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 the primary screen for renal disease — 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 (detected by dipstick and confirmed on microscopy) warrants investigation for bladder cancer, kidney tumour, glomerulonephritis, or urolithiasis, even in an otherwise asymptomatic individual. 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 — indicate active glomerulonephritis and prompt immediate nephrology referral. The FEME therefore functions simultaneously as a screen for renal disease (proteinuria, haematuria, casts), metabolic dysfunction (glycosuria, ketonuria), urinary tract infection, and early urological malignancy — a breadth of surveillance 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
Confirmed microscopic haematuria on two of three consecutive specimens warrants urological investigation (cystoscopy, upper tract imaging) to exclude bladder and kidney pathology, including malignancy. Risk increases with age, smoking history, and pelvic irradiation. Glomerular haematuria is suggested by dysmorphic red cells or red cell casts on microscopy.
AUA/SUFU Guideline on Microhematuria, Journal of Urology, 2020 — doi:10.1097/JU.0000000000001309
Infection Pattern
Leucocyte esterase positive + nitrites positive
Strongly suggestive of urinary tract infection. Urine culture is indicated for confirmation and organism identification. Asymptomatic bacteriuria (infection pattern without symptoms) does not require treatment in most non-pregnant adults.
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
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.