Crystals

Microscopic Not normally found in fresh urine

Examination of Urine
If found in fresh urine, pathologic

Part 4: Formed Elements: Crystals precipitate as urine cools to room

temp or when urine is refrigerated
Crystals
All clinically significant crystals are found
Ricki Otten MT(ASCP)SC in acid urine
uotten@unmc.edu
2

Crystal Formation Enhanced By Crystal Identification

Increased concentration of solute in urine Microscopic appearance

Urine pH Urine pH

Urine stasis

Temperature

3 4

Crystal Correlation Crystals

Correlate microscopic evaluation with Normal acid pH crystals
Physical exam
Color Normal alkaline pH crystals
Clarity

Pathologic crystals found in acid or neutral

Chemical exam urine
pH

Drug induced crystals

5 6

CLS 426 Urinalysis Student Lab,

Microscopic Exam of Urine Lecture Part 4 1
 Normal Acid pH Crystals Amorphous Urates
Amorphous urates These crystals have no distinct form and appear as
sand-like granules microscopically
Uric acid
Calcium oxalate Macroscopically
appear as a pink
sediment after
urine centrifugation

Acid pH urine

7 8

Uric Acid Crystals Uric Acid Crystals

Acid pH urine
Appear in several forms
Multicolored when polarized
Diamond shape most common form

9 10

Calcium Oxalate Crystals Calcium Oxalate Crystals

Acid pH urine

Most frequently observed crystal in urine

Oval form,
Most common form is octahedryl shape, can be
confused with
often referred to as an envelope shape RBC
(RBC do not
Multicolored when polarized polarize light)
11 12

CLS 426 Urinalysis Student Lab,

Microscopic Exam of Urine Lecture Part 4 2
 Normal Alkaline pH Crystals Amorphous Phosphates
Amorphous phosphates These crystals have no distinct form and appear as
sand-like granules microscopically
Triple phosphate
Ammonium biurate Macroscopically
Calcium carbonate appear as a white
sediment after
urine centrifugation

Alkaline pH urine

13 14

Triple Phosphate vs Calcium

Triple Phosphate Crystals
Oxalate
Most frequently
observed crystal in
alkaline urine

Colorless, 4-6 sided

prisms

Referred to as
coffin lid crystals Alkaline pH urine Acid pH urine

15 16

Ammonium Biurate Crystals Calcium Carbonate Crystals

Alkaline pH urine Alkaline pH urine;
very small colorless
Yellow spheres with granules, slightly
spicules on surface larger than
amorphous material
Referred to as thorny apple crystals Multicolored when
polarized
Significant when found in fresh urine Easily confused with
bacteria
Presence indicates urine is old
17 18

CLS 426 Urinalysis Student Lab,

Microscopic Exam of Urine Lecture Part 4 3
 Pathologic Crystals (acid, neutral pH) Cystine Crystals
Cystine Colorless hexagonal
plates
Tyrosine
Leucine
Do not polarize
Cholesterol
Bilirubin Can be confused with
uric acid crystals

19 20

Cystine vs Uric Acid Crystals Cholesterol Crystals

Clear, large, flat, rectangular plates with
notched corners

Multicolored when polarized

Cystine Crystal Uric Acid Crystal Can be confused with radiographic dye
Acid pH urine Acid pH urine
crystals
Do not polarize light Multicolored when polarized
21 22

Cholesterol Crystals Leucine Crystals

Yellow-brown spheres with concentric circles on
surface
Can resemble free fat globules

Bright field Light vs Polarized Light 23 24

CLS 426 Urinalysis Student Lab,

Microscopic Exam of Urine Lecture Part 4 4
 Tyrosine Crystals Bilirubin Crystals
Yellow-brown small clusters
Colorless or yellow-brown fine delicate needles of needles or granules

Must confirm with positive

ictotest

When present in
urine, indicates large
amount of bilirubin is
present
25 26

Bilirubin vs Tyrosine Crystals Drug Induced Crystals

Sulfonamides
Radiographic dye (contrast media)

Bilirubin: thicker needles, blunt ends Tyrosine: fine needles, pointy ends
Ictotest positive Ictotest negative 27 28

Sulfa Crystals Radiographic Dye Crystals

Form varies dependent upon Also referred to as Contrast Media
the type of sulfa drug Colorless long pointed needles, or flat rectangular
plates (resemble cholesterol crystals)
administered
Multicolored when polarized

29 30

CLS 426 Urinalysis Student Lab,

Microscopic Exam of Urine Lecture Part 4 5
 True / False: Crystals are identified by shape
Contrast Media vs Cholesterol and urine pH
Both crystals multicolored when polarized
True / False: Uric acid crystals are found in
Contrast Media: specific gravity > 1.040 acid urine and are shaped like a
coffin lid
Cholesterol: notched edges

Contrast media
True / False: Presence of ammonium biurate
Cholesterol
crystals often indicates the
urine is old

True / False: Presence of bilirubin crystals

31 32
indicates severe liver disease

CLS 426 Urinalysis Student Lab,

Microscopic Exam of Urine Lecture Part 4 6