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Urinalysis and Body Fluids: Unit 2 Session 5

This document provides an overview of crystals found in urine microscopic examination. It discusses that urine crystals are not normally found in freshly voided urine and form based on temperature, solute concentration, and pH. Crystals are broadly categorized by pH into normal acidic, normal alkaline, and abnormal crystals of metabolic or iatrogenic origin. The document outlines methods to identify crystals, including examining their effect of temperature and pH, morphology, solubility, polarization, birefringence, and quantitation. It emphasizes that microscopic evaluation is important to detect crystals since no chemical test can.

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92 views4 pages

Urinalysis and Body Fluids: Unit 2 Session 5

This document provides an overview of crystals found in urine microscopic examination. It discusses that urine crystals are not normally found in freshly voided urine and form based on temperature, solute concentration, and pH. Crystals are broadly categorized by pH into normal acidic, normal alkaline, and abnormal crystals of metabolic or iatrogenic origin. The document outlines methods to identify crystals, including examining their effect of temperature and pH, morphology, solubility, polarization, birefringence, and quantitation. It emphasizes that microscopic evaluation is important to detect crystals since no chemical test can.

Uploaded by

partho143
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Urinalysis and Body Fluids CRg

Unit 2; Session 5

Crystals Found in the Urine


Microscopic Examination -
Part A, an Overview

Microscopic Sediment
– Urine Crystals

• Urine crystals not found in freshly voided urine.

• Formation based on
• Temperature (as specimen cools or is refrigerated)
• Increased solute concentration, (as indicated by increased
specific gravity)
• pH (acid crystals, alkaline crystals, and some??)

• Broadly categorized by pH.


• However, some deviate

Microscopic Sediment
– Urine Crystals
• Clinical Significance
• MOST are NOT clinically significant
• All have been implicated in calculi / kidney
stone formation.
• Generally, clinically significant crystals are
present in freshly voided urine.
• Patient drugs / medication may cause
formation of urine crystals
• Ampicillin
• Hypaque
• Renografin
Microscopic Sediment
– Urine Crystals

• Classification
• Normal and Abnormal
• Normal Acidic crystals
• Normal Alkaline crystals
• Abnormal crystals - metabolic origin or
iatrogenic origin (usually seen in acidic urine)

Microscopic Sediment
– Urine Crystals
• Identifycation Characteristics
• Effect of temperature and pH
• Amorphous urates form in the refrigerated acid urine:
will dissolve with heat
• Amporphous phospates form in refrigerated alkline urine;
will dissolve in acetic acid – so will RBCs
• All abnormal crystals are found in acid urine
• pH ** (acid, alkaline or neutral?)
• Morphology (what is the shape and color?)
• Solubility
• (acid crystals are soluble / go into solution in alkaline environment
and alkaline crystals will disappear if the pH becomes acid)

Microscopic Sediment
– Urine Crystals

• Identification characteristics
• Polarization and birefringence
• Aids in crystal identification
• Uses two polarizing filters that darken the
field
• Crystals that polarize light will reverse the
filter’s effect.

• http://www.microscopyu.com/articles/polarized/polarizedintro.html
Polarization (cont.)

Microscopic Sediment
– Urine Crystals

• Birefringence

Microscopic Sediment
– Urine Crystals

• Quantitation
• UA Reporting Standardization Guide
• High Power Field (hpf)
• Semi-quantitative terms
• Trace
• 1+
• 2+
• 3+
• 4+
• packed
Microscopic Sediment
– Urine Crystals

• Summary
• Urinary crystals may be of no significance or may accompany
metabolic disorders.
• Urinary crystals may be present in acidic or alkaline urine.
• Microscopic evaluation of urine is important for detection of
crystals, because no chemical test detects the presence of
crystals.
• Solubility studies and the use of polarized and compensated
light help to identify crystals and differentiate them from
artifacts.
• They are reported using semi-quantitative terms.

UP DATE 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.
 Mery Haber, MD, A Primer of Microscopic Urinalysis, 2nd Ed.

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