Differential Diagnosis by Shape

Amorphous Needles
Hexagons
Granules

n phosphates n cystine n bilirubin

n urates n uric acid (rare) n hippuric acid
n hippuric acid n tyrosine
(narrow)
n primidone* n acyclovir
n pyridoxylate n amoxicillin
n ampicillin
n epivir
n indinavir
n sulfadiazine
n 6-mercaptopurine

Dumbbells Fans/Besoms
(Brooms) Sheaves

n calcium car- n amoxicillin n uric acid

bonate n sulfadiazine n tyrosine
(tiny)
n calcium oxalate n ampicillin (after
monohydrate refrigeration)
(seen on edge) n epivir
n indinavir
n sulfadiazine
n 6-mercapto-
purine

Dimpled Spheres
Spheres Spheres
starch With Spikes
n ammonium n APRT deficiency n ammonium
biurate biurate
n bilirubin (tiny) n sulfamethox- n bilirubin
n leucine azole
n sulfamethox-
n sulfadiazine azole
n sulfamethox-
azole
n triamterene

*drugs in red
328 Crystals
 Differential Diagnosis by Shape
Hexagonal Stars/
Rods Rods Rosettes
n calcium n uric acid n uric acid (rare)
phosphate n hippuric acid n calcium
n calcium oxalate n calcium oxalate phosphate
monohydrate monohydrate
n 6-mercapto-
n acyclovir purine
n ampicillin
n 6-mercapto-
purine

Irregular Notched
Plates Envelopes
Plates

n talc n cholesterol n calcium oxalate

n calcium dihydrate
phosphate

Rhombic/
Rhomboid Squares Cubes
Plates
n uric acid n uric acid n bilirubin (tiny)
n hippuric acid n uric acid
(rare)

Crystals 329
 Differential Diagnosis by Shape
Prisms Lemons Ovals

n triple phosphate n uric acid n calcium oxalate

(coffin lids) monohydrate
n calcium phos- (seen lying flat)
phate
n uric acid

Rolling Pins World War I Barrels

Grenades

n uric acid n uric acid n uric acid

Feathers/ Unusual
Polyhedrons Shapes
Ferns
n starch n triple phosphate n probably drug

n sulfamethox-
azole
(going into
solution) ?

330 Crystals
Differential Diagnosis by Birefringence

Negative
n cystine (unless stacked)
n calcium phosphate (plates)
n bilirubin (may be very weakly positive)

Positive
n calcium phosphates
(prisms and stars/rosettes)
n acyclovir (strong)
n indinavir (strong)
n hippuric acid (strong)
n calcium carbonate (strong)
n tyrosine (strong)
n ampicillin (strong)
n sulfamethoxazole (strong)
n leucine (strong)
n Whewellite (strong)
n stacked cystine (weak)
n Weddellite
(weak, unless clustered)
n ammonium biurate (strong)
n triple phosphate (moderate)
n cholesterol
(weak or moderate if stacked)

Positive With Polychromatism

n uric acid
n renografin (no longer in use)

Crystals 331