Crystals Flashcards
Urinary crystals formation
Salts, medications, metabolites
low temps -> better precipitation
as concentration increases the ability to remain in solution decreases
variable pH
Disease associated with crystal formation
Liver disease
inborn errors of metabolism
renal disease
renal calculi
Urate Amorphous crystals
Not clinically significant
acidic urine
occur during refrigeration
Ca, Mg, Na, K urates
sediment is pink
soluble in heat and alkaline
Phosphate amorphous crystals
Alkaline urine
phosphates and Calcium
sediment white/grey
soluble in acetic acid
Uric acid Crystals
Acidic Urine
Normal in low concentration
Associated with increased purines & nucleic acids
Soluble in alkali, heat
Uric acid crystal diseases
Gout
Acute Febrile Conditions
Chronic Nephritis
Lesch-Nyhan syndrome
Uric acid Identification
Barrel, Rhomboid, Rosette
Birefringent (florescent in polarized light)
Calcium Oxalate Crystals
Acidic to slightly alkaline pH
soluble in high molarity HCL
Shapes: dumbbell, rectangular, envelope, ovoid
Calcium Oxalate diseases/conditions
Foods high in oxalic acid
Major component of kidney stones
Pathologic conditions: Kidney stones, oxalic acid poisoning, Liver disease, antifreeze poisoning
Calcium oxalate crystal associated with antifreeze poisoning
Long monohydrate form
don’t confuse with hippuric acid
Hippuric Acid crystals
Colorless 6 sided prisms, needles or rhomboid plates
acidic to slightly alkaline urine
soluble in: alkali, hot water
does not polarize light
Hippuric acid conditions/disease
Rare
High fruit/vegetable diet with benzoic acid
liver dysfunction. possible toluene exposure
Amonium Biurate crystals
“Thorny apples”
Alkaline urine
Soluble: acetic acid
Amonium biurate crystal disease/conditions
only significant in freshly voided urine
associated with old/improperly stored urine
Calcium Carbonate crystals
Alkaline urine
dumbbell, spherical, granular
soluble: Effervesces with HCL and acetic acid
Calcium carbonate crystal associations/disease
Don’t confuse with yeast. Yeast -> Acidic urine. Calcium Carbonate -> Alkaline
Calcium Phosphate crystals
colorless flat plates, rosettes, wedge shaped prisms
Alkaline urines
soluble: dilute acetic acid
Calcium phosphate associations/disease
Normal urine, but may indicate kidney stones
Triple Phosphate crystals
“coffin lid”
Alkaline urine
soluble: acetic acid
Birefringent
Triple phosphate crystals association/disease
Bacteria that split urea and CO2
Cystine crystals
Thin, colorless, Hexagonal shapes
Acidic urine
Soluble: HCL, NaOH, NH4OH
Do not polarize light
Cystine Crystal disease/associations
Cystinuria
Most frequent cause of kidney stones in children
Cholesterol crystals
clear flat plates with a corner notch
Acidic urine
soluble: chloroform, ether
polarizes light
Cholesterol crystals associations/disease
excessive tissue breakdown
chyluria due to lymph drainage obstruction
Tyrosine crystals
Very rare
colorless to yellow brown
fine needles with sharp points
acidic urine
soluble in: HCL, NH4OH
Bilirubin test positive
Tyrosine crystals association/disease
severe liver disorders
frequently seen with leucine crystals
Leucine crystals
Spheroid with concentric rings
acidic urine
soluble: NaOH, hot water
bilirubin positive
Leucine crystal disease/associations
severe liver disorders
MSUD
Viral Hepatitis
Bilirubin crystals
Yellow brown needles sometimes attached to cells
acidic urine
soluble: acetic acid, HCL, NaOH, Acetone
Bilirubin crystals disease/conditions
severe liver disorders
patient history, presentation of jaundice
radiographic contrast dye
Flat needles or sheaves
Can be confused with cholesterol, tyrosine, sulfonamides
Radiographic contrast dye findings
Specific gravity usually >1.035
highly birefringent
Patient history valuable
Sulfonamide crystals
Sulfonamide antibiotics
acidic urine
soluble: acetone and alkali
flat needles, Sheaves, or spheroids
Sulfonamide Crystals confusion
Can be confused with leucine, tyrosine, bilirubin
Sulfonamide crystal associations/disease
Dehydration (can cause damage to the nephron)
Kidney stone formation
acyclovir crystals
Anti-viral med
neutral to alkaline pH
confused with tyrosine crystals
Ampicillin
Large doses of ampicillin without adequate hydration
colorless needles that form bundles
Talcum powder
flat sheets. irregular and rocky
Starch artifacts
Cat buttholes
Pseudo maltese cross when polarized
Oil/air bubbles
Highly refractive
confused with RBCs
Trichomonas vaginalis
Most common parasite
pear shaped flagellate, undulate membrane. Motile in a fresh sample
Giardia Lamblia
Intestinal parasite
Appears in fecal contamination
The parasite that looks back at you
