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UA > First test examination of crystals > Flashcards

First test examination of crystals Flashcards

1
Q

nephrolithiasis

A

kidney stone disease

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2
Q

stones that are in the ureter

A

ureterolithiasis

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3
Q

urinary bladder stones which form or have

passed into the bladder

A

cystolithiasis

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4
Q

crystals can form before or after micturation

A

micturation=urination

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5
Q

Crystal precipitation after micturition is most commonly due

to:

A
  • changes in urinary temperature, as can occur if the
    urine is stored at room temperature or in
    a refrigerator;
  • changes in urinary pH, as can occur in the
    presence of contamination of urea-splitting
    organisms.
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6
Q

abnormal crystals are usually seen in ___ urine

A

acidic

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7
Q

Prerequisites for identification of crystals:

A

– pH of urine
– morphology of crystals
– crystals solubility
– crystals polarization

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8
Q

abnormal acidic crystals

A

metabolic origin

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9
Q

abnormal alkaline crystals

A

Iatrogenic orgin

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10
Q

In vitro factors of urinary crystal formation

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

In vivo (body) factors:

A 
Solute concentration
- Kidney filtration rate
- Urine pH
- Diet
- Excretion of diagnostic
imaging and
therapeutic agents
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12
Q

most crystals are clinically

A

insignificant

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13
Q

Generally, clinically significant crystals are present in

freshly voided urine, or in cases of ______

A

metabolic disorders

e.g. gout

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14
Q
  • Metabolic disorders may produce crystals (4)
A
  • Cystine (inherited metabolic disease)
  • Leucine
  • Tyrosine
  • Cholesterol
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15
Q
  • Iatrogenic disorders-high doses of some drugs and supplements may cause formation of crystals:
A
  • Salicilates (Aspirin)
  • Sulfonamides
  • Ascorbic Acid (vitamin C)
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16
Q

_____ light is used for the identification of crystals

and other anisotropic substances.

A

Polarized

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17
Q

The first lens is referred to as the “_____ filter” and it

is nearest the light source, below the condenser

A

polarizing

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18
Q

The second filtering lens is called the “______” and is

located between the objective and the eyepiece lenses

A

analyzer

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19
Q

It is used for differential diagnosis between various

crystals

A

Birefringence

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20
Q

•Birefringence is a double refraction (or bending) of the
light into ___ rays, one is ____to the light axis
and other is at angles to it

A

two, parallel, right

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21
Q

Birefringence demonstrates crystal’s ability to split ____

into the spectrum

A

light

22
Q

when examining with a polarizing filter and RED
compensator filter, the crystals are YELLOW
when aligned parallel to the slow axis of
the red compensator

but they turn BLUE when aligned across the
direction of polarization

A

Negative birefringence: (Y-B)

23
Q

hen examining with a polarizing filter and red
compensator filter, the crystals are BLUE
when aligned parallel to the slow axis of
the red compensator

but they turn YELLOW when aligned across the
direction of polarization

A

• Positive birefringence

24
Q

ACIDIC URINE CRYSTALS

A

Uric acid
• Calcium Oxalates
• Amorphous Urates

25
Q

Are usually formed when urine pH

A

uric acid crystals

26
Q

can look like barrels, rosettes, rhomboids, needles
or hexagonal plates. usually amber in color, irrespective of the size
or shape of the individual crystal.

A

uric acid crystals

27
Q

Uric acid crystals are only pathogenic when in…

A

freshly voided urine.

28
Q

______ are much more common in
patients with urate urolithiasis or acute urate
nephropathy.

A

Urate crystals

29
Q

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

A

gout
- high-purine diet
- Lesch-Nyhan syndrome (when the body is not able to
process purine due to lack an enzyme)
- cancer metastases
- rhabdomyolysis (due to breakdown of muscle fibers)
- myeloproliferative disorders (e.g. multiple myeloma,
leukemias)

30
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
31
Q

May exhibit characteristic “lemon or football” shape appearing singly or in clusters, May also form into barrels, needles, rhomboids, and other shapes

A

Uric acid

32
Q 
Dissolves in alkali
• Insoluble in
– alcohol
– HCl
– acetic acid
A

Uric Acid

33
Q

will re-solubilize when heated at 60° C

A

Amorphous urates

34
Q

often seen in:

  • acidic urine,
  • especially after refrigeration
A

Amorphous Urates

35
Q

formed in urine pH 6.8 - 7, Colorless or yellowish, Needles or slender prisms occurring in
sheaves or clusters.

A

sodium urates

36
Q
  • are formed usually in acidic urine (pH 6)
  • may also been seen in neutral urine
  • they may occur as either:
A

• Calcium oxalate crystals:

37
Q

many small ones can be confused as amorphous

A

Calcium oxalate crystals

38
Q

patients with urolithiasis (___ of all urinary tract stones
consists of oxalates or combination with calcium
phosphate)

A

75%

39
Q

patients with acute renal failure due to ethylene glycol
(antifreeze) intoxication (______ calcium oxalate
crystals are found)

A

monohydrate

40
Q

Dissolves in:
– NaOH
– HCl

A

calcium oxalate

41
Q

Insoluble in:

– acetic acid

A

calcium oxalate

42
Q

Crystals Commonly

Found in Alkaline Urine

A

Triple Phosphates

Calcium Carbonates Ammonium biurate

43
Q

10-15% urinary calculi

A

Triple Phosphate crystals ( a.k.a. magnesium ammonium

phosphate, struvites)

44
Q

frequently seen in patients

with urinary tract infections, triple stones

A

Triple Phosphate crystals ( a.k.a. magnesium ammonium

phosphate, struvites)

45
Q

Exhibit distinct prism shape often termed “coffin-lid”

A

triple phosphate

46
Q

Polarizes light
• Demonstrates birefringence (not all)
• Dissolves in
– Acetic acid

A

Triple Phosphate (cont.)

47
Q

Calcium carbonate crystals are _____ found in urine, in

alkalinic pH

A

normally

48
Q

A unique feature of _____ _____ is that the
crystals bubbling with hydrochloric acid or acetic acid. This
can help to confirm the presence of calcium carbonate in
the urine.

A

calcium carbonate

49
Q

Found in alkaline urine pH 9
• Common seen in old specimens
• Abnormal only if found in freshly voided urine

A

Ammonium Biurate

50
Q

Dissolves in

A

Acetic acid
– NaOH
– And when heated (60oC)

51
Q

Abnormal Crystals of Metabolic Origin

A
  • Cystine
  • Tyrosine
  • Leucine
  • Cholesterol

UA (6 decks)

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