URINARY CRYSTALS

1. Amorphous Urates

2. Uric Acid

3. Sodium Urates

4. Calcium Oxalate (Acid/Neutral)

5. Hippuric Acid

NORMAL CRYSTALS SEEN IN ACIDIC URINE:

1. Amorphous Phosphate (Alkaline/Neutral)

2. Triple Phosphate

3. Calcium Phosphate (Alkaline/Neutral)

4. Calcium Carbonate

5. Ammonium Biurate

NORMAL CRYSTALS SEEN IN ALKALINE URINE:

1. Cystine

2. Cholesterol

3. Radiographic Dye

4. Sulfonamide

5. Ampicillin

ABNORMAL URINE CRYSTALS:

1. Tyrosine Crystals 

2. Leucine Crystals

3. Bilirubin Crystals

CRYSTALS ASSOCIATED WITH LIVER DISEASE:

NORMAL CRYSTALS SEEN IN ACIDIC URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

AMORPHOUS URATES

NORMAL CRYSTALS SEEN IN ACIDIC URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

URIC ACID CRYSTALS

NORMAL CRYSTALS SEEN IN ACIDIC URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

SODIUM URATES CRYSTALS

NORMAL CRYSTALS SEEN IN ACIDIC URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

CALCIUM OXALATE CRYSTALS

NORMAL CRYSTALS SEEN IN ALKALINE URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

AMORPHOUS PHOSPHATE CRYSTALS

NORMAL CRYSTALS SEEN IN ALKALINE URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

TRIPLE PHOSPHATE CRYSTALS

NORMAL CRYSTALS SEEN IN ALKALINE URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

CALCIUM PHOSPHATE CRYSTALS

NORMAL CRYSTALS SEEN IN ALKALINE URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

CALCIUM CARBONATE CRYSTALS

NORMAL CRYSTALS SEEN IN ALKALINE URINE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

AMMONIUM BIURATE CRYSTALS

ABNORMAL URINE CRYSTALS

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

CYSTINE CRYSTALS

ABNORMAL URINE CRYSTALS

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

CHOLESTEROL CRYSTALS

ABNORMAL URINE CRYSTALS

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

RADIOGRAPHIC DYE CRYSTALS

ABNORMAL URINE CRYSTALS

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

SULFONAMIDE CRYSTALS

ABNORMAL URINE CRYSTALS

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

AMPICILLIN CRYSTALS

CRYSTALS ASSOCIATED WITH LIVER DISEASE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

TYROSINE CRYSTALS

CRYSTALS ASSOCIATED WITH LIVER DISEASE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

LEUCINE CRYSTALS

CRYSTALS ASSOCIATED WITH LIVER DISEASE

Identify if NORMAL (ACIDIC OR ALAKLINE) / ABNORMAL / ASSC. W/ LIVER DISEASE:

BILIRUBIN CRYSTALS

• Amorphous Urates

• Amorphous Phosphates

• Ampicillin Crystals

Encountered in refrigerated specimens:

Refrigerated specimens

Amorphous urates can be frequently encountered in what type of specimens?

AMORPHOUS URATES

Disappear when the urine is warmed.

AMORPHOUS URATES

PINK SEDIMENT caused by accumulation of the pigment uroerythrin on the surface of the granules.

pink sediment

Amorphous urates is a what colored sediment?

uroerythrin

Amorphous Urates is a pink sediment caused by accumulation of what pigment on the surface of granules?

>5.5

pH of Amorphous Urates

AMORPHOUS URATES

Random sand-like appearance of the granules

• Uric acid

• Sulfonamide

Seen in a variety of shapes:

• rhombic,

• four-sided flat plates (whetstones),

• wedges,

• rosettes

URIC ACID CRYSTALS

Some also have that six-sided shape, similar to cysteine crystals.

• Uric acid (High)

• Calcium xalate (Strong)

• Cholesterol (Strong)

• Triple phosphate (Moderate)

• Calcium carbonate (Weak)

Birefringent under polarized light:

URIC ACID CRYSTALS

There is an increased amounts of these crystals when there are increased levels of purines and nucleic acids.

URIC ACID CRYSTALS

Seen in patients with:

• Leukemia who are receiving chemotherapy,

• Lesch–Nyhan syndrome, and

• Gout

purines and nucleic acids

Uric Acid Crystals are increased in amounts when there are Increased levels of what?

• Leukemia who are receiving chemotherapy

• Lesch–Nyhan syndrome

• Gout

Uric Acid Crystals can be seen in patients with what?

• Sodium urates

• Tyrosine

• Sulfonamide

• Ampicillin

• Bilirubin

Needle-shaped crystals:

SODIUM URATES CRYSTALS

Needle-shaped and seen in synovial fluid (fluid in between joints) during episodes of gout.

gout

Sodium urates are seen in synovial fluid (fluid in between joints) during episodes of ____.

Acidic/ Neutral urine

Calcium Oxalate Crystals can be seen in what type of urines?

1. Dihydrate

2. Monohydrate

2 FORMS OF CALCIUM OXALATE CRYSTALS:

Dihydrate calcium oxalate crystals

What is the most common form of calcium oxalate crystals?

Dihydrate calcium oxalate crystals

Most common form of cacium oxalate crystals

Dihydrate calcium oxalate crystals

Colorless, octahedral envelope or as 2 pyramids joined at their base.

Monohydrate calcium oxalate crystals

What is the less frequently seen form of calcium oxalate crystals?

Monohydrate calcium oxalate crystals

Less frequently seen form of calcium uxalate crystals

Monohydrate calcium oxalate crystals

Oval or dumbbell shaped.

They are both dumbbell shaped but:

• Calcium oxalate (monohydrate form) = oval

• Calcium carbonate = spherical

Characteristical difference between calcium oxalate crystal (monohydrate) and calcium carbonate crystals

nonpolarizing RBCs

Both calcium oxalate crystal forms are birefringent under polarized light, and you have to distinguish monohydrate form from _____.

renal calculi (kidney stones)

Finding clumps of calcium oxalate crystals in fresh urine may be related to the formation of?

renal calculi (kidney stones)

____ is composed of calcium oxalate.

oxalic acid and ascorbic acid

Calcium oxalate crystals can come from food high in what?

• tomatoes

• asparagus

Foods that can be a source of calcium oxalate crystals:

CALCIUM OXALATE CRYSTALS

Source: Food high in oxalic acid, such as tomatoes and asparagus, and also ascorbic acid, since oxalic acid is an end product of ascorbic acid metabolism.

CALCIUM OXALATE CRYSTALS

Pathologic significance: presence of monohydrate forms in cases of ethylene glycol (antifreeze) poisoning.

ethylene glycol (antifreeze) poisoning

Presence of monohydrate forms of calcium oxalate crystals can be seen in cases of what?

AMORPHOUS PHOSPHATE CRYSTALS

Granular in appearance, similar to amorphous urates.

AMORPHOUS PHOSPHATE CRYSTALS

Appear as white sediment

AMORPHOUS PHOSPHATE CRYSTALS

Does not dissolve upon warming

TRIPLE PHOSPHATE CRYSTALS

Ammonium Magnesium Phosphate Crystal

Ammonium Magnesium Phosphate Crystal

Triple Phosphate Crystals aka?

TRIPLE PHOSPHATE CRYSTALS

Prism shape that resembles “coffin lids”

• Triple phosphate (Ammonium Magnesium Phosphate)

• Ammonium biurate

Associated with the presence of urea splitting bacteria.

urea splitting bacteria

Triple Phospate Crystals are often seen in highly alkaline urine associated with the presence of what?

CALCIUM PHOSPHATE CRYSTALS

Colorless, flat rectangular plates or thin prisms often in rosette formations.

sulfonamide crystals; neutral

Rosette forms in calcium phosphate crystals may be confused with _____ when the urine pH is in ___range.

dilute acetic acid

What is used to check if the crystal is sulfonamide or calcium phosphate?

CALCIUM PHOSPHATE CRYSTALS

Dissolves in dilute acetic acid

SULFONAMIDE CRYSTALS

Does not dissolve in dilute acetic acid

renal calculi

Calcium phosphate is common constituent of what?

• Calcium Oxalate

• Calcium Phosphate

• Triple Phosphate (Ammonium Magnesium Phosphate)

• Cystine

• Uric Acid

Crystals Commonly Found in Renal Calculi:

CALCIUM CARBONATE CRYSTALS

Small and colorless, with dumbbell or spherical shapes

CALCIUM CARBONATE CRYSTALS

May occur in clumps that resemble amorphous material

CALCIUM CARBONATE CRYSTALS

Formation of gas after the addition of acetic acid

formation of gas after the addition of acetic acid

To distinguish calcium carbonate from amorphous:

formation of gas after the addition of acetic acid

To distinguish calcium carbonate from amorphous:

AMMONIUM BIURATE CRYSTALS

“thorny apples” appearance, spicule-covered spheres

AMMONIUM BIURATE CRYSTALS

Resemble other urates → dissolve at 60°C and convert to uric acid crystals when glacial acetic acid is added.

60°C

Ammonium biurate crystals dissolves at what temperature?

uric acid crystals

Ammonium biurate crystals convert to _____ when glacial acetic acid is added.

glacial acetic acid

Ammonium biurate crystals convert to uric acid crystals when ___ is added.

AMMONIUM BIURATE CRYSTALS

Mostly encountered in old specimens and may be associated with the presence of urea splitting bacteria.

old specimens

Ammonium biurate crystals is mostly encountered in what type of specimens?

urea splitting bacteria

Ammonium biurate crystals may be associated with the presence of what type of bacteria?

CYSTINE CRYSTALS

Found in the urine of people with metabolic disorder that prevents the reabsorption of cystine by the renal tubules

CYSTINE CRYSTALS

Clinical significance: Cystinuria

CYSTINE CRYSTALS

Appear as colorless, hexagonal plates, may be thick or thin

CYSTINE CRYSTALS

Disintegrating forms may be seen in the presence of ammonia

CYSTINE CRYSTALS

It is difficult to differentiate from colorless uric acid crystals

With metabolic disorder that prevents the reabsorption of cystine by the renal tubules

Cystine Crystals is found in the urine of people with what?

ammonia

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

colorless uric acid crystals

Cystine crystals is difficult to differentiate with what?

• uric acid crystals (birefringent and thick);

• cystine crystals (polarizing capability)

To differentiate cystine crystals from uric acid crystals:

Cyanide Nitroprusside Test

What test is used for the positive confirmation for cystine crystals?

CHOLESTEROL CRYSTALS

Resembles rectangular plate with a notch in one or more corners.

CHOLESTEROL CRYSTALS

Associated with disorders producing lipiduria (nephrotic syndrome).

CHOLESTEROL CRYSTALS

Seen in conjunction with fatty casts and oval fat bodies.

lipiduria (nephrotic syndrome)

Cholesterol crystals are associated with disorders producing ______.

fatty casts and oval fat bodies

Cholesterol crystals are seen in conjunction with what?

RADIOGRAPHIC DYE CRYSTALS

Appear similarly to cholesterol crystals, also highly birefringent