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Ammonium Biurate

Frequently seen in urine that has undergone prolonged storage
Amorphous Urates

Urate salts
-Calcium
-Magnesium
-Potassium
-Sodium
Ampicillin

Abnormal crystals found in acid urine due to the medication Ampicillin

Seen after large dosage without adequate hydration
Bilirubin Crystals

Hepatic disorders
Branching psuedohyphae

Indicative of an unclean catch
Bubble and cotton fiber

Artifacts
Calcium Carbonate

Difficult to distinguish from amorphous material

Usually paired giving a dumbell appearance
Calcium Oxalate (dihydrate)

Size varies

Found in Acidic Urine

Large numbers found in Ethylene Glycol poisoning
Calcium Phosphate 

Arranged in a rosette or star
Calcium phosphate
Cholesterol Crystals

-Nephrotic syndrome

-Other disorders producing lipiduria
Cotton fibers

Artifact
Crystals due to Xray dye
Fatty casts
Fatty Casts
Hair

Artifact
Hippuric acid

Seen in patients who sniff glue
hyaline casts

Increased in: 
 
-Strenuous exercise
- heat exposure
- emotional stress
- fever
- glomerulonephritis
- pyelonephritis
- chronic renal disease
- congestive heart failure

Increased significance if wider than normal 
Hyaline casts
Leucine crystals

Rare amino acid disorder

Severe liver disease
pin worm eggs
Polarized starch
RBC cast

Bleeding
in the kidney either glomerular or tubular. 

Will demonstrate significant protein on
dipstick.
RBCs and Crenated RBCs
Renal Tubular Epithelium (RTE)

Most clinically significant epithelial cell

Originate from proximal and distal convoluted tubules
Squamous stained with Sternheimer-Malbin
Starch or Talc

Sometimes seen in urine and mistaken for crystals

Distingushable with polarized light
Sulfonamides

Abnormal crystals found in acidic urine due to sulfonamide medications
A. Transitional

B. RTE

C. WBC
Triple phosphate

On its side
Triple phosphate

Found in neutral or alkaline urine
Uric Acid

Barrel shaped

Diamond shaped

Rhombic prism shaped
Waxy casts

Chronic renal failure

Acute renal disease
  -Acute glomerulonephritis
  -Nephrotic syndrome
  -Renal transplant rejection
Waxy vs granular
WBCs

UTI
Fever
Strenous exercise
Oval Fat Body
Hippuric acid
Bili crystal
Mucous
Sulfa cystals
Pin Worm
Hyaline cast
Fatty cast
Waxy cast
Ammonium birute
Granular Cast
RTE cast
RBC cast
Calcium Phosphate crystals
Triple Phosphate crystals
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