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NDT Advance Access originally published online on May 30, 2006
Nephrology Dialysis Transplantation 2006 21(9):2667; doi:10.1093/ndt/gfl278
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Images In Nephrology
(Section Editor: G. H. Neild)

The importance of recognizing whewellite

Nandi J. Reddy1, Arief A. Suriawinata2 and Martin Sedlacek3

1 Department of Pharmacology, 2 Department of Pathology and 3 Division of Nephrology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA

Correspondence and offprint requests to: Martin Sedlacek, MD, Assistant Professor, Division of Nephrology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001, USA. Email: martin.sedlacek{at}hitchcock.org

Keywords: acute renal failure; crystalluria; ethylene glycol; oxalate crystals; urinalysis; whewellite

An 81-year-old man was found lying on the ground outside his home. He was comatose and hypothermic. He had a severe metabolic acidosis with elevated anion and osmol gaps, and his plasma ethylene glycol level was 3180 mg/l. The urine sediment showed calcium oxalate monohydrate crystals (Figure 1). Due to prolonged exposure, the patient died despite treatment.


Figure 1
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  		Fig. 1. Monohydrated calcium oxalate urine crystals ‘whewellite’ after ingestion of ethylene glycol.

 
Survival of ethylene glycol intoxication depends on the rapidity of diagnosis and treatment. If recognized, urinary calcium oxalate crystals may provide an important diagnostic clue. They exist in two forms. Best known are the envelope-shaped dihydrate crystals named weddellite after their first discovery in Antarctic Ocean sediment (Figure 2). The rod-shaped monohydrate crystals named after the British scientist William Whewell (1794–1866) are less recognized, and several monographs on urinalysis do not mention their existence [1–4]. In ethylene glycol intoxication urinary calcium oxalate crystals are usually in the latter monohydrated form (Figure 1), the timely recognition of which may be life-saving.


Figure 2
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  		Fig. 2. For comparison: dihydrated calcium oxalate crystals ‘weddellite’ in urine from a healthy individual.

 
Conflict of interest statement. The authors declare that they have had no involvements that might raise the question of bias in the work reported or in the conclusions, implications or opinions stated.

References

  1. Graff SL. A Handbook of Routine Urinalysis. JB Lippincott, Philadelphia, PA: 1983; 89–90
  2. Haber MH. Urinary Sediment: A textbook Atlas. American Society of Clinical Pathologists, Chicago, IL: 1981; 33–39
  3. McBride LJ. Textbook of urinalysis and Body Fluids. Lippincott, Philadelphia, PA: 1998; 109
  4. Schuhmann GB, Schumann JL, Marcussen N. Cytodiagnostic Urinalysis of Renal and Lower Urinary Tract Disorders. Igaku-Shoin, New York, NY: 1995; 40–41
Received for publication: 15. 3.06
Accepted in revised form: 21. 4.06


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This Article
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Right arrow FREE Full Text (PDF) Freely available
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21/9/2667    most recent
gfl278v1
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