Crystals in Acidic Urine

Uric Acid

Rhomic, Diamond, Lemon or football

Gout, Leukemia, chemotherapy

Calcium Oxalate

Envelope or bipyamidal X shape

Seen in stones, ethylene glycol poisoning

Hippuric Acid

Yellow-brown or colorless elongated prisims or plates, needle clustsers

Little to no significance

Cystine

Clear/colorless hexagonal plates

Cystinuria, cystine stones

Tyrosine 

Fine colorless needles in bundles 

Rare, Severe liver disease

Leucine

Yellow concentric rings with striations and thichk outer border (grapfruit) cross formation under polarized light

Liver disease when seen with tyrosine

Cholesterol

Cross formation under polarized light, large flat colorless plates with one or more notched corners

Renal tubular cells breakdown, Nephrotic syndrome

Amorphous Urates

Pink sediment after refrigeration

Only found in acidic urine. No clinical significance

Sodium urates

Colorless or yellowish, needles or slender prisms in clusters

No clinical significance

Bilirubin

Red-Brown needles or granules

Liver disease, bilirubinuria