey of the urinary tract — from the glomerulus (protein, red cell casts) through the tubules (tubular cells, granular casts) to the bladder and urethra (white cells, bacteria, transitional epithelial cells) — in a single non-invasive sample.
Why we measure it
The clinical reach of urine FEME is unusually broad for a single test. Proteinuria detected by dipstick reflects glomerular barrier dysfunction and is one of the earliest measurable kidney signals — protein in the urine before any change in serum creatinine or eGFR. Glycosuria (glucose in the urine) occurs when blood glucose exceeds the renal threshold for reabsorption, typically around 10 mmol/L — its presence alongside normal fasting glucose can indicate renal glycosuria (a benign variant) or undetected post-prandial hyperglycaemia. Haematuria — blood in the urine — is one of the most important findings in the FEME: macroscopic haematuria is always investigated urgently; microscopic haematuria (seen on dipstick and confirmed on microscopy) is evaluated further under AUA guidance, even without symptoms — causes range from kidney stones and inflammation to, less commonly, bladder or kidney growths. Leucocyturia (white cells in the urine) combined with nitrites indicates urinary tract infection. Red cell casts in the microscopy sediment — an uncommon but diagnostically specific finding — are strongly associated with kidney inflammation (glomerulonephritis) and need prompt medical review. The FEME therefore reflects kidney health (protein, blood, casts), metabolism (glucose, ketones), and urinary tract signals at once — a breadth that justifies its inclusion at every quarterly draw.
Why every 3 months
Urine composition changes rapidly with hydration, diet, exercise, and infection. A single annual FEME provides a one-time snapshot that may miss transient but clinically significant findings — microscopic haematuria, for example, may be intermittent and only detected on repeated testing. Quarterly FEME ensures that any persistent abnormality is caught and confirmed on repeat measurement rather than attributed to transient causes, and that early or intermittent findings are not missed between annual draws. Microscopic haematuria confirmed on two of three consecutive specimens is a standard threshold for urological investigation.
What movement means
The FEME is a qualitative and semi-quantitative panel with multiple components. The key clinical signals are: proteinuria (renal), haematuria (renal/urological), leucocyturia with nitrites (infection), glycosuria (metabolic), and red cell casts (glomerulonephritis — an urgent finding).
Proteinuria
Dipstick ≥ 1+ (≥ 0.3 g/L) on two separate specimens
Persistent proteinuria indicates significant glomerular barrier disruption. Quantification by uACR or 24-hour urine protein collection is the next step. Transient proteinuria can occur with fever, strenuous exercise, or orthostatic stress — confirmation on a rested morning specimen is required before investigation.
KDIGO 2012 Clinical Practice Guideline for Chronic Kidney Disease
Microscopic Haematuria
> 3 red blood cells per high-power field on microscopy
Red blood cells seen on microscopy. The AUA/SUFU guideline recommends further evaluation when this is confirmed, to identify the source — which ranges from benign causes to bladder or kidney conditions. The likelihood of a significant cause rises with age, smoking history, and pelvic radiation. Discuss with a registered medical practitioner.
AUA/SUFU Guideline on Microhematuria, Journal of Urology, 2020 — doi:10.1097/JU.0000000000001309
Leucocytes and Nitrites Present
Leucocyte esterase positive + nitrites positive
IDSA guidance associates this pattern with urinary tract infection, with urine culture as the standard confirmation. Without symptoms (asymptomatic bacteriuria), guidelines generally advise against treatment in non-pregnant adults. Discuss with a registered medical practitioner.
IDSA Clinical Practice Guideline for Uncomplicated UTI, 2011
Glycosuria
Glucose detectable on dipstick (normally absent)
Urine glucose above the renal threshold. Cross-reference with fasting glucose and HbA1c to distinguish hyperglycaemia from benign renal glycosuria (a genetic variant in renal glucose transport producing urine glucose at normal blood glucose levels).
Standard clinical reference
This page summarises published research for general education. It is not medical advice and does not interpret individual results. Discuss your results with a registered medical practitioner.
In the protocol
References
- 1.
Barocas DA, Boorjian SA, Alvarez RD, et al.. “Microhematuria: AUA/SUFU Guideline.” Journal of Urology. 2020.
- 2.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. “KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.” Kidney International Supplements. 2013.
- 3.
Gupta K, Hooton TM, Naber KG, et al.. “International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women.” Clinical Infectious Diseases. 2011.
- 4.
Simerville JA, Maxted WC, Pahira JJ. “Urinalysis: A Comprehensive Review.” American Family Physician. 2005.