Urinary Crystals Part 1

Question 1

Acid

Yellow-brown (rosettes, wedges)

Answer 1

Uric acid

Question 2

Acid

Brick dust or yellow brown

Answer 2

Amorphous urates

Question 3

Acid

Colorless

Answer 3

Sodium urates

Question 4

Acid/neutral (alkaline)

Colorless (envelopes, oval, dumbbell)

Answer 4

Calcium oxalate

Question 5

Alkaline/neutral

White–colorless

Answer 5

Amorphous phosphates

Question 6

Alkaline/neutral

Colorless

Answer 6

Calcium phosphate

Question 7

Alkaline

Colorless (“coffin lids”)

Answer 7

Triple phosphate

Question 8

Alkaline

Yellow-brown (“thorny apples”)

Answer 8

Ammonium biurate

Question 9

Alkaline

Colorless (dumbbells)

Answer 9

Calcium carbonate

Question 10

formed by precipitation of urine solutes

Answer 10

Crystalluria

Question 11

CRYSTALS Reported as

Answer 11

rare, few, moderate, many/ HPF

Question 12

Components that contribute to CRYSTAL FORMATION: (3)

Answer 12

• Temperature
• Solute concentration
•pH

Question 13

Components that contribute to CRYSTAL FORMATION:

Answer 13

• Temperature
• Solute concentration
•pH

Question 14

______ increases precipitation

Answer 14

Refrigeration

Question 15

Normal and Iatrogenic Crystals in Acidic Urine (3)

Answer 15

Uric acids
Amorphous urates
Calcium oxalate

Question 16

Yellow-brown/colorless, pleomorphic, highly birefringent
Shapes: rhombic, four-sided flat plates (whetstones), wedges, and rosettes

Answer 16

URIC ACID

Question 17

URIC ACID is soluble in

Answer 17

Alkali

Question 18

URIC ACID is increased in

Answer 18

• Gout
• Leukemia (Chemotherapy)
• Lesch-Nyhan syndrome (Orange-Diaper
Rash)

Question 19

Uric acid is mistaken for

Answer 19

Cystine crystals

Question 20

Macroscopic: resemble Brick-dust Microscopic: yellow-brown granules

Answer 20

AMORPHOUS URATES

Question 21

AMORPHOUS URATES is soluble in

Answer 21

Alkali and heat

Question 22

AMORPHOUS URATES is commonly seen in

Answer 22

refrigerated samples and with pink sediments (uroerythrin)

Question 23

2 forms of CALCIUM OXALATE

Answer 23

1. Dihydrate (Wheddelite)
2. Monohydrate (Whewellite)

Question 24

What calcium oxalate form? most
common; colorless; octahedral envelope or 2 pyramids joined at their bases

Answer 24

Dihydrate (Wheddelite)

Question 25

What calcium oxalate form? least common; oval or dumbbell shaped

Answer 25

Monohydrate (Whewellite)

Question 26

Calcium oxalate is soluble in

Answer 26

Soluble in dilute HCl

Question 27

Seen in foods high in oxalic acid (tomatoes, asparagus) and ascorbic acid Pathologic: ethylene glycol (antifreeze) poisoning (children and pets)

Answer 27

CALCIUM OXALATE

Question 28

Pathologic: ethylene glycol (antifreeze) poisoning (children and pets)

Answer 28

CALCIUM OXALATE

Question 29

Can also be seen in neutral urine and alkaline urine (rarely)

Answer 29

CALCIUM OXALATE

Question 30

NORMAL URINARY CRYSTAL (2)

Answer 30

CALCIUM SULFATE HIPPURIC ACID

Question 31

Long, thin colorless needles/prisms Cigarette-butt appearance Rarely seen, no clinical significance

Answer 31

CALCIUM SULFATE

Question 32

CALCIUM SULFATE is soluble in

Answer 32

Acetic acid

Question 33

Yellow-brown or colorless, needles, rhombic plates and 4 sided prisms Rare, associated with foods containing benzoic acid

Answer 33

HIPPURIC ACID

Question 34

HIPPURIC ACID is soluble in

Answer 34

in hot water and alkali

Question 35

ABNORMAL URINARY CRYSTALS

Answer 35

RADIOGRAPHIC DYE SULFONAMIDE AMPICILLIN

Question 36

Flat, colorless, notched rhombic plates; highly birefringent Associated with a markedly elevated SG (>1.040)

Answer 36

RADIOGRAPHIC DYE

Question 37

RADIOGRAPHIC DYE is soluble in

Answer 37

10% NaOH

Question 38

Colorless to yellow-brown needles, sheaves of wheat, rosette, arrowheads, petals Possible tubular damage if crystals form in the nephrons

Answer 38

SULFONAMIDE

Question 39

SULFONAMIDE is soluble in

Answer 39

Acetone

Question 40

Colorless needles that tends to form bundles following refrigeration Massive dosage of penicillin

Answer 40

AMPICILLIN

Question 41

White precipitate Macroscopic: milky white Microscopic: granular in appearance Seen in refrigerated specimens

Answer 41

AMORPHOUS PHOSPHATES

Question 42

AMORPHOUS PHOSPHATES soluble in

Answer 42

dilute acetic acid

Question 43

AKA “Apatite” Colorless, flat rectangular plates or thin prisms often rosette formations Common constituent of renal calculi

Answer 43

CALCIUM PHOSPHATES

Question 44

CALCIUM PHOSPHATES is soluble in

Answer 44

dilute acetic acid

Question 45

AKA “Magnesium ammonium phosphate”, “Struvite” Prism shape resembling “coffin lids”, Fern-life Presence of urea-splitting bacteria (ex. Proteus, Pseudomonas)

Answer 45

TRIPLE PHOSPHATE

Question 46

TRIPLE PHOSPHATE is soluble in

Answer 46

dilute acetic acid

Question 47

Yellow-brown spicule covered spheres described as “thorny apples” Presence of urea-splitting bacteria (ex. Proteus, Pseudomonas)

Answer 47

AMMONIUM BIURATE

Question 48

AMMONIUM BIURATE is soluble in

Answer 48

acetic acid and heat

Question 49

Small, colorless, dumbbell or spherical; may occur in clumps No clinical significance

Answer 49

CALCIUM CARBONATE

Question 50

CALCIUM CARBONATE is soluble in

Answer 50

acetic acid with evolution of gas

Question 51

Abnormal Crystals

Answer 51

CYSTINE CHOLESTEROL LEUCINE TYROSINE BILIRUBIN

Question 52

Colorless, hexagonal plates May be confused with colorless uric acid crystals Cystinuria, renal calculi formation

Answer 52

CYSTINE

Question 53

Rectangular plates with a notch in one or more corners (staircase pattern), highly birefringent Lipiduria (Nephrotic syndrome)

Answer 53

CHOLESTEROL

Question 54

Yellow-brown spheres that demonstrate concentric circles and radial striations Soluble in hot alkali or alcohol Severe Liver Disease

Answer 54

LEUCINE

Question 55

Fine colorless to yellow needles that frequently form clumps or rosettes Soluble in alkali or heat Severe Liver Disease

Answer 55

TYROSINE

Question 56

Clumped needles or granules with the characteristic yellow color Soluble in acetic acid, HCl, NaOH, ether, chloroform Severe Liver Disease

Answer 56

BILIRUBIN

Question 57

URINARY ARTIFACTS

Answer 57

STARCH GRANULES Oil droplets and Air bubbles Pollen grains Hair and Fibers Fecal contamination

Question 58

What urinary artifact? Spheres with dimpled center MALTESE CROSS formation

Answer 58

STARCH GRANULES

Question 59

What urinary artifact? refractile; resem. RBCs

Answer 59

Oil droplets and Air bubbles

Question 60

What urinary artifact? spheres w/ cell wall and occasional concentric circles, may cause out of focus

Answer 60

Pollen grains

Question 61

What urinary artifact? mistaken for casts but longer, refractile

Answer 61

Hair and Fibers

Question 62

What urinary artifact? improper collection of specimen

Answer 62

Fecal contamination