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M1: Urine Sediments (Part 4: Crystals) Flashcards

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1
Q

result from the precipitation of urine solutes including inorganic salts, organic compounds, and medications (iatrogenic compounds)

A

Crystals

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2
Q

primary reason for the identification of urinary crystals

a. nothing, its useless
b. identification of viral infection
c. detect the presence of the relatively few abnormal types of disorders (liver, errors of metabolism, renal dmaage, crystallization)
d. ALL
e. NOTA

A

c. detect the presence of the relatively few abnormal types of disorders (liver, errors of metabolism, renal dmaage, crystallization)

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3
Q

What disorders are able to be identified through observation of urinary crystals

A
  1. Liver disease
  2. Inborn errors of metabolism
  3. Renal damage caused by crystallization of medications compounds within the tubules
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4
Q

T or F

Crystals are not usually present in fresh urine and may form as urine cools to hot or refrigerator temperature

A

F (form as urine cools to room or refrigerator temperature)

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5
Q

Precipitation of crystals are subject to changes in what factors?

A

temperature, solute concentration, and pH

which affect solubility

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6
Q

Solute precipitates more readily at what temp?

A

low temp

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7
Q

T or F

Most crystals are of limited clinical significance

A

T

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8
Q

Crystals are usually reported as

apat to

A

Rare, Few, Moderate, or Many per HPF

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9
Q

Abnormal crystals may be reported as?

2 lang

A

Averaged and Reported per LPF

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10
Q

Crystals present in normal acidic urine

A
  1. Amorphous urates
  2. Uric acid
  3. Calcium oxalate
  4. Sodium urates
  5. Hippuric acid
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11
Q

Crystals present in normal alkaline urine

A
  1. Amorphous phosphates
  2. Triple phosphate
  3. Calcium carbonate
  4. Calcium phosphate
  5. Ammonium biurate (only urate)
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12
Q

Shape of crystals in general?

A

Geometric shape or amorphous

amorphous means no definite shape

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13
Q

Additional aids in crystal identification include the use of what ?

2 to

A

polarized microscopy, solubility characteristics of crystals

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14
Q

favors crystallization of organic and iatrogenic
compounds

A

Acid urine

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15
Q

favors formation of inorganic
salts

A

Neutral and alkaline urine

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16
Q

Calcium oxalate is commonly found in

A

acid urine

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17
Q

Calcium oxalate is sometimes found in

A

neutral urine

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18
Q

Calcium oxalate is rarely found in

A

alkaline urine

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19
Q

CRYSTALS IN NORMAL ACIDIC URINE

Aggregates or precipitate of certain chemicals like Ca2+, Na+ , Mg2+

A

Amorphous urates

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20
Q

CRYSTALS IN NORMAL ACIDIC URINE

Appear microscopically as yellow-brown small granules in acidic and neutral specimens

A

Amorphous urates

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21
Q

CRYSTALS IN NORMAL ACIDIC URINE

T or F

Amorphous phosphates may occur in clumps resembling granular casts and attached to other sediment structures

A

F (Amorphous urates)

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22
Q

CRYSTALS IN NORMAL ACIDIC URINE

  • Appear as pink-orange to reddish-brown (“brickdust”)
  • frequently encountered in specimens that have been refrigerated and produce a very characteristic pink sediment.
A

Amorphous urates

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23
Q

CRYSTALS IN NORMAL ACIDIC URINE: amorphous urates

Pink sediment in amorphous urates are beacsue of accumulation of pigment on thesurface
of the granules. What is that pigment?

A

uroerythrin

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24
Q

CRYSTALS IN NORMAL ACIDIC URINE: amorphous urates

Amorphous urates is soluble in what temp and solution?

A

Temp: Soluble in heat (60°C)
Solution: Dilute alkali

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25
# CRYSTALS IN NORMAL ACIDIC URINE: amorphous urates Amorphous urates can be converted to uric acid using ?
HCl
26
# CRYSTALS IN NORMAL ACIDIC URINE Forms at very low pH (pH 5 – 5.5)
Uric acid
27
# CRYSTALS IN NORMAL ACIDIC URINE Usually appear yellow-brown, but may be colorless and have a six-sided shape, similar to cystine crystals.
Uric acid
28
# CRYSTALS IN NORMAL ACIDIC URIN: uric acidE Common form of uric acid
four-sided, flat, yellow or reddishbrown
29
# CRYSTALS IN NORMAL ACIDIC URINE: uric acid Other forms of uric acid
rhombic plates or prisms, lemon-shaped, rosettes, “whetstone“
30
# CRYSTALS IN NORMAL ACIDIC URINE: uric acid Rare form of uric acid
Colorless hexagonals
31
# CRYSTALS IN NORMAL ACIDIC URINE are highly birefringent under polarized light, which aids in distinguishing them from cystine crystals.
Uric acid crystals
32
# CRYSTALS IN NORMAL ACIDIC URINE: uric acid Increased amounts of uric acid crystals, particularly in fresh urine, are associated with what conditions?
* renal stones * high purine metabolism * patients with lymphoma or leukemia * Lesch-Nyhan syndrome * patinets wiht gout (sometimes)
33
# CRYSTALS IN NORMAL ACIDIC URINE: uric acid Uric acid is soluble in what solution?
alkali (NaOH) | insoluble in alcohol and acid
34
# CRYSTALS IN NORMAL ACIDIC URINE Frequently seen in acidic urine, but they can be found in neutral urine and even rarely in alkaline urine.
Calcium oxalate
35
# CRYSTALS IN NORMAL ACIDIC URINE Most common form of calcium oxalate
dihydrate
36
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate easily recognized as a colorless, octahedral envelope or as two pyramids joined at their bases.
dihydrate
37
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate less frequently seen form of calcium oxalate which are oval/ovoid, hour-glass, or dumbbell shaped
monohydrate form
38
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate two forms of calcium oxalate?
1. Dihydrate 2. Monohydrate
39
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate Both dihydrate and monohydrate forms are birefringent under ?
polarized light | helpful to distinguish the monohydrate form from nonpolarizing RBCs.
40
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate T or F Calcium oxalate crystals are sometimes seen in clumps attached to mucous strands and may resemble casts
T
41
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate Clinical significance?
* may be related to the formation of renal calculi * associated with foods highi n oxalic acid, such as tomatoes and asparagus, and ascorbic acid * presence of the monohydrate form in cases of ethylene glycol (antifreeze) poisoning
42
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate end product of ascorbic acid metabolism | clinical sognificance
oxalic acid
43
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate primary pathologic significance of CaOx crystals
monohydrate form in cases of ethylene glycol (antifreeze) poisoning
44
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate majority of renal calculi are composed of?
calcium oxalate
45
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate Soluble in what concentration
dilute HCl
46
# CRYSTALS IN NORMAL ACIDIC URINE: calcium oxalate Insoluble in ?
acetic acid
47
# CRYSTALS IN NORMAL ACIDIC URINE * Slender prisms, usually colorless or sometimes yellowish * Arranged in a fan or leaf-like manner * Referred to as peacock tail-like crystals
Sodium urates
48
# CRYSTALS IN NORMAL ACIDIC URINE * Needle-like crystals which are colorless and sometimes yellowish brown and appear singly * Seen in acidic, neutral and alkaline urine
Hippuric acid
49
# CRYSTALS IN NORMAL ACIDIC URINE Hippuric acid is soluble in?
hot water and alkali
50
# CRYSTALS IN NORMAL ACIDIC URINE This crystal can be seen when ingesting excessive benzoic acid
hippuric acid
51
# CRYSTALS IN NORMAL ALKALINE URINE * Seen as granular aggregates like amorphous urates but seen in increased pH * Seen in neutral and alkaline urine
Amorphous phosphates
52
# CRYSTALS IN NORMAL ALKALINE URINE When present in large quantities following specimen refrigeration, they cause what formation which does not dissolve on warming?
White precipitate
53
# CRYSTALS IN NORMAL ALKALINE URINE Amorphous urates and amorphous phosphates can be differented based on?
color of sediment and ph of urine
54
# CRYSTALS IN NORMAL ALKALINE URINE Amorphous phosphate is insoluble at what temp
heat
55
# CRYSTALS IN NORMAL ALKALINE URINE Amorphous phosphate is soluble in what solution
HAc & dilute HCl
56
# CRYSTALS IN NORMAL ALKALINE URINE * Ammonium magnesium phosphate (STRUVITE) * colorless, three-to-six-sided prisms w/ oblique ends * coffin lid crystals
Triple phosphate
57
# CRYSTALS IN NORMAL ALKALINE URINE: triple phosphate rare form of triple phosphate
flat fern leaf form, sheets & flakes
58
# CRYSTALS IN NORMAL ALKALINE URINE: triple phosphate TOF. Triple phosphate has no clinical significance but it is caused by UTI by urea splitting bactera (proteus sp)
T
59
# CRYSTALS IN NORMAL ALKALINE URINE: triple phosphate Triple phosphate is seen in what concentration of urine?
highly alkaline urine
60
# CRYSTALS IN NORMAL ALKALINE URINE: triple phosphate Triple phosphate is soluble in what concentration of urine?
dilute acetic acid
61
# CRYSTALS IN NORMAL ALKALINE URINE * Small and colorless, with dumbbell or spherical shapes * occur in clumps that resemble amorphous material
Calcium carbonate
62
# CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate Calcium carbonate and Amorphous phosphate can be distinguished from each other by?
formation of gas after the addition of acetic acid
63
# CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate Calcium carbonate and Bacteria can be distinguished from each other by?
presence of birefringent
64
# CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate Clinical significance?
None
65
# CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate Calcium carbonate is usially found in?
neutral and alkaline urine
66
# CRYSTALS IN NORMAL ALKALINE URINE: calcium carbonate Calcium carbonate is soluble in?
acetic acid with effervescence
67
# CRYSTALS IN NORMAL ALKALINE URINE * Not frequently encountered * Colorless, flat, rectangular plates or prisms in rosette forms
Calcium phosphate
68
# CRYSTALS IN NORMAL ALKALINE URINE: calcium phosphate rosette froms may be confused with what when the urine pH is in the neutral range.
sulfonamide crystals
69
# CRYSTALS IN NORMAL ALKALINE URINE: calcium phosphate How is calcium phosphate and sulfonamide crystlas differentiated from each other?
Dissolving in acetic acid | calcium p dissolves while sulfonamide does not
70
# CRYSTALS IN NORMAL ALKALINE URINE: calcium phosphate They have no clinical significance, although calcium phosphate is a common constituent of ?
renal calculi
71
# CRYSTALS IN NORMAL ALKALINE URINE * Exhibit the characteristic yellow-brown color of the urate crystals seen in acidic urine * Spicule-covered spheres * Referred to as thorny apples showing irregular projection or thorns and horns
Ammonium biurate
72
# CRYSTALS IN NORMAL ALKALINE URINE: Ammonium biurate In their occurence in alkaline urine, ammonium biurate crystals resemble urates in that they are soluble at what temp ?
heat (60°C)
73
# CRYSTALS IN NORMAL ALKALINE URINE: Ammonium biurate Ammonium biurate when added with glacial acetic acid are converted into what?
uric acid crystals
74
# CRYSTALS IN NORMAL ALKALINE URINE: Ammonium biurate T or F Ammonium biurate crystals are almost always encountered in old urine
T
75
# CRYSTALS IN NORMAL ALKALINE URINE: Ammonium biurate Ammonium biurate may be associated with ammonia produced by?
urea-splitting bacteria.
76
All abnormal urine crystals are found in?
acidic urine | rarely in neutral
77
abnormal urine crystals are rarely found in?
neutral urine
78
# T or F Most abnormal crystals have very characteristic shapes. However, their identity can be confirmed by patient information, including disorders and medication.
T
79
* can be caused by a variety of compounds, particularly when they are administered in high concentrations * They may be of clinical significance when they precipitate in the renal tubules.
Iatrogenic crystals
80
Abnormal crystals may be from what 2 origins?
Either metabolic or iatrogenic origin
81
What are the abnormal crystals of metabolic origin?
1. Cystine 2. Tyrosine 3. Leucine 4. Cholesterol 5. Bilirubin 6. Hemosiderin
82
What are the abnormal crystals of iatrogenic origin?
1. Ampicillin 2. Radiographic contrast media 3. Sulfonamides 4. Indinavir sulfate (anti-retroviral therapy)
83
# ABNORMAL CRYSTALS: METABOLIC ORIGIN * Found in acid urine * appear as colorless, hexagonal plates and may be thick or thin
Cystine
84
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Disintegrating forms of cystine may be seen in the presence of ?
ammonia
85
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Which crystal is compared to cystine?
uric acid crystal
86
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Identify if uric acid or cystine very birefringent under polarized microscopy
uric acid
87
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Identify if uric acid or cystine have only polarizing capability
cystine
88
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Identify if uric acid or cystine soluble in ammonia
both
89
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Identify if uric acid or cystine dissolves in dilute HCl
cystine
90
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Positive confirmation of cystine crystals is made using ?
cyanide-nitroprusside test.
91
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Cindition associated with cystine
Fanconi syndrome
92
# ABNORMAL CRYSTALS: METABOLIC ORIGIN * Appear as fine colorless to yellow silky needles that frequently form sheaves of wheat, clumps, or rosettes * encountered in inherited disorders of amino acid metabolism | mukhang walis jsncjs
Tyrosine
93
# ABNORMAL CRYSTALS: METABOLIC ORIGIN T or F Tyrosine is usually seen in leucine crystals in specimen with positive chemical results for glucose
F (seen in specimen with positive chemical results for **bilirubin**)
94
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Tyrosine is soluble in?
alkali (ammonia & KOH) & in dilute HCl
95
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Tyrosine is insoluble in?
alcohol or ether
96
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Tyrosine is seen in what diseases
tyrosinuria & liver disease
97
# ABNORMAL CRYSTALS: METABOLIC ORIGIN * Yellow-brown oily appearing spheres that demonstrate concentric circles and radial striations. * less frequently than tyrosine crystals and, when present, should be accompanied by tyrosine crystals. * Scallop like crystal
Leucine
98
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Leucine is soluble in?
hot alcohol & alkali
99
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Leucine is insoluble in?
ether
100
# ABNORMAL CRYSTALS: METABOLIC ORIGIN * Found in acid urine * resembling a rectangular plate with a notch in one or more corners.
Cholesterol
101
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Diseases associated with cholesterol
* Lipiduria * Npehrotic syndrome
102
# ABNORMAL CRYSTALS: METABOLIC ORIGIN T or F Cholesterol is rarely seen unless specimens have been refrigerated, because the lipids remain in solid form
F (lipids remain in **droplet** form)
103
# ABNORMAL CRYSTALS: METABOLIC ORIGIN T or F WHenever cholesterol is seen in disorders producing lipuria, nephortic syndrome. It is seen in conjuection with fatty casts and oval fat bodies
T
104
# ABNORMAL CRYSTALS: METABOLIC ORIGIN T or F Cholesterols are low birefringent underpolarized light
F (**High birefringent** under polarized light)
105
# ABNORMAL CRYSTALS: METABOLIC ORIGIN Cholesterols are soluble in?
chloroform, ether & hot alcohol
106
# ABNORMAL CRYSTALS: METABOLIC ORIGIN * Present in hepatic/liver disorders * appear as clumped needles or granules with the characteristic yellow or red-browncolor of bilirubin * In disorders that produce renal tubular damage, such as viral hepatitis, bilirubin crystals may be found incorporated into the matrix of casts.
Bilirubin
107
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN * Found in acidic and neutral urine * round forms w/ striations, needles, rhombics, whetstones, sheaves of wheat with central bindings, and rosettes * colorless to yellow-brown
Sulfonamides
108
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN the primary cause of sulfonamide crystallization.
Inadequate patinent hydration
109
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN The appearance of sulfonamide crystals in fresh urine suggest what condition?
tubular damage
110
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN Confirmatory test for sulfonamide? what color is it?
Diazo reaction: magenta
111
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN * appear as long, fine, colorless needles that tend to form bundles following refrigeration
Ampicillin
112
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN T or F Precipitation of antibiotics is not frequently encountered except for the rare observation of ampicillin crystals following massive doses of this penicillin compound with adequate hydration
F (**WITHOUT adequate hydration**)
113
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN * Needles or flat plates resemble cholesterol crystal * Urine has a very high specific gravity reading
Radiographic dye
114
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN Radiographic dyes are similar to what crystals | clue: metabolic
cholesterol crystals | also are highly birefringent
115
# ABNORMAL CRYSTALS: IATROGENIC ORIGIN CHolesterol and radiographic dye are differentiated by what?
urinalysis results, patient history
116
What are the non-birefringent crystals?
Amorhpus phosphates Tyrosine Bilirubin | rest are birefringent ## Footnote Birefringent: Crystalline materials may have multiple indices of refraction
117
# Identify what crystal based on characteristics Scallop
Leucine
118
# Identify what crystal based on characteristics Whetstone
Uric acid
119
# Identify what crystal based on characteristics Dumbbell
Calcium oxalate, Calcium carbonate
120
# Identify what crystal based on characteristics Coffin-lid
Triple phosphate
121
# Identify what crystal based on characteristics Stair-step
Cholesterol
122
# Identify what crystal based on characteristics Broken window pane
Cholesterol
123
# Identify what crystal based on characteristics Octahedral
Calcium oxalate
124
# Identify what crystal based on characteristics Hexagonal
Uric acid, Cystine
125
# Identify what crystal based on characteristics 2 pyramids joined at their bases
Calcium oxalate
126
# Identify what crystal based on characteristics Envelope
Calcium oxalate
127
# Identify what crystal based on characteristics 3-sided crystal with oblique ends
Triple phosphate
128
# Identify what crystal based on characteristics Fan-like
Sodium urates
129
# Identify what crystal based on characteristics Tree’s annual ring
Leucine
130
# Identify what crystal based on characteristics Old razor blade
Triple phosphate
131
# Identify what crystal based on disorders associated with MSUD
Leucine
132
# Identify what crystal based on disorders associated with Liver disease
Tyrosine, Leucine, Bilirubin
133
# Identify what crystal based on disorders associated with Lesch Nyhan syndrome
Uric acid
134
# Identify what crystal based on disorders associated with After chemotherapy for leukemia and lymphoma
Uric acid
135
# Identify what crystal based on disorders associated with Ingestion of ethylene glycol
Calcium oxalate (monohydrate)
136
# Identify what crystal based on disorders associated with Ingestion of benzoic acid
Hippuric acid
137
# Identify what crystal based on disorders associated with Fanconi syndrome
Cystine
138
# Identify what crystal based on disorders associated with Excessive Vitamin C
Calcium oxalate
139
# Identify what crystal based on disorders associated with Casts seen in athletic pseudonephritis
RBC casts

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