Question Title: Crystals in Daughters Urine and other Mumbo-Jumbo....

I recently posted a question concerning the possibility of my, then 15 mo. old, daughter, having stones. She has grade 3 reflux on the left side, diagnosed after two kidney infections. She has been on Septra since, which would be for 9 mo., and has had no problems until the symptoms of passing stones one month ago. Four nights ago she started acting the same way, as if in pain, and this time, though I passed it off as teething and waited 3 days, I took her urine in. She only had a trace of blood, was positive for leukocytes, the pH was 8, and specific gravity was approx. 1.005. This was not noted on just one sample, but 5 throughout a 24 hour period. She also had crystals in her urine. The pediatricians' nurse showed them to me and they looked like little prisms, some long and some shorter in length. The nurse said she thought they were "normal," but I am not convinced. She is now 16 mo. old and I am very concerned for the health of her kidney(s). They did do a culture on her urine, which I won't here back on until tomorrow, and the pediatrician also sent in another sample to test the levels of calcium present, as adviced by the urologist when she had the symptoms a month ago. She has not seen her urologist in a month, and I am going to contact him about this. Unfortunately he is out of the office for a week. I would appreciate any insight you could give me. My questions are:

1)Are these crystals normal? After some research, I have noticed that the appearance seemed close to that of phosphate crystals. This seems to be related to struvite stone formation.

2)Are the pH and specific gravity values of significance?

3)I have noticed an increase in urine output at night, which I have passed off as normal. Could that be related to what is going on now?

4)Could the Septra be causing these problems? When looking up information regarding crystal formation, Septra showed up on my list of articles to read about.

I am sorry this is lengthy. I want to provide you with enough information so that you can better answer the questions. I appreciate your time very much!

Thanks, in advance,
Cyndi

Dear Cyndi,
Identification of crystals in the urine is important in patients with stone disease. Many types of crystals are harmless and can be seen in the normal patient. The identification of cystine crystals would establish a diagnosis of cystinuria, a hereditary stone forming disease. In regards to the pH, calcium oxalate, uric acid, and cystine crystals are found in acidic urine(pH<7), calcium phosphate, and triple phosphate (struvite) form in alkaline urine such as your daughter’s case.
Most likely the crystals seen are phosphate based crystals and were probably seen soon after eating. Although your child’s specific gravity indicates they are well hydrated, to help prevent stones, I would encourage your child to drink water as well as eating a normal diet. The high output of urine at night is nothing to worry about, when individuals are in a recumbent position for a sustained period of time (sleep) the body is able to mobilize fluid more efficiently. And finally, Septra is a quality antibiotic used for many years, to my knowledge, it has never been associated with stone formation.
Just a thought about your daughter’s pain, I would need to see her films, but sometimes a partial UPJ obstruction can cause flank pain at times of high fluid diuresis. This would be evident during a nuclear renal scan showing an obstructed picture.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword: Reflux

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