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Clinmic
Cast
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Casts
Only element found in urine that are unique to the kidneys
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Cast formation
1. Formed primarily within the lumen of DCT and Collecting Ducts
2. Favored by urine stasis, acid urine, and sodium and calcium presence
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UROMODULIN
/
TAMM-HORSFALL
Matrix of cast formation produced by the
RTE
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Cylindroids
Casts with
tapered end
produced at the junction of
ALH
and
DCT
Incomplete cast formation
or
disintegration
Same significance as
casts
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Cylindruria
Presence of cast in the urine
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Site of cast formation is
DCT
,
ALH
, &
CD
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Order of cast degeneration
Hyaline casts
(mucus) ->
cellular casts
(RBC, WBC, RTE) ->
Granular Cast
(Coarse and Final) ->
Waxy cast
(Final degeneration product)
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Urine examination for cast detection
1.
Scanning
is performed using the
LPO
along the
edges
of the coverslip
2. Observed under
subdued light
because cast matrix has
low refractive index
3. Casts are
dissolved quickly
in
dilute alkaline urine
4. Casts must be identified as to composition using the
HPO
5. Reported as
average #/LPO
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Hyaline cast
Only
normal
and most frequently seen cast
Colorless
,
homogenous
, and has some
RI
with urine; consist almost entirely of
Tamm Horsfall protein
Nonpathologic:
strenuous exercise
,
dehydration
,
heat exposure
,
emotional stress
Pathologic:
acute glomerulonephritis
,
pyelonephritis
,
chronic renal disease
,
congestive heart failure
Normal value:
0-2
/
LPF
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Red blood cell cast
Orange-red color
, cast matrix containing
RBCs
Glomerulonephritis
,
strenuous exercise
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White blood cell cast
Cast matrix containing
WBCs
Pyelonephritis,
Acute interstitial nephritis
Presence indicates the need to perform
bacterial cultures
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Epithelial
cell cast
RTE cells attached to protein matrix
Renal tubular damage
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Granular cast
Coarse
and
fine granules
in a cast matrix
Glomerulonephritis
,
Pyelonephritis
,
stress
and
exercise
Represents the
disintegration
of
cellular cast
Granular dirty brown cast
-
hemoglobin degradation products
(bc of
methemoglobin
);
acute tubular necrosis
,
massive hemoglobinuria
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Waxy cast
Highly refractile cast
with
jagged edges
and
notches
Stasis
of
urine flow
,
chronic renal failure
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Fatty cast
Brittle
; ground glass appearance with
cracks
and
fissures
Pink
-
KOVA STAIN
Fat droplets
and
oval fat bodies
attached to a
protein matrix
Nephrotic syndrome
,
toxic tubular necrosis
,
diabetes mellitus
,
crush injuries
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Broad cast
Wider than normal cast matrix
Indicates distention of tubular lumen
Granular and waxy casts are the most common broad casts
Bile-stained broad, waxy casts are seen in tubular necrosis in viral hepatitis
Extreme urine stasis and renal failure
Also called Renal Failure Cast
View source
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