Difference between revisions of "Crystals in body fluids"

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==Gout==
==Gout==
===General===
===General===
*Classically big toe.
*Classically afflicts the big toe - known as '''podagra'''.


Etiology:<ref name=Ref_PCPBoD8>{{Ref PCPBoD8|634}}</ref>
Etiology:<ref name=Ref_PCPBoD8>{{Ref PCPBoD8|634}}</ref>
*Overproduction of uric acid ~ 10% of cases.
*Overproduction of uric acid ~ 10% of cases.
*Reduced excretion of uric acid ~ 90% of cases.
*Reduced excretion of uric acid ~ 90% of cases.
**May be genetic - URAT1 mutation.<ref name=omim607096>{{OMIM|607096}}</ref><ref>{{Cite journal  | last1 = Tin | first1 = A. | last2 = Woodward | first2 = OM. | last3 = Kao | first3 = WH. | last4 = Liu | first4 = CT. | last5 = Lu | first5 = X. | last6 = Nalls | first6 = MA. | last7 = Shriner | first7 = D. | last8 = Semmo | first8 = M. | last9 = Akylbekova | first9 = EL. | title = Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele. | journal = Hum Mol Genet | volume = 20 | issue = 20 | pages = 4056-68 | month = Oct | year = 2011 | doi = 10.1093/hmg/ddr307 | PMID = 21768215 }}</ref>
**May be genetic, e.g. URAT1 mutation.<ref name=omim607096>{{OMIM|607096}}</ref><ref>{{Cite journal  | last1 = Tin | first1 = A. | last2 = Woodward | first2 = OM. | last3 = Kao | first3 = WH. | last4 = Liu | first4 = CT. | last5 = Lu | first5 = X. | last6 = Nalls | first6 = MA. | last7 = Shriner | first7 = D. | last8 = Semmo | first8 = M. | last9 = Akylbekova | first9 = EL. | title = Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele. | journal = Hum Mol Genet | volume = 20 | issue = 20 | pages = 4056-68 | month = Oct | year = 2011 | doi = 10.1093/hmg/ddr307 | PMID = 21768215 }}</ref>
**Renal failure.
**Renal failure.


Revision as of 18:24, 27 April 2012

This article deals with crystals in body fluids.

Crystals

Joint crystals

Types:[1]

  • Gout = needle-shaped, negatively birefringent, yellow when aligned.
  • Pseudogout = rhomboid-shaped, positively birefringent, blue when aligned.

Notes:

  • Pseudogout also known as CPPD = calcium pyrophosphate dehydrogenase.
  • Memory device: ABC+ = aligned blue is calcium & cuboid - positively birefringent.

Urine crystals

Types - morphology:

  • Envelope shape (calcium oxalate).
  • Diamond shape (uric acid).
  • Coffin-lid shape (struvite).
  • Hexagonal shape (cysteine).

Notes:

  • Memory devices:
    • Diamonds are see-through; ergo, uric acid stones not seen on KUB.
    • Calcium oxalate = envelope, uric acid = diamond.
  • Uric acid crystals: usually dissolve in formalin... but do not dissolve in alcohol.[2]
  • Calcium oxalate crystals are seen in the context of ethylene glycol poisoning.[3]

Diseases

Gout

General

  • Classically afflicts the big toe - known as podagra.

Etiology:[4]

  • Overproduction of uric acid ~ 10% of cases.
  • Reduced excretion of uric acid ~ 90% of cases.
    • May be genetic, e.g. URAT1 mutation.[5][6]
    • Renal failure.

Gross/radiology

  • Radiologically may mimic anconeus epitrochlearis muscle.[7]

Microscopic

Features:[8]

  • Tophi (advanced)
    • Reactive granulomatous inflammation.
      • Surrounds fluffy (cotton candy-like) material.
    • Fibrotic synovium.
    • Aggregates of urate crystals.

Images:

Pseudogout

  • AKA Calcium pyrophosphate dihydrate deposition disease,[9] abbreviated CPPD.

General

  • Classically found in the knee.

Microscopic

Features:

  • Crystals with a rhomboid-shape.
    • Positively birefringent, blue when aligned.

Notes:

  • Memory device: ABC+ = aligned blue is calcium & cuboid - positively birefringent.

Images:

See also

References

  1. ↑ TN05 RH6
  2. ↑ WG. 8 January 2010.
  3. ↑ Saukko, Pekka; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). A Hodder Arnold Publication. pp. 589. ISBN 978-0340760444.
  4. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 634. ISBN 978-1416054542.
  5. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 607096
  6. ↑ Tin, A.; Woodward, OM.; Kao, WH.; Liu, CT.; Lu, X.; Nalls, MA.; Shriner, D.; Semmo, M. et al. (Oct 2011). "Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele.". Hum Mol Genet 20 (20): 4056-68. doi:10.1093/hmg/ddr307. PMID 21768215.
  7. ↑ URL: http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213. Accessed on: 7 August 2011.
  8. ↑ URL: http://pathologyoutlines.com/joints.html#gout. Accessed on: 5 August 2011.
  9. ↑ URL: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/. Accessed on: 28 October 2011.

External links

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