crystals 2 urinary crystals most crystals form after urine sits –urinary solutes precipitate(ppt)...
TRANSCRIPT
Crystals
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Urinary Crystals
• Most crystals form after urine sits– urinary solutes precipitate(ppt) out of solution
• Clinical Significance– MOST are clinically INsignificant– Generally clinically significant crystals are present
on freshly voided urine (body temp.)– Crystal composition may imply urinary calculi
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Urinary Crystals• Clinical Significance Continued
– May indicate metabolic disorder• Cystinuria - inherited metabolic condition
– Crystals of some drugs may precipitate(ppt) out, especially in high doses
• Sulfonamides
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• Formation – crystals ppt out of solution when the
concentration in solution is greater than the solubility threshold for that solute
– Factors that affect crystal formation• pH, solute concentration, filtrate volume passing
through kidneys
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• Classification– Normal and Abnormal
• Normal Acidic crystals
• Normal Alkaline crystals
• Abnormal crystals - metabolic origin or iatrogenic origin
– Morphology• Based on pH
• Generally reported based on morphology alone
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Normal Acidic Crystals
• Amorphous urates– amorphous:– salt of uric acid (Na, Mg, Ca or K)– yellow/red to red/brown
• Uric Acid– along with amorphous urates, most common– pH <6.0
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Uric Acid
Acid urineYellowish Brown Ovals with pointed Ends
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Uric Acid
Birefringence under polarized light
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Uric Acid
Sometimes associated with gout
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Uric Acid Rosette Form
Many Forms
“Great Imposters”
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Normal Acidic Crystals
• Calcium oxalate– may also been seen in neutral or alkaline urine– dihydrate form is easily recognized
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Calcium Oxalate
• Common• pH acid or neutral• Envelope or dumb
bell shaped• Oval May be
mistaken for RBC• Ca Ox soluble in
HCl Insoluble in acetic acid
• RBC lyse in acetic acid
15Calcium Oxalate and Epi
16Calcium Oxalate
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Calcium oxalate dihydrate and monohydrate (dumbbell and ring forms)
- x400 magnification.
18Calcium Oxalate
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Amorphous Urates
Brown or colorless granulesNa or KSediment in spin down tube may have brick red color
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Amorphous Phosphates• Ca or Mg • Found in Basic
urine• Dissolves in
Acetic Acid
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Normal Alkaline Crystals
• Amorphous Phosphates
• Triple Phosphate (ammonium magnesium)
• Ammonium Biurate
• Calcium Phosphate Crystals
• Calcium Carbonate
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Triple Phosphate
Coffin Lid
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Triple Phosphate
AKA Ammonium Magnesium Phosphate
Found in Basic or Neutral urine
Soluble in Acetic Acid
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Calcium Phosphate Crystals
Alkaline urine
Irregular plates
“Sheets of Ice”
Rosettes
Associated with Cystitis and Urine retention
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Calcium Carbonate Crystals
Alkaline urine
Spheres or Dumb-bell forms
Birefringent
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Ammonium Biurate
– Rarely seen in freshly voided urine - common in old specimens
– Dark yellow or brown
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Calcium Carbonate
• Rhombohedral form
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Calcium Carbonate
• Dumbbell form
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Abnormal Crystals
• All are found in acidic urine
• Indicate pathologic condition
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Tyrosine
Acid pH
Needle shaped fine and silky appearance
Liver disease due to hepatitis, hepatocellular poisons
Leukemia's Typhoid fever and smallpox
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LeucineAcid pH
Spheres, Yellow-brown concentric rings
Birefringence
Pseudo Maltese Cross
Maple syrup disease
Liver Disease
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CystineAcid pH
Thin colorless hexagonal plates
Birefringent in polarized light
Hereditary metabolic disorders involving renal transport of various amino acieds
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Cystine
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Cystine
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CholesterolAcid Urine
Regular or irregular plate with Notched corner
Birefringent under polarized light
Various renal diseases
Nephrotic Syndrome or other condition where there is a deposition of lipids in Kidney
36Cholesterol
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Fiber
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Bilirubin Crystals
• Acidic Urine
• Pigmented yellowish Brown Granules
• Pathologic appear in a wide variety of hepatobiliary and hematopoietic diseases
39Bilirubin Crystals
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