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What to Do When Urinalysis Results Aren't Crystal Clear

What to Do When Urinalysis Results Aren't Crystal Clear

My patient is a 48-year-old woman who has no significant medical history and takes no medications or supplements. Routine urinalyses consistently show mucus threads, calcium oxalate and calcium phosphate crystals, and hyaline casts. The pH is 6, and specific gravity is normal. The remainder of the results are normal. Is further workup required?
-- Joel Tumberello, MD
If your patient's physical findings (including blood pressure) are normal and there is no laboratory evidence of either hypercalcemia (which could indicate hyperparathyroidism, for example) or normal anion gap acidemia (which would be suggested by a low serum bicarbonate level), she does not require an extensive workup. A low bicarbonate level could indicate renal tubular acidosis--a rare but occasional cause of calcium phosphate crystals. Further workup would be necessary only if the patient had urinary lithiasis. Without a stone or symptoms, the urinary findings are not disturbing enough to warrant further evaluation.
-- Gregory Rutecki, MD
    Associate Professor of Medicine
    Northwestern University Medical School

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