Transcript Powerpoint
Urinalysis and Body Fluids CRg Unit 2; Session 5 Crystals Found in the Urine Microscopic Examination - Part C, Common Alkaline Crystals Normal Crystals in Alkaline Urine Obj. Explain why performing all aspects of the urinalysis as soon as possible will provide the most accurate assessment of macroscopic and microscopic characteristics. Obj. Identify or describe the normal and abnormal constituents that may be seen in the urine microscopic including…….cells… acid, alkaline and pathologically significant crystals…. • Alkaline urine pH ≥ 7.0, however, crystals don’t always follow the rules regarding pH • Phosphates • Amorphous phosphates • Triple phosphates • Calcium phosphates • Calcium Carbonate • Ammonium biurate Amorphous Phosphates • May appear similar to amorphous urates • Differentiate: • Heavy white precipitate after refrigeration • Alkaline ph • Soluble in acetic acid Triple Phosphate Exhibit distinct prism shape often termed “coffin-lid”. Some views may resemble picture frames, or the roof line of a house as seen from an airplane. • Triple (ammonium magnesium) phosphate • Also called struvite • Appearance • Distinct shape • Colorless, prism, or coffin-lid shaped • Will Polarize • No clinical significance, though makes up 10-20% of urinary calculi Triple Phosphate • Triple phosphate crystals (can look like fern leaf when going into solution) • Polarizes light • Demonstrates birefringence • Dissolves in – Acetic acid Calcium phosphate • Small, flat plates; rectangle or wedged shaped • May be single, or rosettes • No clinical significance Calcium Carbonate • Ca Carbonate • Small, colorless dumbbell, and spherical shapes • Appear similar to dumbbell shaped calcium oxalate • Gas produced with addition of acetic acid • No clinical significance Ammonium Biurate • Rarely seen in freshly voided urine • Abnormal only if found in freshly voided urine • Common in old specimens and with urea-splitting bacteria • Only urates in alkaline urine • Low power magnification Ammonium Biurate • • • • Yellow–brown spherical bodies with long, irregular spicules Termed “thorn apple” or “cocklebur’, “Medusa head” Rare form has no spicules Dissolves in • Acetic acid • NaOH • And when heated (60oC References Lillian Mundt & Kristy Shanahan, Graff’s Textbook of Urinalysis and Body Fluids, 2nd Ed. Susan Strassinger & Marjorie Di Lorenzo, Urinalysis and Body Fluids, 5th Ed. Meryl Haber, MD, A Primer of Microscopic Urinalysis, 2nd Ed. Nikon Microscopy, The Source for Microscopy Education. Website http://www.microscopyu.com/articles/polarized/polarizedintro.html