Microscopic exam of urine pt 3 Flashcards
(95 cards)
1
Q
Two types of amorphous crystals
A
- Amorphous urates: acidic urine
- Amorphous phosphates: alkaline urine
2
Q
Color of amorphous urates and phosphates
A
Urates = pink
Phosphates = white
3
Q
Amorphous urates and phosphates solubility
A
Urates = heat and alkaline pH
Phosphates = acetic acid
4
Q
ID the element
A
Amorphous crystals
5
Q
Sodium urate
A
- Normal, appears by refrigeration
- Caused by protein rich diet, typically NOT reported if seen
6
Q
List normal crystals found in acidic urine
A
- Uric acid
- Calcium oxalate
- Hippuric acid
7
Q
List normal crystals found in alkaline urine
A
- Ammonium biurate
- Calcium carbonate
- Calcium phosphate
- Triple phosphate
- Calcium oxalate possible
- Hippuric acid possible
8
Q
List abnormal crystals
A
- Cystine
- Cholesterol
- Tyrosine
- Leucine
- Bilirubin
- Radiographic dye
- Sulfonamide
- Acyclovir
- Ampicillin
9
Q
Abnormal crystals are typically found in what pH?
A
Acidic urine
10
Q
ID the element
A
Sodium urates
11
Q
ID the element
A
Uric acid
lemon
12
Q
ID the element
A
Uric acid
rhombus
13
Q
ID the element
A
Uric acid
barrels
14
Q
ID the element
A
Uric acid
rosettes
15
Q
Are uric acid crystals birefringent?
A
Yes
16
Q
How to distinguish between uric acid and cystine crystals?
A
- Polarizing microscopy
- Uric acid polarizes light and cystine does not
17
Q
ID the element
A
Calcium oxalate
octahedral
dihydrate most common form
18
Q
ID the element
A
Calcium oxalate
rectangular
monohydrate
Looks like rice
19
Q
ID the element
A
Calcium oxalate
dumbell
monohydrate
20
Q
ID the element
A
Calcium oxalate
ovoid
monohydrate
21
Q
Can calcium oxalate polarize light?
A
Yes, so can help distinguish from RBCs (don’t polarize light)
22
Q
Major component of kidney stones
A
Calcium oxalate
23
Q
Foods high in oxalic acid
A
- Asparagus
- Spinach
- Tomatoes
- Rhubarb
- Garlic
- Ascorbic acid
24
Q
Pathologic conditions involving calcium oxalate
A
- Kidney stones
- Oxalic acid poisoning
- Liver disease
- Ethylene glycol (anti-freeze) poisoning
25
Which form of calcium oxalate crystal is most frequently associated with ethylene glycol poisoning?
Long, monohydrate form (can be confused with hippuric acid)
26
Hippuric acid pH and solubility
- Found in acidic urine, but also neutral or alkaline urine
- Soluble in alkaline and hot water
- Rare crystal
27
Hippuric acid crystals can be a sign of
Toluene exposure
28
Hippuric acid crystals associated with
Diets high in fruits/veggies high in **benzoic acid**
29
ID element
Hippuric acid (sharp ends)
30
Ammonium biurate crystals are also known as
"Thorny apples"
31
Ammonium biurate crystal solubility
Acetic acid and heat
32
Ammonium biurate crystal clinical significance
- Only significant if seen in freshly voided urine
- Usually artifact of old/improperly stored urine
33
What happens to ammonium biurate if you add acetic acid?
They convert to uric acid crystals
34
ID element
Ammonium biurate crystal
35
ID the element
Ammonium biurate crystals
36
Calcium carbonate solubility
Effervesces (bubbles) in HCl and acetic acid
37
Calcium carbonate crystals confused with
RBCs and yeast
38
ID the element
Calcium carbonate crystals (dumbell)
39
ID the element
Calcium carbonate crystals (spherical)
40
Calcium phosphate shape variations
- Large flat plates
- Rosette
- Wedge-shaped prisms
41
Calcium phosphate solubility
Dilute acetic acid
42
ID the element
Calcium phosphate (most common form)
43
ID the element
Calcium phosphate
44
ID the element
Calcium phosphate
45
Calcium phosphate clinical significance
May be associated with kidney stones
46
Triple phosphate solubility
Acetic acid
47
Does triple phosphate polarize light?
Yes
48
Triple phosphate formation
Bacteria split urea into ammonia and CO2 in alkaline urines
49
ID the element
Triple phosphate
50
Cystine solubility
- HCl
- NaOH
- NH4OH (ammonium hydroxide)
51
Does cystine polarize light?
No
52
Cystine clinical significance
- Cystinuria (metabolic disorder)
- Most freq cause of kidney stones in kids
53
Cholesterol solubility
Chloroform, ether
54
Does cholesterol polarize light?
Yes
55
ID the element
Cholesterol
Note notch on one or more corners
56
Cholesterol clinical significance
- Nephritis
- Nephrotic conditions
- Chyluria due to obstruction of lymph drainage
- Tumors
- Filariasis
- Lymph node enlargement
- Rarely seen
57
Cholesterol formation
Lipids getting refrigerated
58
Tyrosine frequency and color
- Very rare
- Colorless to yellow-brown
59
Tyrosine shapes
- Single, fine needles with sharp points
- Sheaves
- Rosettes
60
Tyrosine clinical significance
- **Severe liver disorders**
- Inherited aa metabolism disorders
- **Frequently seen with leucine crystals**
60
Chemical strip test result if tyrosine present
Bilirubin positive bc Tyr crystals in liver damage
61
ID the element
Tyrosine crystals
62
Leucine appearance
- Yellow-brown spheroids
- **Concentric rings**
63
Chemical strip test result if leucine present
Bilirubin positive
64
ID the element
Leucine crystal
65
Leucine crystals confused with
Sulfonamide crystals
66
Bilirubin crystal appearance
- Yellow-brown needles or granules in clumps
- Sometimes attached to cells
67
Bilirubin crystal clinical significance
- Severe liver disorders
- Jaundice
68
ID the element
Bilirubin crystal
69
Radiographic dye appearance
Mostly flat needles or sheaves
70
Radiographic dye may be confused with
- Cholesterol
- Tyrosine
- Sulfonamides
71
How does radiographic dye affect the physical properties of urine?
Very high specific gravity (>1.035)
*Note that chemical reagent strips only detect ionic solutes so radiographic dye not detected. Use refractometer to detect*
72
Does radiographic dye polarize light?
Yes
73
Sulfonamide appearance
- Flat needles
- Sheaves of small needles
- Spheroids
- Brown
74
ID the element
Sulfonamides
75
ID the element
Sulfonamides
76
Sulfonamides confused with
Tyrosine, radiographic dye, leucine
77
Sulfonamide clinical significance
- Seen in pt taking sulfonamide abx
- May crystallize if not adequately hydrated -> nephron tubular damage and/or kidney stones
78
Acyclovir crystals
- Anti-viral medication
- Confused with tyrosine crystals
79
ID the element
Acyclovir crystals
80
Ampicillin crystals seen when
Pt is receiving large ampicillin doses **without adequate hydration**
81
ID the element
Ampicillin crystals
82
ID the element
Ampicillin crystals
83
Artifacts seen when
- Urine is improperly collected or in unclean containers
- More common in pediatric or nursing home patients
84
Are artifacts reported?
No
Only reported if gross contamination prevents proper analysis
85
List artifacts found in urine
- Talcum powder
- Starch
- Oil droplets
- Air bubbles
- Pollen
- Hair/cloth fibers
- Fecal contamination
86
ID the element
Talcum powder (artifact)
87
ID the element
Starch
88
How to distinguish starch from RBCs?
Polarized light
Starch shows pseudo-maltese cross
89
ID the element
Starch under polarized light microscopy
Characteristic pseudo-maltese cross
90
ID the element
Oil droplet artifact
91
ID the element
Air bubble artifact
92
ID the element
Pollen artifact
93
Hair and cloth fibers mistaken for __
Distinguish by __
- Casts and parasites
- Fibers are refractile whilst casts are not
94
Fecal contamination seen when
- Urine improperly collected (infants)
- Fistula between intestinal and urinary tracts
