Sulfonamide crystals are typically yellow in color and often resemble uric acid crystals. However, sulfa crystals are easily distinguished from uric acid by confirmatory tests. Sulfa crystals are readily soluble in acetone and exhibit a positive dextrine/sulfuric acid test ("old yellow newspaper" test).
Many drugs excreted in the urine have the potential to form crystals. Hence, a review of the patient's drug history is useful when an unidentified crystal is found.
Sulfadiazine crystals are a common finding with administration of Trimethoprim-sulfadiazine. They are often seen as "shocks of wheat" or radially-striated spherules.
Cholesterol crystalizes as thin rectangular plates with one (sometimes two) of the corners having a square notch. The cause of the presence of crystalized cholesterol is obscure. These crystals are seen in degenerative renal disease and are thought to have an identical clinical meaning as OFB. The presence of cholesterol crystals is usually accompanied by proteinuria, but they are only rarely seen.
Tyrosine crystals are usually seen as fine brownish needles, either isolated or as rosettes. These are sometimes associated with severe liver disease.
Leucine crystals are seen as yellow spheres with concentric and radial strias. These crystals can sometimes be mistaken for cells, with the center resembling a nucleus.
Under polarized light, leucine crystals transmit a "maltese cross" interference pattern.
Crystals of the amino acids leucine and tyrosine are very rarely seen in urine sediments. These crystals can be observed in some hereditary diseases like tyrosinosis and "Maple Syrup Disease". More often one finds these crystals concurrently in patients with severe (often terminal) liver disease.
Cystine crystals are seen as flat colorless hexagonal plates. They often aggregate in layers, and their formation is favored in acidic urine.
Cystine crystalluria or urolithiasis is an indication of cystinuria, which is an inborn error of metabolism involving defective renal tubular reabsorption of certain amino acids including cystine.
Ammonium urate (or biurate) crystals generally appear as yellow-brown, radially-striated spheres with irregular "thorn-apple" or "ox-horn" projections. Although they may be seen in acid urine, their formation is favored in neutral to alkaline urine.
Uric acid crystals may appear as yellow to brown rhombic or hexagonal plates, needles or rosettes. With rare exceptions, the finding of uric acid crystals in urine is of little clinical value.
Triple phosphate (Struvite, Magnesium Ammonium Phosphate) crystals usually appear as colorless, prism-like "coffin lids". They are often seen in urine from clinically normal individuals. Although they can be found in urine of any pH, their formation is favored in neutral to alkaline urine. Urinary tract infection with urease producing bacteria (eg. Proteus vulgaris) can promote struvite crystalluria (and urolithiasis) by raising urine pH and increasing free ammonia.
Amorphous crystals appear as aggregates of finely granular material without any defining shape. Amorphous urates of Na, K, Mg or Ca tend to form in acidic urine and may have a yellow or yellow-brown color. Amorphous phosphates are similar in general appearance, but tend to form in alkaline urine and lack color. Generally, no specific clinical interpretation can be made for the presence of amorphous crystals.
Trichomonas vaginalis is a sexually-transmitted urogenital parasite of men and women. The organism varies in size between 1-2 times the diameter of WBC. The organism is readily identified by its rapid erratic "jerky" movement.
Renal Tubular Cells (RTC) are originally cubic in shape; but once exfoliated, they adopt a rounded shape. These cells are slightly larger than leukocytes (10-14 um) with lightly granular cytoplasm. The nucleus is round, well defined and usually centric. The cytoplasm often shows a perinuclear halo when stained. Note the "glitter" cell (fatty degenerated WBC) in the lower-left corner.
Transitional epithelial cells originate from the renal pelvis, ureters, bladder and/or urethra. Their size and shape depends on the depth of origin in the epithelial mucosa. Most often they are round or polygonal; less commonly pear-shaped, caudate or spindle-shaped. They are generally somewhat smaller and smoother in outline than squamous cells, but larger than WBC. They may develop refractile, fatty inclusions as they degenerate in older specimens (upper panel).
In cleanly-collected normal specimens, transitional cells are few (ca. <2/HPF), but are more frequent in the elderly population. However, the presence of transitional sheets ("brick wall" appearance) is sometimes associated with Transitional Cell Cancer (TCC).
Parabasal squamous epithelial cells are immature squamous epithelial cells. They are commonly seen in urine specimens from postmenopausal women with atrophic vaginitis resulting from decreased estrogen (estradiol) levels.
Squamous epithelial cells are the largest cells seen in normal urine specimens. They are thin, flat cells, usually with an angular or irregular outline and a small round nucleus. They may be present as single cells or as variably-sized clusters. Those shown in the upper panel are unstained; that in the lower panel was prepared using Sedi-Stain.
Squamous cells are common in lower numbers in voided specimens and generally represent contamination from the genital tract. Their main significance is as an indicator of such contamination.
Fresh RBC tend to have a red or yellow color (lower panel). Prolonged exposure results in a pale or colorless appearance as hemoglobin may be lost from the cells (upper panel). In fresh specimens with a Specific Gravity (SG) of 1.010-1.020, RBC may retain the normal disc shape (upper panel). In more concentrated urines (SG>1.025), RBC tend to shrink and appear as small, crenated cells (lower panel). In more dilute specimens, they tend to swell. At a SG<1.008 and/or highly alkaline pH, RBC lysis is likely. Lysed RBC appear as very faint "ghost cells".
Red blood cells up to 5/HPF are commonly accepted as normal. Increased RBC in urine is termed hematuria, which can be due to hemorrhage, inflammation, necrosis, trauma or neoplasia somewhere along the urinary tract (or urogenital tract in voided specimens).
White Blood Cells (WBC) in unstained urine sediments typically appear as round, granular cells which are 1.5-2.0 times the diameter of RBCs. WBC in urine are most commly neutrophils. Like erythrocytes, WBC may lyse in very dilute or highly alkaline urine; WBC cytoplasmic granules released into the urine often resemble cocci bacteria.
WBC up to 5/HPF are commonly accepted as normal. Greater numbers (pyuria) generally indicate the presence of an inflammatory process somewhere along the course of the urinary tract (or urogenital tract in voided specimens). Pyuria often is caused by urinary tract infections, and often significant bacteria can be seen on sediment preps, indicating a need for bacterial culture.
Oval Fat Bodies (OFB) are similar in composition and significance to fatty casts.
Desmorphic red cells (pictured ar right) are observed in glomerulonephritis. "Dysmorphic" red cells refer to heterogeneous sizes, hypochromia, distorted irregular outlines and frequently small blobs extruding from the cell membrane.
Waxy casts have a smooth consistency but are more refractile and therefore easier to see compared to hyaline casts. They commonly have squared off ends, as if brittle and easily broken.
Waxy casts are found especially in chronic renal diseases, and are associated with chronic renal failure; they occur in diabetic nephropathy, malignant hypertension and glomerulonephritis.
Fatty casts are identified by the presence of refractile lipid droplets. The background matrix of the cast may be hyaline or granular. Often, they are seen in urines in which free lipid droplets are present as well. Interpretation of the significance of fatty casts should be based on the character of the cast matrix, rather than on the lipid content. Pictured is a fatty cast with a hyaline matrix. As an isolated finding, lipiduria is seldom of clinical significance.
Granular casts have a textured appearance which ranges from fine to coarse. Since they usually form as a stage in the degeneration of cellular casts, the interpretation is similar to that for cellular casts.
Cellular casts most commonly result when disease processes such as ischemia, infarction or nephrotoxicity cause degeneration and necrosis of tubular epithelial cells. A common scenario is the patient with decreased renal perfusion and oliguria secondary to severe dehydration. Ischemic injury results in degeneration and sloughing of the epithelial cells. The resulting casts often are prominent in urine produced following rehydration with fluid therapy. The restoration of urine flow flushes numerous casts out of the tubules. Leukocytes can also be incorporated into casts in cases of tubulo-interstitial inflammation (eg., pyelonephritis).
Hyaline casts are formed in the absence of cells in the renal tubular lumen. They have a smooth texture and a refractive index very close to that of the surrounding fluid. When present in lower numbers (0-1/LPF) in concentrated urine of otherwise normal patients, hyaline casts are not always indicative of clinically significant disease. Greater numbers of hyaline casts may be seen associated with proteinuria of renal (eg., glomerular disease) or extra-renal (eg., overflow proteinuria as in myeloma) origin.
(A) Calcium oxalate crystals (arrows; 100 X); (B) uric acid crystals (100 X); (C) triple phosphate crystals with amorphous phosphates (400 X); (D) cystine crystals (100 X).
(A) Hyaline cast (200 X); (B) erythrocyte cast (100 X); (C) leukocyte cast (100 X); (D) granular cast (100 X).
Convoluted renal tubule cells (200 X).
Squamous epithelial cells (arrows) and leukocytes (200 X).
These cystine crystals are shaped like stop signs. Cystine crystals are quite rare.
These "triple phosphate" crystals look like rectangles, or coffin lids if you are feeling depressed.
These are oxalate crystals, which look like little envelopes (or tetrahedrons, depending upon your point of view). Oxalate crystals are common.
This is a broad, waxy cast. Note that the edges are sharp and there are "cracks" in this cast.
Casts which persist may break down, so that the cells forming it are degenerated into granular debris, as has occurred in this granular cast.
Red blood cell cast
Microscopic urinalysis reveals a protein cast containing red blood cells. The RBC's are anucleate. The cast takes the shape of the renal tubule.
Acute glomerulo nephritis
Abu Zubair meriwayatkan dari Jabir bin Abdullah bahwa Nabi Muhammad SAW bersabda:
"Setiap penyakit ada obatnya. Jika obat yang tepat diberikan dengan izin Allah, penyakit itu akan sembuh".
(HR. Muslim, Ahmad dan Hakim).
Rabu, 25 November 2009
Diposkan oleh FX di 18.00
The Holy Al-Qur'an (English version)
- Surah 1 - Al Fatiha THE OPENING
- Surah 2 - Al Baqarah THE HEIFER
- Surah 3 - Ali 'Imran - THE FAMILY OF 'IMRAN
- Surah 4 - Al-Nisa' THE WOMEN
- Surah 5 - Al Ma'idah THE REPAST
- Surah 6 - Al An'am THE CATTLE
- Surah 7 - Al A'raf THE HEIGHTS
- Surah 8 - Al Anfal THE SPOILS OF WAR
- Surah 9 - Al Tawbah THE REPENTANCE
- Surah 10 - Yunus JONAH
- Surah 11 - Hud THE PROPHET HUD
- Surah 12 - Yusuf JOSEPH
- Surah 13 - Al Ra'd THE THUNDER
- Surah 14 - Ibrahim ABRAHAM
- Surah 15 - Al Hijr THE ROCKY TRACT
- Surah 16 - Al Nahl BEES
- Surah 17 - Al Isra' THE NIGHT JOURNEY
- Surah 18 - Al Kahf THE CAVE
- Surah 19 - Maryam MARY
- Surah 20 - TA HA
- Surah 21 - Al Anbiya THE PROPHETS
- Surah 22 - Al Hajj THE PILGRIMAGE
- Surah 23 - Al Mu'minun THE BELIEVERS
- Surah 24 - Al Nur THE LIGHT
- Surah 25 - Al Furqan THE CRITERION
- Surah 26 - Al Shu'ara' THE POETS
- Surah 27 - Al Naml THE ANTS
- Surah 28 - Al Qasas THE NARRATIONS
- Surah 29 - Al 'Ankabut THE SPIDER
- Surah 30 - Al Rum THE ROMANS
- Surah 31 - Luqman LUQMAN
- Surah 32 - Al Sajdah THE PROSTRATION
- Surah 33 - Al Ahzab THE CONFEDERATES
- Surah 34 - Saba' SHEBA
- Surah 35 - Fatir THE ORIGINATOR OF CREATION
- Surah 36 - Ya Sin YA SIN
- Surah 37 - Al Saffat THOSE RANGED IN RANKS
- Surah 38 - Sad SAD
- Surah 39 - Al Zumar CROWDS
- Surah 40 - Ghafir FORGIVER
- Surah 41 - Fussilat EXPOUNDED
- Surah 42 - Al Shura CONSULTATION
- Surah 43 - Al Zukhruf THE GOLD ADORNMENTS
- Surah 44 - Al Dukhan THE SMOKE
- Surah 45 - Al Jathiyah THE KNEELING DOWN
- Surah 46 - Al Ahqaf WINDING SAND-TRACTS
- Surah 47 - Muhammad MUHAMMAD
- Surah 48 - Al Fath THE VICTORY
- Surah 49 - Al Hujurat THE CHAMBERS
- Surah 50 - Qaf QAF
- Surah 51 - Al Dhariyat THE WINDS THAT SCATTER
- Surah 52 - Al Tur THE MOUNT
- Surah 53 - Al Najm THE STAR
- Surah 54 - Al Qamar THE MOON
- Surah 55 - Al Rahman THE MOST GRACIOUS
- Surah 56 - Al Waq'iah THE INEVITABLE
- Surah 57 - Al Hadid IRON
- Surah 58 - Al Mujadilah THE WOMAN WHO PLEADS
- Surah 59 - Al Hashr THE MUSTERING
- Surah 60 - Al Mumtahinah THAT WHICH EXAMINES
- Surah 61 - Al Saff THE BATTLE ARRAY
- Surah 62 - Al Jumu'ah FRIDAY
- Surah 63 - Al Munafiqun THE HYPOCRITES
- Surah 64 - Al Taghabun THE MUTUAL LOSS AND GAIN
- Surah 65 - Al Talaq DIVORCE
- Surah 66 - Al Tahrim PROHIBITION
- Surah 67 - Al Mulk THE DOMINION
- Surah 68 - Al Qalam THE PEN
- Surah 69 - Al Haqqah THE SURE REALITY
- Surah 70 - Al Ma'arij THE WAYS OF ASCENT
- Surah 71 - Nuh NOAH
- Surah 72 - Al Jinn THE SPIRITS
- Surah 73 - Al Muzzammil THE ENFOLDED ONE
- Surah 74 - Al Muddaththir THE ONE WRAPPED UP
- Surah 75 - Al Qiyamah THE RESURRECTION
- Surah 76 - Al Insan MAN
- Surah 77 - Al Mursalat THOSE SENT FORTH
- Surah 78 - Al Naba' THE GREAT NEWS
- Surah 79 - Al Nazi'at THOSE WHO TEAR OUT
- Surah 80 - 'Abasa HE FROWNED
- Surah 81 - Al Takwir THE FOLDING UP
- Surah 82 - Al Infitar THE CLEAVING ASUNDER
- Surah 83 - Al Mutaffifin THE DEALERS IN FRAUD
- Surah 84 - Al Inshiqaq THE RENDING ASUNDER
- Surah 85 - Al Buruj THE CONSTELLATIONS
- Surah 86 - Al Tariq THE NIGHT STAR
- Surah 87 - Al A'la THE MOST HIGH
- Surah 88 - Al Ghashiyah THE OVERWHELMING EVENT
- Surah 89 - Al Fajr THE DAWN
- Surah 90 - Al Balad THE CITY
- Surah 91 - Al Shams THE SUN
- Surah 92 - Al Layl THE NIGHT
- Surah 93 - Al Duha THE GLORIOUS MORNING LIGHT
- Surah 94 - Al Sharh THE EXPANSION OF THE BREAST
- Surah 95 - Al Tin THE FIG
- Surah 96 - Al Alaq THE CLINGING CLOT
- Surah 97 - Al Qadr THE NIGHT OF POWER
- Surah 98 - Al Bayyinah THE CLEAR EVIDENCE
- Surah 99 - Al Zalzalah THE EARTHQUAKE
- Surah 100 - Al 'Adiyat THOSE THAT RUN
- Surah 101 - Al Qari'ah THE GREAT CALAMITY
- Surah 102 - Al Takathur THE PILING UP
- Surah 103 - Al 'Asr TIME THROUGH THE AGES
- Surah 104 - Al Humazah THE SCANDALMONGER
- Surah 105 - Al Fil THE ELEPHANT
- Surah 106 - Quraysh THE TRIBE OF QURAYSH
- Surah 107 - Al Ma'un THE NEIGHBOURLY ASSISTANCE
- Surah 108 - Al Kawthar THE ABUNDANCE
- Surah 109 - Al Kafirun THOSE WHO REJECT FAITH
- Surah 110 - Al Nasr THE HELP
- Surah 111 - Al Masad THE PLAITED ROPE
- Surah 112 - Al Ikhlas THE PURITY OF FAITH
- Surah 113 - Al Falaq THE DAYBREAK
- Surah 114 - Al Nas MANKIND
- Acute Coronary Syndromes
- Angina Pectoris
- Anomalous Left Coronary Artery From the Pulmonary Artery
- Aortic Coarctation
- Aortic Dissection
- Aortic Regurgitation
- Aortic Stenosis
- Aortic Stenosis, Subaortic
- Aortic Stenosis, Supravalvar
- Ashman Phenomenon
- Atrial Fibrillation
- Atrial Flutter
- Atrial Myxoma
- Atrial Septal Defect
- Atrial Tachycardia
- Atrioventricular Block
- Atrioventricular Dissociation
- Atrioventricular Nodal Reentry Tachycardia (AVNRT)
- Benign Cardiac Tumors
- Brugada Syndrome
- Complications of Myocardial Infarction
- Coronary Artery Atherosclerosis
- Coronary Artery Vasospasm
- Digitalis Toxicity
- Dissection, Aortic
- Ebstein Anomaly
- Eisenmenger Syndrome
- First-Degree Atrioventricular Block
- HACEK Group Infections (Infective Endocarditis)
- Heart Failure - Decompensatio Cordis
- Holiday Heart Syndrome
- Hypertensive Heart Disease
- Junctional Rhythm
- Loeffler Endocarditis
- Long QT Syndrome
- Lutembacher Syndrome
- Mitral Regurgitation
- Mitral Stenosis
- Mitral Valve Prolapse
- Myocardial Infarction
- Myocardial Rupture
- Paroxysmal Supraventricular Tachycardia
- Patent Ductus Arteriosus
- Patent Foramen Ovale
- Pericardial Effusion
- Pericarditis Acute
- Pericarditis, Constrictive
- Pericarditis, Constrictive-Effusive
- Pulmonic Regurgitation
- Pulmonic Stenosis
- Right Ventricular Infarction
- Saphenous Vein Graft Aneurysms
- Second-Degree Atrioventricular Block
- Sinus of Valsalva Aneurysm
- Sudden Cardiac Death
- Tetralogy of Fallot
- Third-Degree Atrioventricular Block
- Torsade de Pointes
- Tricuspid Regurgitation
- Tricuspid Stenosis
- Unstable Angina
- Ventricular Fibrillation
- Ventricular Septal Defect
- Ventricular Tachycardia
- Wolff-Parkinson-White Syndrome
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