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Teenage Boy with Severe Side Pain


4. Sometimes the crystals at the end of the arrow below form 6-sided crystals and get confused with the ones present in this patient's urine. How can they be differentiated?

arrow points to uric acid, calcium oxalate also present


The crystal at the end of the arrow is uric acid. When uric acid is thin and hexagonal, it can resemble cystine. To make sure the crystals are really cystine and not uric acid, add sodium cyanide to the sample, which reduces cystine to cysteine. Free sulfhydryl groups react with nitroprusside to form a purple color. This is called the sodium-nitroprusside reaction. If the sample just has uric acid, then the purple color will not be present. In this photomicrograph, there are multiple forms of uric acid, none of which have the hexagonal shape of cystine.


Back to the questions




A 14 year old boy went to his doctor complaining of severe side and back pain, which got worse while he slept. His family history showed males on both his mother's side and his father's side with chronic kidney stones. Urinalysis results are:

Color
yellow
Protein
negative
Blood
small
Appearance
cloudy
Glucose
negative
Urobilinogen
normal
Sp. Gravity
1.025
Ketones
negative
Nitrite
negative
pH
6.0
Bilirubin
negative
Leukocyte
negative

Microscopic
10-20 RBCs/hpf                                       Few Calcium Oxalate crystals
Many crystals which look like this:
cysteine crystals  




  



Colleen Carey | Honors Urinalysis | Fall 2005