1 DO remember to distinguish between in vivo and in vitro crystalluria (Table 1).
2 DO remember that crystalluria cannot be reliably inferred from diagnostic urine reagent strips. Crystalluria can be confirmed
only by evaluating properly collected and processed urine sediment.
Table 1: Variables influencing crystalluria
3 DO remember that fresh nonrefrigerated urine samples are more likely to reflect in vivo crystalluria.
4 DO recognize refrigeration will preserve many physical, chemical and morphologic properties of urine sediment. However, refrigeration
must be used with caution when evaluating crystalluria qualitatively and quantitatively. Although refrigeration of urine samples
is likely to enhance the formation of various types of crystals, in vitro crystalluria may have no relationship to events
occurring in the urinary tract.
5 DON'T rely on urine samples collected and submitted by clients; unknown variables such as contamination, temperature, length of
storage and changes in urine pH may result in formation or dissolution of crystals after sample collection.
6 DO evaluate the conditions of urine preservation after collection when urine contains both struvite and calcium oxalate crystals.
This phenomenon could reflect both in vivo and vitro crystal formation. How so? The solubility of calcium oxalate crystals
is not influenced by pH changes within the physiologic range. Thus, the calcium oxalate crystals could have formed in vivo
under conditions of hypercalciuria associated with acidemia. If an acid urine sample with calcium oxalate crystals becomes
contaminated with urease-producing microbes after collection, urine pH may become alkaline, resulting in struvite crystalluria.
7 DO consider urine pH when interpreting crystalluria because many (but not all ) crystals tend to form and persist in certain
pH ranges. Exceptions may be related to large concentrations of lithogenic substances in urine or recent in vivo or in vitro
changes in urine pH. A portable pH meter will provide more accurate measurements than most diagnostic pH reagent strips (see
8 DO measure urine pH at the time of collection and again at the time of urinalysis when more than one hour is expected to elapse
between the time of collection and the time of analysis. Differences between the two pH values suggest that in vitro changes
have occurred and should be considered when interpreting the significance of crystalluria. This point is especially applicable
when mailing urine samples to laboratories.
9 DO determine whether crystals are aggregating together because crystals that aggregate in vivo represent a greater risk for
urolith formation than single crystals.
10 DO watch for different sizes of crystals. Why? Because in vivo formation of large crystals indicates that the composition of
urine at the time of collection is conducive to crystal growth.
11 DO verify the composition of urine crystals of questionable identity by physical methods of quantitative mineral analysis. Contact
diagnostic laboratories for details on how to submit samples.
12 DO consider whether other risk factors for urolithiasis (e.g., breed, sex, age, diet, concomitant illness) are present when
interpreting the significance of crystalluria.
13 DO investigate calcium oxalate or urate crystals in fresh urine samples, especially those collected from high-risk patients.
These crystals indicate that the urine formed at that time can at least sustain the crystals and may support their formation