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Crystal cast in patient with AKI and TLS on Urine Microscopy

Randy Luciano MD, PhD @RandyLucianoMD

#TLS #Crystal
Crystal cast in ... AKI and TLS on Urine ... RandyLucianoMD #TLS #Crystal ... #casts #crystalluria ... #Urine #Microscopy
Atlas of Urine Microscopy Findings
 • Epithelial cells - Normal
 • Renal tubular cells - Acute
Atlas of Urine Microscopy ... also be seen if urine ... tubular injury • Crystals ... - Some crystals ... contamination #Urine
Urinalysis & Urine Sodium 
Theophilus Protospatharius, a seventh-century physician who wrote the first manuscript focused exclusively
Urinalysis & Urine ... Microscopic exam • Crystals ... • Urinary casts ... #Urinalysis #crystals ... #UNa #casts #glucosuria
Urine Microscopy - Urinary Sediment Examination Instructions
Preparation of the urine for microscopic examination:
 • Clean catch
up by cells or casts ... Ill stain) and crystals ... RBC's, lipids, crystals ... protein matrix of casts ... identification of lipids, crystals
Simplified Approach to Acute Kidney Injury (AKI)
1) IS THIS AN EMERGENCY? 
Is there a dialysis indication
PROBLEM ~80% of AKI cases ... IMPROVEMENT If the urine ... for WBCs, RBCs, casts ... , crystals, protein
Sulfa Crystals on Urine Microscopy
Sulfa Crystal!  Drug-induced crystalluria is a cause of acute renal failure
Sulfa Crystals on ... Urine Microscopy ... Sulfa Crystal! ... solubles in acidic urine ... #Urine #Microscopy
Hippuric Acid Crystals on Urine Microscopy

This crystal is present in the urine of people working with
Hippuric Acid Crystals ... on Urine Microscopy ... This crystal is ... present in the urine ... #crystalluria #Urine
Urine Microscopy and Casts - Image Atlas Key

- Squamous Epithelial Casts
- Transitional Epithelial Cells
- Renal Tubular
Urine Microscopy ... and Casts - Image ... - WBC Cast - ... Cast - Waxy Cast ... JoseTesser) #Urine
Granular & “Muddy Brown” Casts on Urine Microscopy
A. Finely granular cast B. slightly coarser granular cast
“Muddy Brown” Casts ... on Urine Microscopy ... Finely granular cast ... “urine poker quads ... #Urine #Microscopy
Urine Microscopy Crystals
Uric Acid crystals:
 - Formation promoted by acidic urine
 - Seen in tumor lysis
Urine Microscopy ... Crystals Uric Acid ... crystals: - Formation ... promoted by acidic urine ... Calcium phosphate crystals