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 • Polarizes light
(can look like fern leaf
when going into solution) • 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.
 Mery 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