8 Microscopic UA Crystals

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50 Terms

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3 factors important in crystal formation

  • temperature (lower = more percip)

  • concentration (higher = more percip)

  • pH (crystal type)

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Crystal ID (4 characteristics)

  1. Morphology - shape, color, size

  2. pH

  3. Polarizing light

  4. Solubility - heat/cold acid/alkaline

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Amorphous crystal - Urate

Normal

  • acidic urine

  • form upon refrigeration

  • pink sediment, brown/yellow/pink granule microscopically

  • heat and sodium hydroxide (alkaline) soluble

<p>Normal</p><ul><li><p>acidic urine</p></li><li><p>form upon refrigeration</p></li><li><p>pink sediment, brown/yellow/pink granule microscopically</p></li><li><p>heat and sodium hydroxide (alkaline) soluble</p></li></ul><p></p>
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Amorphous crystal - Phosphate

Normal

  • Phosphates and calcium

  • white sediment

  • Soluble in acetic acid

<p>Normal</p><ul><li><p>Phosphates and calcium</p></li><li><p>white sediment</p></li><li><p>Soluble in acetic acid</p></li></ul><p></p>
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Sodium Urate Crystal

Normal

  • protein rich diet

  • usually not reported

  • seen in refrigerated specimens

<p>Normal</p><ul><li><p>protein rich diet</p></li><li><p>usually not reported</p></li><li><p>seen in refrigerated specimens</p></li></ul><p></p>
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Uric acid crystal

Normal in low amount

  • Acidic urine

  • Increased if purine and nucleic acid levels increase → can see high amounts in urine with

    • gout

    • acute febrile condition

    • chronic nephritis

    • lesch nyhan syndrome

  • Soluble in alkaline soln and heat

  • Polarized!!

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Uric acid barrel shape

knowt flashcard image
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Uric acid rhombic shape

knowt flashcard image
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Uric acid rosette shape

nucleated crystal

<p>nucleated crystal</p>
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Uric acid long hexagon shape

dont confuse with cystine

<p>dont confuse with cystine</p>
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Distinguish uric acid crystal and cystine crystal

Polarized light (uric acid with polarize, cystine will not!)

<p>Polarized light (uric acid with polarize, cystine will not!)</p>
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Calcium oxalate crystal

Normal in low amount

  • Acidic ~ neutral pH urine

  • Soluble in HCl but insoluble in acetic acid

  • Polarize!

  • Major component of kidney stone in high amount

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Calcium oxalate dihydrate form

Most common form

<p>Most common form</p>
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Calcium oxalate monohydrate form

dumbbell or oval shape, can be confused with RBC → use polarizer

<p>dumbbell or oval shape, can be confused with RBC → use polarizer</p>
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Pathologic conditions with elevated calcium oxalate

  • renal calculi (most common cause)

  • oxalic acid poisoning

  • liver disease

  • ethylene glycol poisoning (antifreeze breaks down into oxalic acid)

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Hippuric acid crystal

Normal in low amount

  • acidic urine (can also be in neutral~alkaline)

  • soluble in alkaline, heat

  • No polarization

  • rare

    • seen in people with high fruit and veggie diet (high benzoic acid)

    • liver dysfunction

    • toluene exposure

<p>Normal in low amount</p><ul><li><p>acidic urine (can also be in neutral~alkaline)</p></li><li><p>soluble in alkaline, heat</p></li><li><p>No polarization</p></li><li><p>rare</p><ul><li><p>seen in people with high fruit and veggie diet (high benzoic acid)</p></li><li><p>liver dysfunction</p></li><li><p>toluene exposure</p></li></ul></li></ul><p></p>
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Distinguish hippuric acid with monohydrate calcium oxalate

  • polarization (calcium oxalate!)

  • solubility

    • Calcium oxalate: HCl

    • Hippuric acid: alkaline

<ul><li><p>polarization (calcium oxalate!) </p></li><li><p>solubility</p><ul><li><p>Calcium oxalate: HCl</p></li><li><p>Hippuric acid: alkaline</p></li></ul></li></ul><p></p>
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Ammonium Biurate crystal

Normal

  • alkaline urine

  • soluble in acetic acid, heat

    • acetic acid turns crystals into uric acid crystal

  • Usually an artifact of old or improperly stored urine

  • If in fresh urine → clinically significant

  • Thorny apple, brown

<p>Normal </p><ul><li><p>alkaline urine</p></li><li><p>soluble in acetic acid, heat</p><ul><li><p>acetic acid turns crystals into uric acid crystal</p></li></ul></li><li><p>Usually an artifact of old or improperly stored urine</p></li><li><p>If in fresh urine → clinically significant</p></li><li><p>Thorny apple, brown</p></li></ul><p></p>
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Ammonium biurate in acetic acid

Turns into uric acid crystal

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Calcium carbonte

Normal

  • alkaline urine

  • soluble: HCl and acetic acid will make it bubble (effervesce)

  • Can be confused with yeast, RBC

<p>Normal</p><ul><li><p>alkaline urine</p></li><li><p>soluble: HCl and acetic acid will make it bubble (effervesce)</p></li><li><p>Can be confused with yeast, RBC</p></li></ul><p></p>
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Calcium Phosphate

Normal

  • alkaline urine

  • Soluble in acetic acid

  • rosette can be confused with sulfonamide (sulfonamide wont dissolve in acid)

  • Sometimes in kidney stones

<p>Normal</p><ul><li><p>alkaline urine</p></li><li><p>Soluble in acetic acid</p></li><li><p>rosette can be confused with sulfonamide (sulfonamide wont dissolve in acid)</p></li><li><p>Sometimes in kidney stones</p><p></p></li></ul><p></p>
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Triple phosphate

Normal

  • alkaline urine

  • soluble in acetic acid

  • Polarized!!

  • coffin shape

<p>Normal</p><ul><li><p>alkaline urine</p></li><li><p>soluble in acetic acid</p></li><li><p>Polarized!!</p></li><li><p>coffin shape</p></li></ul><p></p>
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Dissolved triple phosphate shape

feathery

<p>feathery</p>
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Abnormal crystals general info

  • Usually found in acidic urine

  • ID usually confirmed by other tests, patient history, and pathologist/technical specialist

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Cystine crystal

Abnormal

  • acid urine

  • Soluble in HCl, NaOH, NH4OH

  • No Polarization

<p>Abnormal</p><ul><li><p>acid urine</p></li><li><p>Soluble in HCl, NaOH, NH4OH</p></li><li><p>No Polarization</p></li></ul><p></p>
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Cystine crystal cause

  • most common cause of kidney stone in kids

  • cystinuria

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Cholesterol

Abnormal

  • Acidic urine

  • soluble in chloroform, ether

  • Polarization!!

  • flat plates

  • Rare - usually caused by refrigeration

<p>Abnormal</p><ul><li><p>Acidic urine</p></li><li><p>soluble in chloroform, ether</p></li><li><p>Polarization!!</p></li><li><p>flat plates</p></li><li><p>Rare - usually caused by refrigeration</p></li></ul><p></p>
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Cholesterol crystal cause

  • excessive tissue breakdown - nephritis, nephrotic conditions

  • chyuria from lymph drainage obstruction

<ul><li><p>excessive tissue breakdown - nephritis, nephrotic conditions</p></li><li><p>chyuria from lymph drainage obstruction</p></li></ul><p></p>
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Tyrosine

Abnormal

  • Acidic urine

  • Soluble in HCl, NH4OH

  • SUPER RARE

  • Seen with positive bilirubin test, and leucine crystals

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Tyrosine crystal cause

  • severe liver disorder

  • inherited disorders of amino acid metabolism

<ul><li><p>severe liver disorder</p></li><li><p>inherited disorders of amino acid metabolism </p></li></ul><p></p>
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Tyrosine crystal seen with

  • positive bilirubin

  • positive urobilinogen (not always)

  • commonly seen with leucine crystal

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Leucine crystal

Abnormal

  • acidic urine

  • solube in NaOH, hot water

  • Biliruben and urobilinogen usually positive

  • Seen with tyrosine crystal

<p>Abnormal</p><ul><li><p>acidic urine</p></li><li><p>solube in NaOH, hot water</p></li><li><p>Biliruben and urobilinogen usually positive</p></li><li><p>Seen with tyrosine crystal</p></li></ul><p></p>
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Leucine crystal cause

  • severe liver disorder

  • amino acid metabolism disorder

    • maple syrup disease

  • severe viral hepatits

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Leucine crystal confused with

sulfonamide crystal

<p>sulfonamide crystal</p>
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Bilirubin crystal

Abnormal

  • acidic urine

  • soluble in acetic acid, HCl, NaOH, acetone

  • Usually seen in refrigerated urine

  • bilirubin strip should be positive

  • Bilirubin pigement will stain WBC, RBC, etc

<p>Abnormal</p><ul><li><p>acidic urine</p></li><li><p>soluble in acetic acid, HCl, NaOH, acetone</p></li><li><p>Usually seen in refrigerated urine</p></li><li><p>bilirubin strip should be positive</p></li><li><p>Bilirubin pigement will stain WBC, RBC, etc</p></li></ul><p></p>
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Bilirubin crystal cause

  • severe liver disorder

  • jaundice seen

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Radiographic dye crystal

  • check patient history

  • Specific gravity should be high >1.035

  • Polarizes!!!!

  • sheaves or flat needles

<ul><li><p>check patient history</p></li><li><p>Specific gravity should be high &gt;1.035</p></li><li><p>Polarizes!!!!</p></li><li><p>sheaves or flat needles</p></li></ul><p></p>
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Radiographic dye crystal confused with

Cholesterol, tyrosine, sulfonamide crystal

<p>Cholesterol, tyrosine, sulfonamide crystal</p>
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Sulfonamide crystal

  • acidic urine

  • soluble with acetone and alkaline

  • seen in patients taking sulfonamide antibiotics who are dehydrated → can cause tubular damage

  • shapes: flat needles, sheaves, small needles, spheroids, brown

<ul><li><p>acidic urine</p></li><li><p>soluble with acetone and alkaline</p></li><li><p>seen in patients taking sulfonamide antibiotics who are dehydrated → can cause tubular damage</p></li><li><p>shapes: flat needles, sheaves, small needles, spheroids, brown</p></li></ul><p></p>
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Sulfonamide can be confused with

Leucine, tyrosine, radiographic dye crystals

<p>Leucine, tyrosine, radiographic dye crystals</p>
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Acyclovir crystal

  • Neutral ~ slightly alkaline urine

  • From anti-viral medication for herpes

<ul><li><p>Neutral ~ slightly alkaline urine</p></li><li><p>From anti-viral medication for herpes</p></li></ul><p></p>
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Acyclovir can be confused with

Tyrosine

<p>Tyrosine</p>
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Ampicillin

  • seen in patients with high dose and dehydrated

  • Shape: needles and bundles

  • increased with refrigeration

<ul><li><p>seen in patients with high dose and dehydrated</p></li><li><p>Shape: needles and bundles</p></li><li><p>increased with refrigeration</p></li></ul><p></p>
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Talcum powder

Artifact

  • flat sheets

  • can be confused with cholesterol

<p>Artifact</p><ul><li><p>flat sheets</p></li><li><p>can be confused with cholesterol</p></li></ul><p></p>
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Starch

Artifact

  • dimpled

  • with polarize, for psuedo maltese cross

<p>Artifact</p><ul><li><p>dimpled</p></li><li><p>with polarize, for psuedo maltese cross</p></li></ul><p></p>
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Schistosoma harmatobium

Parasite, lives in bladder

<p>Parasite, lives in bladder</p>
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Trichomonas vaginalis

  • most frequently seen parasite in sediment

  • resembles WBCs or epithelial cell

  • STD so contaminant from genetilia

<ul><li><p>most frequently seen parasite in sediment</p></li><li><p>resembles WBCs or epithelial cell</p></li><li><p>STD so contaminant from genetilia</p></li></ul><p></p>
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Enterobius vermicularis

Intestinal parasite, fecal contamination

<p>Intestinal parasite, fecal contamination</p>
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Giardia lambia

Intestinal parasite, fecal contamination

<p>Intestinal parasite, fecal contamination</p>
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Mites

Skin parasite, contamination (dust mite)

<p>Skin parasite, contamination (dust mite)</p>