Crystals - Acidic Urine

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Amorphous urates

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• Found in: acidic urine
• Soluble: alkali and heat

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Amorphous urates

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Sodium Urate

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• Found: acidic urine
• Soluble: heat, slightly acetic acid
• Can be amorphous or needle-like shape, in clusters/ sheaves

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Sodium Urate

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Calcium Sulfate

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• Colorless Found: acid urine
• Soluble: acetic acid

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Calcium sulfate

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Uric Acid

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• Found: acidic urine
• Soluble: alkali, heat
• Insoluble: HCL, ETOH, acetic acid

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Uric Acid

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Uric Acid

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Uric acid

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Uric acid

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Uric acid

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Uric acid

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Highly birefringent under polarized light

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Uric acid crystals

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• associated with increased levels of purines and nucleic acids
• gout
• acute febrile conditions
• chronic nephritis, Lesch-Nyhan syndrome

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Calcium Oxalate

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• Found: acid urine
• Soluble: HCL
• Insoluble: acetic acid
• birefringent
• major component of kidney stones

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Calcium oxalate

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Calcium oxalate

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Calcium oxalate

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Calcium oxalate

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Calcium oxalate

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Pathologic conditions:

• Renal calculi (kidney stones)
• Oxalic acid poisoning
• Liver disease
• Ethylene glycol (antifreeze) poisoning (long form)

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Hippuric Acid

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• Found: acid urine, but also neutral or alkaline urine
• Soluble: ether, hot H2O
• Insoluble: acetic acid

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Hippuric Acid

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• Associated with diets high in fruits and vegetables that contain high quantities of benzoic acid
• Can be a sign of toluene exposure

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Hippuric acid

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Acidic urine crystals

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• Amorphous urates
• Sodium urate
• Uric Acid
• Calcium Oxalate
• Calcium Sulfate
• Hippuric Acid
• Cystine
• Cholesterol
• Tyrosine
• Leucine
• Bilirubin
• Sulfa

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Cystine

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• Found: acid urine
• Polarized light: no birefringence

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Cystine

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• Found in the inherited, metabolic disorder “cystinuria” (Prevents reabsorption of cystine by renal tubules)
• Most frequent cause of kidney stones in children

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Cystine

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Cholesterol

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• Found: acid urine
• birefringent

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Cholesterol

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• excessive tissue breakdown (nephritis, nephrotic conditions)
• chyluria due to obstruction of lymph drainage

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Cholesterol

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Tyrosine

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• Found: acid urine
• Single, fine needles with sharp points; may also be in sheaves, or rosettes

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Tyrosine

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Tyrosine

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Tyrosine

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Seen in severe liver disorders, inherited disorders of aminoacid metabolism

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Leucine

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• Found: acid urine
• Bilirubin test: positive
• birefringent

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Leucine

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Seen in severe liver disorders where amino acid metabolism is impaired, maple syrup disease, severe viral hepatitis

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Leucine

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Bilirubin

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• Found: acid urine
• Bilirubin: positive

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Bilirubin

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Bilirubin

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Seen in severe liver disorders

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Radiographic Dye

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• Patient history is very useful
• Specific gravity usually very high (>1.035)
• Highly birefringent with polarized light

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Radiographic dye

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Sulfonamide

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• sulfonamide antibiotics
• Found in acid urine

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Sulfonamide

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Acyclovir

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• Anti-viral medication
• Confirm patient history
• Found: neutral to slightly alkaline pH

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Acyclovir

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