Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Crystal ua

238 views

Published on

the value of detected crystals in urine analysis

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Crystal ua

  1. 1. Crystalluria in Urinalysis Dr. Afshin Ghalehgolab Behbahan Pediatric Nephrologist Tabriz Children’s Hospital
  2. 2. Crystalluria in Urinalysis • It is common to find crystals on microscopic examination of the urine (about 8%). • the presence of crystals may be normal or pathologic. • Usually, the presence of crystals in the urine is of limited clinical significance.
  3. 3. Supersaturation of the solute components of the crystals must occur for crystallization to initiate. • Factors affecting supersaturation, include; – Solute concentration, – Ionic strength (solubility), – Urine pH, – The presence of promoters or inhibitors. • Causes of Supersaturation: • Low fluid intake (dehydration), • Hi dietary intake – Drug ingestion, • Body metabolism, • Prolonged interval between urine collection and urine examination.
  4. 4. Crystalluria - Supersaturation • In most instances, crystalluria is an occasional finding without clinical importance because it reflects transient supersaturation of urine, these are called Common Crystals. • Some crystals that almost always correlate with a known pathology if they are seen in a child’s urine, are called Pathological Crystals.
  5. 5. Urinary Crystals Classification: Common (Normal) Crystals - Pathological (Abnormal) Crystals
  6. 6. Urinary Crystals Classification: Common Crystals vs Pathological Crystals Common Crystals
  7. 7. Urinary Crystals Classification: Common Crystals vs Pathological Crystals Pathological Crystals Other Pathological Crystals include: Tyrosine, Leucine, Bilirubin & Cholesterol Crystals.
  8. 8. However, Common Crystals May Be Seen In Some Pathologic Situations As Well ! • persistent Calcium Oxalate crystalluria in repeated samples of the same subject should raise the suspicion of a possible disorder: • Hypercalciuria, • Hyperoxaluria, • Hypocitraturia, – Citrate is a crystallization inhibitor • Ethylene Glycol Intoxication, • Ingestion of the Exotic Star Fruit, • Drug ingestion (Vitamin C, Naftidrofuryl Oxalate, & Orlistat) Envelope or pyramid shaped crystals
  9. 9. However, Common Crystals May Be Seen In Some Pathologic Situations As Well ! • Persistent Uric Acid crystalluria in repeated samples of the same subject should raise the suspicion of a possible disorder: • Hyperuricosuria (with or without Hyperuricemia) • Acute Uric Acid Nephropathy, • Persistent Dehydration
  10. 10. However, Common Crystals May Be Seen In Some Pathologic Situations As Well ! • Persistent Triple phosphate, or Struvite crystalluria in repeated samples of the same subject should raise the suspicion of a possible disorder: • Infections due to urease-producing bacteria – typically associated with Proteus species • Alkaline Urine Triple phosphate crystals have the shape of “coffin lids”: 3 to 4 to 6 – sided prism , composed of magnesium ammonium phosphate
  11. 11. Pathologic Crystals Seen in Pathologic Situations • Cystine crystals are always abnormal and are pathognomonic of the inherited disease: Cystinuria, patients often have kidney stones. • Found only in fresh urine, because if there is delay, they are soluble and not seen. • May also be seen in transient acute phase of pyelonephritis Flat, hexagonal plates with well-defined edges, colorless, and highly retractile.
  12. 12. Pathologic Crystals Seen in Pathologic Situations • Tyrosine and leucine crystals are also abnormal and suggest liver disease. • Bilirubin crystals are seen in All conditions associated with Conjugated Hyperbilirubinemia and Hyperbilirubinuria, such as Cholestasis. Leucine crystalTyrosine crystals Bilirubin crystals
  13. 13. Pathologic Crystals Seen in Pathologic Situations • Cholesterol crystals – are found in patients with marked proteinuria.
  14. 14. Pathologic Crystals Seen in Pathologic Situations • 2,8-dihydroxyadenine crystals – are a highly sensitive marker of homozygotic deficiency of the enzyme adenine phosphoribosyltransferase (APRT), found in about 96% of untreated patients.
  15. 15. Association between Urine pH & Crystals • I. Acidic urine crystals • -Amorphous Urates, • -Uric acid crystals, • -Cystine crystals • -Calcium Phosphate • -Cholesterol • -Ammonium Biurates • -Tyrosine, Leucien, Bilirubin, • -Calcium sulfates • -Calcium urates • -Calcium carbonate • II. Acidic, Neutral, or slightly alkaline Urine crystals • - Calcium Oxalate crystals • III. Alkaline, Neutral, or Slightly acidic urine • - Triple phosphates (Struvite) • IV. Alkaline Urine Crystals • - Amorphous phosphate • - Calcium carbonate • - Calcium phosphate
  16. 16. Drug Crystals in Urine • As a general rule: – one should always suspect drug crystalluria when finds Atypical Crystals, because: Most drugs cause atypical and/or pleomorphic crystals, which differ remarkably from common or pathological crystals
  17. 17. Drug Crystals in Urine • Factors causing Drug-crystals precipitation in urine: – Drug overdose, – Rapid intravenous bolus administration, – Hypoalbuminemia, – Dehydration, – Urine pH: • Indinavir at pH > 6.0, • Amoxicillin at pH ≤ 4.0 or >7.0 with “U” shaped behavior, • Ciprofloxacin at pH>7.3
  18. 18. Drug Crystals in Urine • If confirmed, this should always prompt the check of renal function because acute renal failure can occur, especially in patients with impaired renal function. • When crystalluria is caused by drugs, this may be the only urinary abnormality or it may be associated with: – Hematuria (either gross or microscopic), – Acute Tubular Necrosis caused by precipitation of crystals within renal tubules, – Obstructive uropathy caused by drug stones.
  19. 19. Drug Crystals in Urine
  20. 20. Drug Crystals in Urine • If confirmed, this should always prompt the check of renal function because acute renal failure can occur, especially in patients with impaired renal function. • It is advisable to: – Withdraw the drug or decrease the dosage, – Reestablish euvolemia, – Stimulate a high urine flow, – Manipulate urine pH in reverse direction
  21. 21. Drug Crystals in Urine

×