URINARY

CRYSTALS
URINARY CRYSTALS
• Rarely of clinical significance.
• Appear as:
 true geometrically formed structures
 amorphous crystals.
• Reason for ID: Detect presence of relative few abnormal types.
• Disorders:
 Liver Disease
 Inborn errors of metabolism
 Renal damage
• Report: Rare, Few, Moderate, Many per hpf.
 (Abnornal Urine May be averaged and reported per lpf.)
CRYSTAL FORMATION
• Formed by precipitation of urine solutes
 Inorganic salts
 Organic compounds
 Medication (iatrogenic compounds)
• Precipitation is subject to changes which affect solubility.
 Temperature
 Solute concentration
 pH
• Readily at low temperatures and extremely abundant in refrigerated
specimen.
• High Specific Gravity
GENERAL IDENTIFICATION TECHNIQUES
• Shape and Color
 Variations may occur, present ID problems
• pH - First consideration
 Acidic Urine
 Alkaline Urine
• Polarized microscopy
 Geometric shape determines its birefringence
 Ability to polarize light
Note:Temperature and pH change contribute to crystal formation. Reverse of
these changes can cause crystals to dissolve.
Sediment should be aliquoted
NORMAL URINE CRYSTALS
 NORMAL CRYSTALS
SEEN IN ACIDIC URINE
URIC ACID CRYSTALS
• Appear as large granules and
have spicules, yellow brown
(rosettes, wedges)
• Increased amounts of uric acid
crystals, particularly in fresh
urine, are associated with
increased levels of purines and
nucleic acids and are seen in
patients with Leukemia who are
receiving chemotherapy.
AMORPHOUS URATES
• Brick dust or yellow brown
• Frequently encountered in
specimens that have been
refrigerated and produce a very
characteristic pink sediment.
• Accumulation of the pigment,
uroerythrin, on the surface of the
granules is the cause of the pink
color.
CALCIUM OXALATE
• colorless, octahedral envelope or
dumbbell or as two pyramids
joined at their bases.
• the finding of clumps of calcium
oxalate crystals in fresh urine may
be related to the formation of
renal calculi because majority of
renal calculi are composed of
calcium oxalate.
• associated with foods high in
oxalic acid and ascorbic acid.
NORMAL CRYSTALS
SEEN IN ALKALINE
URINE
AMORPHOUS PHOSPHATES
• granular in appearance
• causes a white precipitate
that does not dissolve on
warming
CALCIUM PHOSPHATES
• not frequently
encountered
• appear as colorless, flat
rectangular plates or
prisms in rosette formation
• no clinical significance,
although calcium
phosphate is a common
constituent of renal calculi
TRIPLE PHOSPHATE
• colorless, “coffin-lids”
• no clinical significance,
however they are often seen
in highly alkaline urine
associated with the presence
of urea-splitting bacteria.
AMMONIUM BIURATES
• yellow-brown,
• “thorny apples”, spicule
covered spheres
• almost encountered in old
specimens and may be
associated with the
presence of ammonia by
urea-splitting bacteria
CALCIUM CARBONATE
• colorless, dumbbell or
spherical shapes
• can be destinguish by the
formation of gas after the
addition of acetic acid
• no clinical significance
ABNORMAL CRYSTALS
SEEN IN URINE
CYSTINE CRYSTALS
• colorless hexagonal plates
• found in persons who inherit a
metabolic disorder that prevents
reabsorption of cystine by the
renal tubules
• persons with cystinuria have a
tendency to form renal calculi at
an early age
• positive confirmation is made by
by cyanide-nitropusside test
CHOLESTEROL
• colorless notched plates, with
fatty casts and oval fat bodies
• associated with disorders
producing lipiduria such as
nephrotic syndrome and are
seen in conjunction with fatty
casts and oval fat bodies
LEUCINE CRYSTALS
• yellow concentric circles and
radial striations
• frequently seen
• when present, should be
accompanied by tyrosine
crystals
• associated with liver diseases
TYROSINE
• colorless-yellow needles or
rosettes
• seen in conjunction with leucine
crystals in specimens with
positive chemical test results for
bilirubin
• associated with liver disease,
inherited disorder of amino acid
metabolism
BILIRUBIN CRYSTALS
• yellow clumped needles or
granules.
• in disorders that produce
renal tubular damage, such
as viral hepatitis, bilirubin
crystals may be found
incorporated into the matrix
of casts.
SULFONAMIDES CRYSTALS
• varied (needles, rhombics,
whetstones, shaves of wheat,
rosette) colorless to yellow-brown
• finding of these crystals in the
urine of patients being treated for
UTIs was common.
• inadequte patient hydration was
and still is the primary cause of
sulfonamide crystallization.
• can be associated with the
possibility of tubular damage
RADIOGRAPHIC DYE CRYSTALS
• colorless flat plates
• markedly elevated
specific gravity
accompanied by other
lipid elements and
heavy proteinuria
AMPICILLIN CRYSTALS
• colorless needles that tend to
form bundles following
refrigeration
• massive dose of penicillin
without adequate hydration
URINARY SEDIMENT
ARTIFACTS
STARCH
• granules, highly refractile
spheres with dimpled center
• seen when cornstarch is the
powder used in powdered
gloves

Confused with: RBCs or fat

droplets
OIL DROPLETS
• Highly refractile
• Contamination with immersion
oil or lotions and creams in
fecal contamination

Confused With: RBCs

AIR BUBBLES
• Occurs when specimen is placed
under cover slip

Confused with: RBCs

POLLEN GRAINS
• Spheres, with cell wall and
occasional concentric
circles
• Their large sizes may cause
out of focus of true
sediment constituents
HAIR AND FIBERS
• From clothing or diaper
• much longer and more refractile

Confused with: casts

FECAL CONTAMINATION
• Improperly collected
specimens or rarely the
presence of fistula
• appear as plant or meat
fibers as brown amorphous
material
• Their large sizes may cause
out of focus of true
sediment constituents