Summarize the following text to main points and sub-points and make detailed explain for them:

ned as the ratio of the density of a given solid or 
liquid substance to the density of water at a specific 
temperature and pressure. 
 
 
Normal: The range of urine SG depends on the state of 
hydration and usually between 1.015 and 1.025. 
3.2.4 Urine Chemical examination 
a. Dipstick test 
Dipstick urinalysis a dipstick a thin, plastic stick with strips of 
chemicals on it is placed in the urine as shown in figure (3-3). The 
chemical strips change color if certain substances are present or if 
 
 
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their levels are above typical levels. It provides information about the 
multiple physicochemical properties of urine. Used predominantly in 
screening, dipstick testing requires less sophisticated training of 
personnel, and results are obtainable in only a few minutes. 
 
 
 
 
 
 
 
 
Figure (3-3): Urine dipstick test 
A dipstick test checks for: 
1. Urine reaction: this is a measure of the acidity or basicity of a 
solution. The kidneys maintain a normal acid-base balance 
primarily through the reabsorption of sodium and tubular 
secretion of hydrogen and ammonium ions as shown in figure 
(3-3A).  
Figure (3-3A): Urine dipstick test 
Normal: The pH of normal urine can vary widely, from 4.6 to 
8.0 (The average pH value is about 6.0 (acid) see table (3-2). 
 
 
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Table(3-2): Urine pH 
Acidic urine ( PH < 7.0 ) occurs in: 
Alkaline urine (pH >7.0) occurs in : 
a. Prolonged diarrhea. 
b. Starvation. 
c. Uremia. 
d. UTI caused by Escherichia coli. 
e. Gout. 
f. A diet high in meat and protein 
keeps the urine acid. 
 
a. UTI caused by urea-splitting bacteria. 
b. Renal tubular acidosis. 
c. Chronic renal failure. 
d. Metabolic alkalosis (as in prolonged 
vomiting due to lose of hydrogen ion) 
e. Age of specimen (loss of CO2 from the 
sample to the air raises the pH) 
f. Drugs that increase urine PH include 
potassium 
citrate, 
and 
sodium 
bicarbonate. 
2.  Urine protein test: 
a. Urine Albumin: In a healthy renal and urinary tract 
system, the urine contains no protein or only traces 
amounts. These consist of albumin. 
Normal: Only trace amounts (about 20 mg/dL/24h) 
 These consist of albumin: 
- Physiological proteinuria includes: 
1. 
Transient proteinuria: 
a. Excessive ingestion of proteins 
b. Emotional stress 
c. High fever 
d. Dehydration 
2. 
Intermittent proteinuria: 
It is frequently associated with postural changes (protein 
excretion is normal when the patient is lying down but is 
increased when a person is sitting or standing). 
- Pathological proteinuria includes: 
 
 
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A. Pre-renal proteinuria: This proteinuria is caused by conditions 
unrelated to the Kidney (protein loss occurs in the normal kidneys) 
and will disappear when those underlying conditions are resolved. 
B. Renal proteinuria:  
1. Glomerular proteinuria (albuminuria): Causes: 
a. Idiopathic glomerulonephritis 
b. Post-streptococcal glomerulonephritis 
c. Nephrotic syndrome 
2. Tubular proteinuria: Develop if the tubules fail to reabsorb 
proteins that are normally filtered in small amounts by the 
glomeruli 
3. Mixed glomerular-tubular proteinuria: This condition may 
be seen in advanced renal disease that involves the entire 
nephron, such as chronic renal failure and chronic 
pyelonephritis. 
C. 
Post-renal proteinuria:  Occurs when protein enters the urine 
because of haemorrhage or inflammation within the lower urinary 
tract. 
Causes: (Inflammation, Haemorrhage). 
 
 
Figure (3-3B): Urine dipstick test 
b. Sulfosalicylic acid Test: The chemical added causes the 
precipitation of dissolved proteins, which is measured from the 
degree of turbidity as shown in figure (3-3C). 
 
 
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Figure (3-3C): Sulfosalicylic acid Test 
3. Urine 
sugar: 
Glycosuria 
or 
glucosuria, 
under 
normal 
circumstances glucose in not excreted in urine. Glucosuria occurs 
when: blood glucose exceeds this renal threshold, for example: 
Diabetes mellitus as shown in figure (3-3D). 
False positive reactions 
a. The presence of bacterial peroxidases (e.g. cystitis) 
b. Drugs: Nalidixic acid, cephalosporins, Chloramphenicol. 
c. Stress, excitement, testing after a heavy meal. 
False negative reactions 
a. High concentrations of ascorbic acid. 
b. Drugs: salicylates, tetracyclines. 
c. High pH inhibit the reaction. 
 
Figure (3-3D): Urine dipstick test 
 
 
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4. Urine Ketone: are three water-soluble compounds that are 
produced as by-products when fatty acids are broken down for 
energy in the liver and kidney as shown in figure (3-3E). 
Interfering Factors 
False-positive results caused by drugs such as Levodopa, Insulin, 
Penicillamine. 
False-negative results occur if urine stands too long, due to loss of 
ketones into the air. 
 
Figure (3-3E): Urine dipstick test 
 
1. Urine Nitrite: Whereas NITRATES are normal in urine 
(mainly coming from food additives and from food protein,), 
the presence of NITRITES is not normal Bacteria that cause a 
urinary tract infection as shown in figure (3-3F). 
 
Figure (3-3F): Urine dipstick test 
2. Urine Bilirubin: Bilirubin is the yellow breakdown product of 
normal heme catabolism, its appears in Jaundice. Increased 
bilirubinuria may be caused by liver diseases, cholestasis or 
haemolytic anaemia as shown in figure (3-3G). 
Normal: Normally, a tiny amount of bilirubin is excreted in the 
urine, accounting for the light yellow color. 
Figure (3-3G): Urine dipstick test 
 
 
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 ﺗﻘﻨﻲ ﺗﺤﻠﻴﻠﺎﺕ ﻣﺮﺿﻴﺔ ﺍﺑﺮﺍﻫﻴﻢ ﻋﺒﺎﺱ
 
3. Urine Urobilinogen: Urobilinogen is a colorless product of 
bilirubin reduction. It is formed in the intestines by bacterial 
action as shown in figure (3-3H). 
 
Figure (3-3H): Urine dipstick test 
4. Leukocytes: Lowest Detectable Range 6–15 WBCs/hpf 
Positive result Indicator of urinary tract infection as shown in 
figure (3-3I). 
 
Figure (3-3I): Urine dipstick test 
5. Blood: haemoglobin Test equally sensitive to myoglobin and 
hemoglobin (including both intact erythrocytes and free 
Hemoglobin) as shown in figure (3-3J). 
 
Figure (3-3J): Urine dipstick test 
3.2.5 Microscopic Examination 
3.2.5.1 Urine Sediment Preparation: 
1. Mix urine well. 
2. Always pour the same amount of urine (approximately 10 ml) 
from the urine sample cup or urine vial into a conical plastic 
sediment tube. 
3. Apply urine to a test strip and analyse. 
4. To obtain the sediment, the urine sample is centrifuged for 8–
10 min at 400 g in a swing-out centrifuge. 
5. The supernatant is decanted in one go without the sediment 
being agitated or poured out. 
 
 
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6. Carefully resuspend the remaining sediment with the residual 
urine. (Do not shake the sediment excessively or tap it against 
the edge of the table to mix it up, since this can cause the casts 
to dissolve). 
3.2.5.2 Preparing the Native Sample: 
1. Using a plastic dropping pipette, place a small drop 
(approximately 20 μL) of urine sediment on the center of 
a clean slide and cover with a clean cover glass (hold at 
edges), paying attention to avoid air bubbles as shown in 
figure (3-4A). 
2. To achieve this, one side of the cover glass is placed directly 
on the drop of urine sediment on the slide and slowly (using 
the pipette) lowered in such a way that the sediment beneath 
the cover glass is well distributed. 
3. The weight of the cover glass ensures that the sediment drop is 
distributed evenly. 
4. The cover glass should not float away, nor should air bubbles 
be visible under the cover glass. 
 
 
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Figure (3-4A): Native urine sample preparation 
3.2.5.3 Specimen-Specific Adjustment of the Microscope 
1. In a first step, the microscopic plane of the specimen is set with 
the 10× objective. Finding the correct plane can be challenging 
if the specimen is too thin or contains insufficient urinary 
sediment constituents. The plane can be seen more readily by 
adjusting the edge of the cover glass. 
2. The sediment is then analysed for casts using a 10× objective. 
Large urinary sediment constituents can often be found at the 
edge of the cover glass. 
3. Following this, the sediment is analysed per field of view using 
a 40× objective. 
 
 
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4. Ir

Summary :