Normal Crystals Abnormal Crystals

1. Uric acid Crystals 1. Bilirubin Crystals

2. Calcium Oxalate Crystals 2. Cholesterol Crystals
3. Hippuric Crystals 3. Cysteine Crystals
4. Calcium Phosphate Crystals 4. Leucine Crystals
5. Triple Phosphate Crystals 5. Tyrosine Crystals
6. Calcium Carbonate Crystals 6. Sulfa Crystals
7. Ammonium Biurate Crystals 8. Indinavir Crystals

Uric acid Crystals

Uric acid crystals are of varying sizes and shapes, found in acidic urine. They resemble
rhomboids, parallelograms, and rosettes in shape and are amber in color. Though they are seen in
normal urine, are also an indicator of disease processes, such as acute uric acid nephropathy or
urate nephrolithiasis.

Calcium Oxalate Crystals

Calcium oxalate crystals are found in individuals with acidic, neutral or alkaline urine. These
crystals are colorless when viewed microscopically. There are two forms of the calcium oxalate
crystal: the monohydrate and dihydrate form.
The monohydrate calcium oxalate crystal is described as the “picket fence” form. These
dumbbells shaped crystals are common in ethylene glycol toxicity. The dihydrate form is
octahedral or “envelope” shaped.

Hippuric acid Crystals

Hippuric acid crystals are found in acid, neutral, or slightly alkaline urine. These colorless
crystals are prisms, plates, or needle-like in shape. These crystals are often conglomerated into
masses.

Triple Phosphate Crystals or struvite

Triple phosphate crystals form in alkaline urine and are composed of magnesium, ammonium
and phosphate. These are rectangular in shape or similar with the coffin lid. These are sometimes
associated with a bacterial urinary tract infection caused by urea splitting bacteria.

Calcium Carbonate Crystals

Calcium carbonate crystals are yellow to colorless dumbells or spheres with radial striations,
found in alkaline urine. They are usually large crystals and can be readily observed at low
magnification.

Calcium Phosphate Crystals

These are colorless crystals having shape like blunt ended needles or prisms, rosettes. These
crystals are found in neutral to alkaline pH.

Ammonium Biurate Crystals

Ammonium urate (or biurate) crystals generally appear as brown or yellow-brown spherical
bodies with irregular protrusions resembling “throny-apples”. These are found in alkaline urine.

Amorphous Crystals

Amorphous urates are found in acid urine. These crystals may appear pink on gross analysis and
yellow microscopically. These crystals appear as granules in the urine sediment.
Amorphous phosphates are found in alkaline urine. These granules are colorless microscopically.
Crystals that are abnormal in Urine

Bilirubin crystals
Bilirubin crystals are abnormal crystals in urine. They form from conjugated bilirubin and are
needle-like to granular crystals that are yellow in color. They are frequently attached to the
surface of cells. Bilirubin crystals are seen in several hepatic disorders.

Cholesterol Crystals

These appear as colorless rectangular plates with a notch in one or more corners and are found in
acidic urine. The appearance of cholesterol is associated with the Nephrotic Syndrome.

Cysteine Crystals
Cystine crystals are flat colorless plates and have a characteristic hexagonal shape with equal or
unequal sides. They occur in acidic urine that are associated with an inherited disorder. Presence
of cystine crystals represents a proximal tubular defect in amino acid reabsorption.

Leucine Crystals

These are Yellowish-brown spheres with concentric circles with radial striations found in
acidic/neutral urine. Leucine crystals may be seen in liver disorders in which amino acid
metabolism is impaired.

Tyrosine Crystals
Tyrosine crystals appear as colorless/yellow fine needles in acidic/neutral urine. Tyrosine
crystals may be seen in tyrosinemia and in certain liver disorders in which amino acid
metabolism is impaired.

Sulfanomide Crystals

These are flat needles, sheaves of small needles or as spheroids. Often brown in color. The
presence of sulfanomide crystals usually indicates administration of the drug and not necessarily
a pathological condition. However, their presence is also associated with kidney stone formation.