Discussion room

Comment 1

A colleague from Spain, Dr. Sofia Zaera (medical area specialist, Laboratorio de Análisis Clinicos, Hospital Universitario Lucus Augusti – Lugo – Spain) commented on the possibility that the crystals shown in this image might be due to cholesterol rather than triple phosphate.
 

The appearance of thin plated crystals apparently heaped one upon another might be in favour of Dr. Zaera challenging view.
However, it must be considered that cholesterol crystals usually:
1. Do not have such a regular trapezoidal shape.  
2. Are associated with moderate-to-heavy proteinuria, which was not the case with the sample containing the crystals shown in the image (by dipstick: albumin 1+).
3. Are associated with other fatty particles in the urine sediment (i.e., fatty droplets, oval fat bodies and/or fatty casts), which were not found in the sample.

In addition, triple phosphate crystals are usually associated with urinary tract infection as suggested by the presence in the image of bacteria and a few leukocytes (in addition, by dipstick: leukocyte esterase ++/+++, nitrites positive).

However, we also think that also for these unusual triple phosphate crystals it would have been useful to perform infrared spectroscopy investigation to be sure about their nature. 

We thank Dr. Zaera for her sharp observation which led to this clarification.

The scientific editors:

Giovanni B. Fogazzi

Giuseppe Garigali

September 21, 2016

Comments can be sent via e-mail to the Scientific Editors.