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AUBF > M1: Urine Sediments (Part 4: Crystals) > Flashcards

M1: Urine Sediments (Part 4: Crystals) Flashcards

1
Q

result from the precipitation of urine solutes including inorganic salts, organic compounds, and medications (iatrogenic compounds)

A

Crystals

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2
Q

primary reason for the identification of urinary crystals

a. nothing, its useless
b. identification of viral infection
c. detect the presence of the relatively few abnormal types of disorders (liver, errors of metabolism, renal dmaage, crystallization)
d. ALL
e. NOTA

A

c. detect the presence of the relatively few abnormal types of disorders (liver, errors of metabolism, renal dmaage, crystallization)

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3
Q

What disorders are able to be identified through observation of urinary crystals

A
  1. Liver disease
  2. Inborn errors of metabolism
  3. Renal damage caused by crystallization of medications compounds within the tubules
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4
Q

T or F

Crystals are not usually present in fresh urine and may form as urine cools to hot or refrigerator temperature

A

F (form as urine cools to room or refrigerator temperature)

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5
Q

Precipitation of crystals are subject to changes in what factors?

A

temperature, solute concentration, and pH

which affect solubility

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6
Q

Solute precipitates more readily at what temp?

A

low temp

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7
Q

T or F

Most crystals are of limited clinical significance

A

T

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8
Q

Crystals are usually reported as

apat to

A

Rare, Few, Moderate, or Many per HPF

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9
Q

Abnormal crystals may be reported as?

2 lang

A

Averaged and Reported per LPF

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10
Q

Crystals present in normal acidic urine

A
  1. Amorphous urates
  2. Uric acid
  3. Calcium oxalate
  4. Sodium urates
  5. Hippuric acid
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11
Q

Crystals present in normal alkaline urine

A
  1. Amorphous phosphates
  2. Triple phosphate
  3. Calcium carbonate
  4. Calcium phosphate
  5. Ammonium biurate (only urate)
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12
Q

Shape of crystals in general?

A

Geometric shape or amorphous

amorphous means no definite shape

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13
Q

Additional aids in crystal identification include the use of what ?

2 to

A

polarized microscopy, solubility characteristics of crystals

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14
Q

favors crystallization of organic and iatrogenic
compounds

A

Acid urine

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15
Q

favors formation of inorganic
salts

A

Neutral and alkaline urine

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16
Q

Calcium oxalate is commonly found in

A

acid urine

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17
Q

Calcium oxalate is sometimes found in

A

neutral urine

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18
Q

Calcium oxalate is rarely found in

A

alkaline urine

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19
Q

CRYSTALS IN NORMAL ACIDIC URINE

Aggregates or precipitate of certain chemicals like Ca2+, Na+ , Mg2+

A

Amorphous urates

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20
Q

CRYSTALS IN NORMAL ACIDIC URINE

Appear microscopically as yellow-brown small granules in acidic and neutral specimens

A

Amorphous urates

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21
Q

CRYSTALS IN NORMAL ACIDIC URINE

T or F

Amorphous phosphates may occur in clumps resembling granular casts and attached to other sediment structures

A

F (Amorphous urates)

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22
Q

CRYSTALS IN NORMAL ACIDIC URINE

  • Appear as pink-orange to reddish-brown (“brickdust”)
  • frequently encountered in specimens that have been refrigerated and produce a very characteristic pink sediment.
A

Amorphous urates

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23
Q

CRYSTALS IN NORMAL ACIDIC URINE: amorphous urates

Pink sediment in amorphous urates are beacsue of accumulation of pigment on thesurface
of the granules. What is that pigment?

A

uroerythrin

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24
Q

CRYSTALS IN NORMAL ACIDIC URINE: amorphous urates

Amorphous urates is soluble in what temp and solution?

A

Temp: Soluble in heat (60°C)
Solution: Dilute alkali

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25
Q

CRYSTALS IN NORMAL ACIDIC URINE: amorphous urates

Amorphous urates can be converted to uric acid using ?

A

HCl

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26
Q

CRYSTALS IN NORMAL ACIDIC URINE

Forms at very low pH (pH 5 – 5.5)

A

Uric acid

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27
Q

CRYSTALS IN NORMAL ACIDIC URINE

Usually appear yellow-brown, but may be colorless and have a six-sided shape, similar to cystine crystals.

A

Uric acid

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28
Q

CRYSTALS IN NORMAL ACIDIC URIN: uric acidE

Common form of uric acid

A

four-sided, flat, yellow or reddishbrown

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29
Q

CRYSTALS IN NORMAL ACIDIC URINE: uric acid

Other forms of uric acid

A

rhombic plates or prisms, lemon-shaped,
rosettes, “whetstone“

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30
Q

CRYSTALS IN NORMAL ACIDIC URINE: uric acid

Rare form of uric acid

A

Colorless hexagonals

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31
Q

CRYSTALS IN NORMAL ACIDIC URINE

are highly birefringent under polarized light, which aids in distinguishing them from cystine crystals.

A

Uric acid crystals

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32
Q

CRYSTALS IN NORMAL ACIDIC URINE: uric acid

Increased amounts of uric acid crystals, particularly in fresh urine, are associated with what conditions?

A
  • renal stones
  • high purine metabolism
  • patients with lymphoma or leukemia
  • Lesch-Nyhan syndrome
  • patinets wiht gout (sometimes)
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33
Q

CRYSTALS IN NORMAL ACIDIC URINE: uric acid

Uric acid is soluble in what solution?

A

alkali (NaOH)

insoluble in alcohol and acid

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34
Q

CRYSTALS IN NORMAL ACIDIC URINE

Frequently seen in acidic urine, but they can be found in neutral urine and even rarely in alkaline urine.

A

Calcium oxalate

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35
Q

CRYSTALS IN NORMAL ACIDIC URINE

Most common form of calcium oxalate

A

dihydrate

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36
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

easily recognized as a colorless, octahedral envelope or as two pyramids joined at their bases.

A

dihydrate

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37
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

less frequently seen form of calcium oxalate which are oval/ovoid, hour-glass, or dumbbell shaped

A

monohydrate form

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38
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

two forms of calcium oxalate?

A
  1. Dihydrate
  2. Monohydrate
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39
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

Both dihydrate and monohydrate forms are birefringent under ?

A

polarized light

helpful to distinguish the monohydrate form from nonpolarizing RBCs.

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40
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

T or F

Calcium oxalate crystals are sometimes seen in clumps attached to mucous strands and may resemble casts

A

T

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41
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

Clinical significance?

A
  • may be related to the formation of renal calculi
  • associated with foods highi n oxalic acid, such as tomatoes and asparagus, and ascorbic acid
  • presence of the monohydrate form in cases of ethylene glycol (antifreeze) poisoning
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42
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

end product of ascorbic acid metabolism

clinical sognificance

A

oxalic acid

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43
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

primary pathologic significance of CaOx crystals

A

monohydrate form in cases of ethylene glycol (antifreeze) poisoning

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44
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

majority of renal calculi are composed of?

A

calcium oxalate

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45
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

Soluble in what concentration

A

dilute HCl

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46
Q

CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate

Insoluble in ?

A

acetic acid

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47
Q

CRYSTALS IN NORMAL ACIDIC URINE

  • Slender prisms, usually colorless or sometimes yellowish
  • Arranged in a fan or leaf-like manner
  • Referred to as peacock tail-like crystals
A

Sodium urates

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48
Q

CRYSTALS IN NORMAL ACIDIC URINE

  • Needle-like crystals which are colorless and sometimes yellowish brown and appear singly
  • Seen in acidic, neutral and alkaline urine
A

Hippuric acid

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49
Q

CRYSTALS IN NORMAL ACIDIC URINE

Hippuric acid is soluble in?

A

hot water and alkali

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50
Q

CRYSTALS IN NORMAL ACIDIC URINE

This crystal can be seen when ingesting excessive benzoic acid

A

hippuric acid

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51
Q

CRYSTALS IN NORMAL ALKALINE URINE

  • Seen as granular aggregates like amorphous urates but seen in increased pH
  • Seen in neutral and alkaline urine
A

Amorphous phosphates

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52
Q

CRYSTALS IN NORMAL ALKALINE URINE

When present in large quantities following specimen refrigeration, they cause what formation which does not dissolve on warming?

A

White precipitate

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53
Q

CRYSTALS IN NORMAL ALKALINE URINE

Amorphous urates and amorphous phosphates can be differented based on?

A

color of sediment and ph of urine

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54
Q

CRYSTALS IN NORMAL ALKALINE URINE

Amorphous phosphate is insoluble at what temp

A

heat

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55
Q

CRYSTALS IN NORMAL ALKALINE URINE

Amorphous phosphate is soluble in what solution

A

HAc & dilute HCl

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56
Q

CRYSTALS IN NORMAL ALKALINE URINE

  • Ammonium magnesium phosphate (STRUVITE)
  • colorless, three-to-six-sided prisms w/ oblique ends
  • coffin lid crystals
A

Triple phosphate

57
Q

CRYSTALS IN NORMAL ALKALINE URINE: triple phosphate

rare form of triple phosphate

A

flat fern leaf form, sheets & flakes

58
Q

CRYSTALS IN NORMAL ALKALINE URINE: triple phosphate

TOF. Triple phosphate has no clinical significance but it is caused by UTI by urea splitting bactera (proteus sp)

A

T

59
Q

CRYSTALS IN NORMAL ALKALINE URINE: triple phosphate

Triple phosphate is seen in what concentration of urine?

A

highly alkaline urine

60
Q

CRYSTALS IN NORMAL ALKALINE URINE: triple phosphate

Triple phosphate is soluble in what concentration of urine?

A

dilute acetic acid

61
Q

CRYSTALS IN NORMAL ALKALINE URINE

  • Small and colorless, with dumbbell or spherical shapes
  • occur in clumps that resemble amorphous material
A

Calcium carbonate

62
Q

CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate

Calcium carbonate and Amorphous phosphate can be distinguished from each other by?

A

formation of gas after the addition of acetic acid

63
Q

CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate

Calcium carbonate and Bacteria can be distinguished from each other by?

A

presence of birefringent

64
Q

CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate

Clinical significance?

A

None

65
Q

CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate

Calcium carbonate is usially found in?

A

neutral and alkaline urine

66
Q

CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate

Calcium carbonate is soluble in?

A

acetic acid with effervescence

67
Q

CRYSTALS IN NORMAL ALKALINE URINE

  • Not frequently encountered
  • Colorless, flat, rectangular plates or prisms in rosette forms
A

Calcium phosphate

68
Q

CRYSTALS IN NORMAL ALKALINE URINE: calcium phosphate

rosette froms may be confused with what when the urine pH is in the neutral range.

A

sulfonamide crystals

69
Q

CRYSTALS IN NORMAL ALKALINE URINE: calcium phosphate

How is calcium phosphate and sulfonamide crystlas differentiated from each other?

A

Dissolving in acetic acid

calcium p dissolves while sulfonamide does not

70
Q

CRYSTALS IN NORMAL ALKALINE URINE: calcium phosphate

They have no clinical significance, although calcium phosphate is a common constituent of ?

A

renal calculi

71
Q

CRYSTALS IN NORMAL ALKALINE URINE

  • Exhibit the characteristic yellow-brown color of the urate crystals seen in acidic urine
  • Spicule-covered spheres
  • Referred to as thorny apples showing irregular projection or thorns and horns
A

Ammonium biurate

72
Q

CRYSTALS IN NORMAL ALKALINE URINE: Ammonium biurate

In their occurence in alkaline urine, ammonium biurate crystals resemble urates in that they are soluble at what temp ?

A

heat (60°C)

73
Q

CRYSTALS IN NORMAL ALKALINE URINE: Ammonium biurate

Ammonium biurate when added with glacial acetic acid are converted into what?

A

uric acid crystals

74
Q

CRYSTALS IN NORMAL ALKALINE URINE: Ammonium biurate

T or F

Ammonium biurate crystals are almost always encountered in old urine

A

T

75
Q

CRYSTALS IN NORMAL ALKALINE URINE: Ammonium biurate

Ammonium biurate may be associated with ammonia produced by?

A

urea-splitting bacteria.

76
Q

All abnormal urine crystals are found in?

A

acidic urine

rarely in neutral

77
Q

abnormal urine crystals are rarely found in?

A

neutral urine

78
Q

T or F

Most abnormal crystals have very characteristic shapes. However, their identity can be confirmed by patient information, including disorders and medication.

A

T

79
Q
  • can be caused by a variety of compounds, particularly when they are administered in high concentrations
  • They may be of clinical significance when they precipitate in the renal tubules.
A

Iatrogenic crystals

80
Q

Abnormal crystals may be from what 2 origins?

A

Either metabolic or iatrogenic origin

81
Q

What are the abnormal crystals of metabolic origin?

A
  1. Cystine
  2. Tyrosine
  3. Leucine
  4. Cholesterol
  5. Bilirubin
  6. Hemosiderin
82
Q

What are the abnormal crystals of iatrogenic origin?

A
  1. Ampicillin
  2. Radiographic contrast media
  3. Sulfonamides
  4. Indinavir sulfate (anti-retroviral therapy)
83
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

  • Found in acid urine
  • appear as colorless, hexagonal plates and may be thick or thin
A

Cystine

84
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Disintegrating forms of cystine may be seen in the presence of ?

A

ammonia

85
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Which crystal is compared to cystine?

A

uric acid crystal

86
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Identify if uric acid or cystine

very birefringent under polarized
microscopy

A

uric acid

87
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Identify if uric acid or cystine

have only polarizing capability

A

cystine

88
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Identify if uric acid or cystine

soluble in ammonia

A

both

89
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Identify if uric acid or cystine

dissolves in dilute HCl

A

cystine

90
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Positive confirmation of cystine crystals is made using ?

A

cyanide-nitroprusside test.

91
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Cindition associated with cystine

A

Fanconi syndrome

92
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

  • Appear as fine colorless to yellow silky needles that frequently form sheaves of wheat, clumps, or rosettes
  • encountered in inherited disorders of amino acid metabolism

mukhang walis jsncjs

A

Tyrosine

93
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

T or F

Tyrosine is usually seen in leucine crystals in specimen with positive chemical results for glucose

A

F (seen in specimen with positive chemical results for bilirubin)

94
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Tyrosine is soluble in?

A

alkali (ammonia & KOH) & in dilute HCl

95
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Tyrosine is insoluble in?

A

alcohol or ether

96
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Tyrosine is seen in what diseases

A

tyrosinuria & liver disease

97
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

  • Yellow-brown oily appearing spheres that demonstrate concentric circles and radial striations.
  • less frequently than tyrosine crystals and, when present, should be accompanied by tyrosine crystals.
  • Scallop like crystal
A

Leucine

98
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Leucine is soluble in?

A

hot alcohol & alkali

99
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Leucine is insoluble in?

A

ether

100
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

  • Found in acid urine
  • resembling a rectangular plate with a notch in one or more corners.
A

Cholesterol

101
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Diseases associated with cholesterol

A
  • Lipiduria
  • Npehrotic syndrome
102
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

T or F

Cholesterol is rarely seen unless specimens have been refrigerated, because the lipids remain in solid form

A

F (lipids remain in droplet form)

103
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

T or F

WHenever cholesterol is seen in disorders producing lipuria, nephortic syndrome. It is seen in conjuection with fatty casts and oval fat bodies

A

T

104
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

T or F

Cholesterols are low birefringent underpolarized light

A

F (High birefringent under polarized light)

105
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

Cholesterols are soluble in?

A

chloroform, ether & hot alcohol

106
Q

ABNORMAL CRYSTALS: METABOLIC ORIGIN

  • Present in hepatic/liver disorders
  • appear as clumped needles or granules with the characteristic yellow or red-browncolor of bilirubin
  • In disorders that produce renal tubular damage, such as viral hepatitis, bilirubin crystals may be found incorporated into the matrix of casts.
A

Bilirubin

107
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

  • Found in acidic and neutral urine
  • round forms w/ striations, needles, rhombics, whetstones, sheaves of wheat with central bindings, and rosettes
  • colorless to yellow-brown
A

Sulfonamides

108
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

the primary cause of sulfonamide crystallization.

A

Inadequate patinent hydration

109
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

The appearance of sulfonamide crystals in fresh urine suggest what condition?

A

tubular damage

110
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

Confirmatory test for sulfonamide? what color is it?

A

Diazo reaction: magenta

111
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

  • appear as long, fine, colorless needles that tend to form bundles following refrigeration
A

Ampicillin

112
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

T or F

Precipitation of antibiotics is not frequently encountered except for the rare observation of ampicillin crystals following massive doses of this penicillin compound with adequate hydration

A

F (WITHOUT adequate hydration)

113
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

  • Needles or flat plates resemble cholesterol crystal
  • Urine has a very high specific gravity reading
A

Radiographic dye

114
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

Radiographic dyes are similar to what crystals

clue: metabolic

A

cholesterol crystals

also are highly birefringent

115
Q

ABNORMAL CRYSTALS: IATROGENIC ORIGIN

CHolesterol and radiographic dye are differentiated by what?

A

urinalysis results, patient history

116
Q

What are the non-birefringent crystals?

A

Amorhpus phosphates
Tyrosine
Bilirubin

rest are birefringent

Birefringent: Crystalline materials may have multiple indices of refraction

117
Q

Identify what crystal based on characteristics

Scallop

A

Leucine

118
Q

Identify what crystal based on characteristics

Whetstone

A

Uric acid

119
Q

Identify what crystal based on characteristics

Dumbbell

A

Calcium oxalate, Calcium carbonate

120
Q

Identify what crystal based on characteristics

Coffin-lid

A

Triple phosphate

121
Q

Identify what crystal based on characteristics

Stair-step

A

Cholesterol

122
Q

Identify what crystal based on characteristics

Broken window pane

A

Cholesterol

123
Q

Identify what crystal based on characteristics

Octahedral

A

Calcium oxalate

124
Q

Identify what crystal based on characteristics

Hexagonal

A

Uric acid, Cystine

125
Q

Identify what crystal based on characteristics

2 pyramids joined at their bases

A

Calcium oxalate

126
Q

Identify what crystal based on characteristics

Envelope

A

Calcium oxalate

127
Q

Identify what crystal based on characteristics

3-sided crystal with oblique ends

A

Triple phosphate

128
Q

Identify what crystal based on characteristics

Fan-like

A

Sodium urates

129
Q

Identify what crystal based on characteristics

Tree’s annual ring

A

Leucine

130
Q

Identify what crystal based on characteristics

Old razor blade

A

Triple phosphate

131
Q

Identify what crystal based on disorders associated with

MSUD

A

Leucine

132
Q

Identify what crystal based on disorders associated with

Liver disease

A

Tyrosine, Leucine, Bilirubin

133
Q

Identify what crystal based on disorders associated with

Lesch Nyhan syndrome

A

Uric acid

134
Q

Identify what crystal based on disorders associated with

After chemotherapy for leukemia and lymphoma

A

Uric acid

135
Q

Identify what crystal based on disorders associated with

Ingestion of ethylene glycol

A

Calcium oxalate (monohydrate)

136
Q

Identify what crystal based on disorders associated with

Ingestion of benzoic acid

A

Hippuric acid

137
Q

Identify what crystal based on disorders associated with

Fanconi syndrome

A

Cystine

138
Q

Identify what crystal based on disorders associated with

Excessive Vitamin C

A

Calcium oxalate

139
Q

Identify what crystal based on disorders associated with

Casts seen in athletic pseudonephritis

A

RBC casts

AUBF (34 decks)

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