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6- UA > 5- Micro-examination: Crystals > Flashcards

5- Micro-examination: Crystals Flashcards

1
Q

kidney stone disease is called

A

nephrolithiasis

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2
Q

stones that are in the ureter is called

A

ureterolithiasis

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3
Q

urinary bladder stones which form or have passed into the bladder is called

A

cystolithiasis

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4
Q

seeing crystals under microscope do not guarantee that they result from:

A

urolithiasis

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5
Q

Crystal precipitation after micturition is most commonly due:

A

changes in urinary temperature

changes in urinary pH

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6
Q

Crystals are usually not found in

A

freshly voided urine

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7
Q

Normal Urinary Crystals

A

Normal acidic crystals

Normal alkaline crystals

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8
Q

Abnormal Urinary Crystals

A

Metabolic origin

Iatrogenic origin

Abnormal crystals usually seen in acidic urine

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9
Q

Urinary Crystals-formation factors

In vivo (body) factors:

A
  • Solute concentration
  • Kidney filtration rate
  • Urine pH
  • Diet
  • Excretion of:

diagnostic and therapeutic agents

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10
Q

Urinary Crystals-formation factors

In vitro factors:

A
  • Temperature (solubility decreases with low temperature)
  • Evaporation (increases solute concentration)
  • Urine pH (changes with standing and bacterial overgrowth)
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11
Q

Normal Urinary Crystals MOST are clinically _____

A

insignificant

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12
Q

clinically significant crystals are present in

A

freshly voided urine

or

metabolic disorders

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13
Q

urinary calculi aka

A

urolithiasis

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14
Q

Metabolic disorders may produce crystals

A
  • Cystine (inherited metabolic disease)
  • Leucine
  • Tyrosine
  • Cholesterol
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15
Q

Latrogenic disorders-high doses of some drugs that froms crystals?

A
  • Salicilates (Aspirin)
  • Sulfonamides
  • Ascorbic Acid (vitamin C)
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16
Q

Polarized light is used for the identification of

A

crystals and other anisotropic

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17
Q

crystals that polarize the light are said to be?

A

optically active

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18
Q

Birefringence is used for

A

differential diagnosis between various crystals

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19
Q

Negative birefringence: (Y-B)

in polarizing filter with red compensator filter, the crystals are yellow when aligned

A

parallel

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20
Q

Negative birefringence: (Y-B)

but crystals turn blue when aligned

A

across the direction of polarization

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21
Q

Positive birefringence:(B-Y)

crystals are blue when aligned

A

parallel to the slow axis of the red compensator

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22
Q

Positive birefringence:(B-Y)

but they turn yellow when aligned

A

across the direction of polarization

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23
Q

Birefringence - VS +

(picture)

A
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24
Q

Uric Acid crystals size and shape

A

can vary in both size and shape

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25
Q

Uric Acid is Pathologic only when seen in

A

freshly voided urine

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26
Q

Urate crystals are common in patients with

A

urate urolithiasis

or

acute urate nephropathy

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27
Q

A high uric acid level in the urine may be due to

A
  • gout (monosodium urate)
  • high-purine diet (red meats, seafood, fish, spinach, mushrooms, dried peas)
  • Lesch-Nyhan syndrome
  • cancer metastases
  • rhabdomyolysis (breakdown of muscle fibers)
  • myeloproliferative disorders (e.g. multiple myeloma, leukemias)
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28
Q

define Lesch-Nyhan syndrome

A

when the body is not able to process purine due to lack an enzyme

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29
Q

Low uric acid levels in the urine may be due to

A
  • inability of kidney to get rid of uric acid well, which can lead to gout with kidney damage
  • chronic glomerulonephritis
  • lead poisoning
  • long-term (chronic) alcohol use
  • a diet low in purines
30
Q

what colour will uric acid crystals look under polarizes light?

A

various colours

31
Q

Viewing uric acid with red compensation filter demonstrates

A

negative birefringence (yellow to blue color)

32
Q

Amorphous urates often seen in:

A

acidic urine

especially after refrigeration

33
Q

Amorphous urates appear as aggregates of finely granular material without

A

any defining shape at the light microscopic

34
Q

Amorphous urates will re-solubilize when

A

heated at 60° C

35
Q

does Amorphous Urates has any clinical interpretation?

A

No

36
Q

Monosodium Urate vs Calcium pyrophosphate

A
37
Q

Calcium oxalate crystals may occur as either

A

di-hydrate (bi-hydrate)

or

mono-hydrate calcium oxalate

38
Q

Calcium Oxalate can be seen in

A
  • individuals with high dietary oxalate ingestion
  • patients with urolithiasis
  • patients with acute renal failure
39
Q

Calcium Oxalate in patients with acute renal failure due to

A

ethylene glycol (antifreeze) intoxication

40
Q

what form of Calcium Oxalate found in acute renal failure?

A

monohydrate calcium oxalate

41
Q

75% of all urinary tract stones consists of

A

oxalates or combination with calcium phosphate

42
Q

Common calcium oxalate appearance

A

bi-hydrate

colorless

bi-pyramids

43
Q

Crystals Commonly Found in Alkaline Urine

A
  • Triple Phosphates
  • Calcium Carbonates
  • Ammonium biurate
44
Q

Triple phosphate crystals are frequently seen in

A

patients with UTI caused by urea-splitting bacteria, such as Proteus or Klebsiella species

45
Q

Calcium carbonate crystals are normally found in urine, in _____ pH

A

alkalinic

46
Q

Calcium carbonate appearance

A

small

colorless granules

dumbbells

47
Q

A unique feature of calcium carbonate is

A

crystals bubbling with hydrochloric acid or acetic acid

48
Q

Ammonium Biurate shape

A

Yellow–brown spherical bodies

with long, irregular spicules

“thorn apple”

49
Q

Cystine occur in the sediment of patients with

A

Cystinuria

50
Q

Define Cystinuria

A

genetic defect in renal cystine transport

51
Q

Cystine crystals indicate an abnormality in metabolism of

A

the amino acid cystine

52
Q

Cystine crystals are the most frequent cause of kidney stones in

A

children or young patients

53
Q

cystine stones can fill renal collecting system, resulting in formation of

A

staghorn calculi

54
Q

Define Staghorn calculi

A

branched stones that occupy a large portion of the renal pelvis and branch into several or all of the calices

55
Q

Cystine crystals vs Uric acid under light

A

Cystine crystals do not polarize light

Uric acid crystals are multicolored when polarized

56
Q

Cystine crystals vs Uric acid crystals solubility in ammonia?

A

Cysitine is soluble

Uric acid is not

57
Q

Tyrosine Is found in patients with

A

severe liver disorders

58
Q

The presence of tyrosine crystals is usually accompanied by

A

bilirubin

and

leucine crystals

59
Q

describe Tyrosine

A

Colorless to yellow-brown single needles.

also as sheaves or rosettes, needles in bundles.

60
Q

Describe Leucine shape and color

A

yellow-brown spheroids

concentric rings around the outer edge

radial striations in the center

61
Q

leucine crystals is often accompanied by

A

bilirubin

and

tyrosine crystals

62
Q

Leucine can indicate which disease

A

Maple Syrup Disease

63
Q

Cholesterol can be present in cases of

A

glomerulonephritis associated with Nephrotic Syndrome

64
Q

describe the shape and color of Cholesterol

A

colorless

large

flat
rectangular plate with one or more corners notched

65
Q

Bilirubin Crystals color and shape

A

Yellow-brown needles or granules

66
Q

Bilirubin crystals are seen in patients with

A

hepatic disorders

67
Q

Bilirubin Crystals are present in urine is called

(name the condition)

A

bilirubinuria

68
Q

Confusing Artifacts includes

A
  • Starch
  • Talc
  • Glass fragments
69
Q

Confusing Artifacts: Starch

Polarize light into Maltese cross but without the:

A

outer edge resembling “crushed diamonds”

70
Q

Confusing Artifacts: Talc and Glass Fragments

(Picture)

A

6- UA (9 decks)

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