5- Micro-examination: Crystals Flashcards by The Deen

kidney stone disease is called

nephrolithiasis

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stones that are in the ureter is called

ureterolithiasis

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urinary bladder stones which form or have passed into the bladder is called

cystolithiasis

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seeing crystals under microscope do not guarantee that they result from:

urolithiasis

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Crystal precipitation after micturition is most commonly due:

changes in urinary temperature

changes in urinary pH

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Crystals are usually not found in

freshly voided urine

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Normal Urinary Crystals

Normal acidic crystals

Normal alkaline crystals

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Abnormal Urinary Crystals

Metabolic origin

Iatrogenic origin

Abnormal crystals usually seen in acidic urine

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Urinary Crystals-formation factors

In vivo (body) factors:

Solute concentration
Kidney filtration rate
Urine pH
Diet
Excretion of:

diagnostic and therapeutic agents

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Urinary Crystals-formation factors

In vitro factors:

Temperature _{(solubility decreases with low temperature)}
Evaporation _{(increases solute concentration)}
Urine pH_{(changes with standing and bacterial overgrowth)}

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Normal Urinary Crystals MOST are clinically _____

insignificant

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clinically significant crystals are present in

freshly voided urine

metabolic disorders

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urinary calculi aka

urolithiasis

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Metabolic disorders may produce crystals

Cystine (inherited metabolic disease)
Leucine
Tyrosine
Cholesterol

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Latrogenic disorders-high doses of some drugs that froms crystals?

Salicilates (Aspirin)
Sulfonamides
Ascorbic Acid (vitamin C)

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Polarized light is used for the identification of

crystals and other anisotropic

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crystals that polarize the light are said to be?

optically active

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Birefringence is used for

differential diagnosis between various crystals

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Negative birefringence: (Y-B)

in polarizing filter with red compensator filter, the crystals are yellow when aligned

parallel

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Negative birefringence: (Y-B)

but crystals turn blue when aligned

across the direction of polarization

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Positive birefringence:(B-Y)

crystals are blue when aligned

parallel to the slow axis of the red compensator

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Positive birefringence:(B-Y)

but they turn yellow when aligned

across the direction of polarization

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Birefringence - VS +

(picture)

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Uric Acid crystals size and shape

can vary in both size and shape

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Uric Acid is **Pathologic** only when seen in

**freshly voided** urine

Urate crystals are common in patients with

urate urolithiasis or acute urate nephropathy

A **high uric** acid level in the urine may be due to

- gout_{(monosodium urate)} - high-purine diet _{(red meats, seafood, fish, spinach, mushrooms, dried peas)} - **Lesch-Nyhan** syndrome - cancer metastases - rhabdomyolysis _{(breakdown of muscle fibers)} - myeloproliferative disorders _{(e.g. multiple myeloma, leukemias)}

define Lesch-Nyhan syndrome

when the body is not able to process purine due to lack an enzyme

**Low** uric acid levels in the urine may be due to

- inability of kidney to get rid of uric acid well, _{which can lead to gout with kidney damage} - chronic glomerulonephritis - lead poisoning - long-term (chronic) alcohol use - a diet low in purines

what colour will uric acid crystals look under polarizes light?

various colours

Viewing uric acid with red compensation filter demonstrates

**negative birefringence** (yellow to blue color)

Amorphous urates often seen in:

**acidic** urine especially after **refrigeration**

Amorphous urates **appear** as aggregates of finely granular material **without**

any **defining shape** at the light microscopic

Amorphous urates **will re-solubilize when**

**heated at 60° C**

does Amorphous Urates has any **clinical** **interpretation**?

**No**

Monosodium Urate vs Calcium pyrophosphate

Calcium oxalate crystals may occur as either

**di-hydrate** (bi-hydrate) or **mono-hydrate** calcium oxalate

Calcium Oxalate can be seen in

- individuals with high dietary oxalate ingestion - patients with **urolithiasis** - patients with **acute renal failure**

Calcium Oxalate in patients with acute renal failure due to

**ethylene glycol** (antifreeze) **intoxication**

what form of Calcium Oxalate found in acute renal failure?

monohydrate calcium oxalate

**75%** of all urinary tract stones consists of

oxalates or combination with calcium phosphate

Common calcium oxalate appearance

**bi-hydrate** colorless bi-pyramids

Crystals Commonly Found in Alkaline Urine

* Triple Phosphates * Calcium Carbonates * Ammonium biurate

Triple phosphate crystals are frequently seen in

patients with UTI caused by **urea-splitting bacteria**, such as **Proteus or Klebsiella** species

Calcium carbonate crystals are **normally** found in urine, in _____ pH

**alkalinic**

Calcium carbonate **appearance**

small colorless granules dumbbells

A **unique feature** of calcium carbonate is

crystals **bubbling** with hydrochloric acid or acetic acid

Ammonium Biurate shape

Yellow–brown spherical bodies with long, irregular spicules “thorn apple”

**Cystine** occur in the sediment of patients with

**Cystinuria**

Define **Cystinuria**

**genetic defect** in renal cystine transport

Cystine crystals indicate an abnormality in metabolism of

the amino acid **cystine**

Cystine crystals are the most frequent cause of kidney stones in

**children or young patients**

cystine stones can **fill renal collecting** system, resulting in formation of

**staghorn** calculi

Define **Staghorn calculi**

branched stones that occupy a large portion of the renal pelvis and branch into several or all of the calices

Cystine crystals vs Uric acid under light

Cystine crystals **do not polarize** light Uric acid crystals are **multicolored** when polarized

Cystine crystals vs Uric acid crystals solubility in ammonia?

Cysitine **is soluble** Uric acid **is not**

Tyrosine Is found in patients with

severe liver disorders

The presence of **tyrosine** crystals is usually **accompanied by**

**bilirubin** and **leucine crystals**

describe Tyrosine

Colorless to yellow-brown single needles. also as sheaves or rosettes, needles in bundles.

Describe Leucine shape and color

yellow-brown spheroids concentric rings around the outer edge radial striations in the center

leucine crystals is often accompanied by

bilirubin and tyrosine crystals

Leucine can indicate which disease

Maple Syrup Disease

Cholesterol can be present in cases of

**glomerulonephritis** associated with **Nephrotic** Syndrome

describe the shape and color of Cholesterol

colorless large flat rectangular plate with **one or more corners notched**

Bilirubin Crystals color and shape

Yellow-brown needles or granules

Bilirubin crystals are seen in patients with

**hepatic disorders**

Bilirubin Crystals are present in urine is called (name the condition)

bilirubinuria

Confusing Artifacts includes

* Starch * Talc * Glass fragments

_{Confusing Artifacts: Starch} Polarize light into Maltese cross but **without** the:

**outer edge** resembling “crushed diamonds”

Confusing Artifacts: Talc and Glass Fragments (Picture)

5- Micro-examination: Crystals Flashcards

(70 cards)