The checklist for identification of common urine sediment findings includes cells (eg, epithelial cells, erythrocytes, leukocytes), crystals (eg, struvite, calcium oxalate, bilirubin, ammonium biurate), and microorganisms (typically bacteria). Some practitioners, however, may encounter unusual findings that hold great diagnostic value. In the cases that follow, unusual urine sediment findings yielded interesting, if not diagnostically critical, information.