Cystine crystals (bright field, x400).

Their presence in #urinarysediment is pathognomonic for #cystinuria, the most common kidney stone disease with Mendelian genetics.

While perfectly specific, the sensitivity of cystine crystalluria is quite low. 

#nephsky #skyneph

10/
This explanation is supported by data in Roux-en-Y gastric bypass recipients. These patients have RAPID gastric emptying. This results in:

➤ Faster time to maximum plasma furosemide concentration
➤ Earlier natriuresis

<a href="http://t.ly/xCqW" class="hover:underline text-blue-600 dark:text-sky-400 no-card-link" target="_blank" rel="noopener" data-link="bsky">http://t.ly/xCqW

Bilirubin and PB stain together producing visually appealing images of RTEC and waxy casts in the #UrinarySediment with dark field illumination, in a suspected case of cholemic tubulopathy. #artpiece ⁦⁦@rmohty⁩ 🔬⁦@OchsnerNephro⁩

1/n context: obstructive ureteral stone, UTI, pyonephrosis on ureteroscopy, hypotension, AKI. 99% ischemic ATN from septic shock. Fair enough. #UrineMicroscooy still done as routine diagnostics. At glance, looks like tons of muddy brown granular casts, anchoring our impression

Kidney shaped agglomeration of uric acid crystals, polarized - just in time for New Years! #UrineMicroscopy #UrinarySediment

Yep. And one more here

Leukocyte (neutrophil) casts can be found in pyelonephritis, interstitial nephritis and glomerulonephritis. But in this case, there’s only one clear possibility. Can you tell? #UrinarySediment #UrineMicroscopy #PisseProphet

Clearly the right thing to do if patient is a PD candidate but so hard/ near impossible to do in real life. The PD numbers are low for a reason despite most nephrologists being on the PD train. What do you do if the only surgeon in town says urgent patients are unsafe for surgery?