Chapter 6: 2.4 - Type of Casts

Question 1

• most frequent seen cast in urine

- consists of entirely Tamm-Horsfall protein

Answer 1

Hyaline casts

Question 2

• appear colorless

- appears pink when stained with Sternheimer Malbin

Answer 2

Hyaline

Question 3

Normal Value:

Hyaline / lpf

Answer 3

0-2/ lpf

Question 4

presence indicates:
glomerular leakage of proteins, fever, upright position, dehydration, or emotional stress
strenuous exercise, emotional stress, heat

Answer 4

Hyaline casts

Question 5

pathologic significance:
Hyaline casts (4)

Answer 5

acute glomerulonephritis
pyelonephritis
chronic renal disease
congestive heart failure

Question 6

• appears red- color
• more fragile than other casts
• indicates bleeding within nephron

Answer 6

RBC casts

Question 7

RBC casts could be indicative of

Answer 7

glomerulonephritis ( serious renal disease)

Question 8

WBC casts are most frequently composed of what kind of WBCs

Answer 8

Neutrophils

Question 9

Presence of WBC casts indicates the need to perform..

Answer 9

bacterial cultures

Question 10

Presence of WBC casts in the urine signifies- (3)

Answer 10

1. infection - inflammation w/ nephron
2. pyelonephritis
3. Non bacterial inflammation
   eg. Acute intertitial nephritis

Question 11

• formed as the result of stasis and desquamation of renal tubular epithelial cells

Answer 11

Epithelial cell casts

Question 12

Bilirubin stained RTE cells may be seen in what condition?

Answer 12

Hepatitis

Question 13

Clinical Significance:

Epithelial cell casts

Answer 13

advance tubular destruction
heavy metal or drug toxicity
a
= observed in conjuction with RBC and WBC cast in glomerulonephrits and pyelonephritis

Question 14

result of either:

• degeneration of cellular casts
• direct aggregation of serum proteins into a matrix of tamm-horsfall mucoprotein

Answer 14

Granular Casts

Question 15

Granular Cast

non pathologic condition origin

Answer 15

origin of granules - from lysosomes excreted by RTE cells during normal metabolism

Question 16

• casts which have incorporated either free fat droplets or oval fat bodies
• seen in conjunction with oval fat bodies and free fat droplets

Answer 16

Fatty casts

Question 17

Confirmatory:

Fatty casts

Answer 17

Polarized microscopy and stain:

Sudan III or Oil Red O

Question 18

Fatty casts are frequently associated with: (4)

Answer 18

1. Nephrotic Syndrome
2. Toxic tubular necrosis
3. DM
4. Crush injuries

Question 19

• from degeneration of granular casts
• fragmented with jagged ends
• brittle, highly refractive

Answer 19

Waxy casts

Question 20

Waxy casts may be indicative of (3)

Answer 20

1. chronic renal failure
2. advance nephritis
3. amyloidosis

Question 21

• consider their presence when WBC casts and many free WBCs and bacteria are found in sedement

Answer 21

Bacterial Casts

Question 22

Confimation of bacterial casts can best be made by performing:

Answer 22

gram stain on dried or centrifugated sediment

Question 23

• casts that consist of different cell types

- identification is difficult unless stains and phase contrast microscope are employed

Answer 23

Mixed Cellular casts

Question 24

• may be up to 2-6 times wider than ‘regular’ casts

- can be cellular, waxy or granular in composition

Answer 24

Broad Casts

Question 25

• formed in pathologically dilated

atrophied tubules, collecting tubules

Answer 25

Broad casts

Question 26

• often referred to as “renal failure casts” representing extreme urine stasis
• grave prognosis

Answer 26

Broad casts

Question 27

bile stained broad-waxy casts are seen in:

Answer 27

Tubular necrosis - caused by viral hepatitis