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AUBF > M1: Urine Sediments (Part 3: Casts) > Flashcards

M1: Urine Sediments (Part 3: Casts) Flashcards

1
Q

Sole site of casts?

A

Kidney

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2
Q

They are formed within the** lumens of the distal convoluted tubules** and collecting ducts, providing a microscopic view of conditions within the nephron

A

Casts

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3
Q

Formed when proteins precipitate & gel in the lumen

A

Casts

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4
Q

Shape of of casts that is representatiave of tubular lumen?

A

cylindrical with parallel sides and somewhat rounded ends

they may contain additional elements present in the filtrate.

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5
Q

the cast matrix dissolves quickly in what concentration of urine?

A

dilute, alkaline urine

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6
Q

COMPOSITION AND FORMATION

major constituent of casts is?

A

uromodulin

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7
Q

COMPOSITION AND FORMATION

Other proteins present in the urinary filtrate, such as (blank) and (blank), are also incorporated into the cast matrix.

A

Albumin and Immunoglobulins

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8
Q

COMPOSITION AND FORMATION

1/3 of cast is made up of?

A

Tamm Horsfall protein/uromodulin

forms the matrix of all casts

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9
Q

COMPOSITION AND FORMATION

Forms a meshwork of fibrils that may trap cells and
granules

A

Tamm Horsfall protein/uromodulin

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10
Q

COMPOSITION AND FORMATION

2/3 of cast is made up of ?

A

Albumin and Globulin

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11
Q

5 factors involved in casts formation ?

A
  1. Lower pH
  2. Increased ionic concentration
  3. Stasis (decrease in flow)
  4. Obstruction of the nephron by cells or cell debris
  5. Proteinuria (increase in albumin and globulin)
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12
Q

factors involved in casts formation

this means there is decrease in flow

A

stasis

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13
Q

What equipment was used that have provided a step- by-step analysis of the formation of the uromodulin protein matrix?

A

Electron microscope

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14
Q

Familiarize the process of cast formation or memorize up to u

A
  1. Uromodulin protein aggregates into protein fibrils attached to RTEs
  2. The protein fibrils interweave until a solid structure is formed
  3. Urinary elements attach to the solid matrix
  4. Protein fibrils detach from the RTE
  5. Cast is excreted into the urine
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15
Q

Casts formation takes shape in what part of RTE?

A

Tubules

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16
Q

T or F

As the cast forms, urinary flow within the tubule increases as the lumen becomes blocked

A

F (As the cast forms, urinary flow within the tubule **decreases **as the lumen becomes blocked)

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17
Q

T or F

The accompanying dehydration of the protein fibrils and internal tension may account for the wrinkled and convoluted appearance of older hyaline casts

A

T

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18
Q

Formation of casts at the junction of the ascending loop of Henle and the** distal convoluted tubule **may produce structures with?

A

Tapered ends

referred to as cylindroids, same isgnificance as casts

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19
Q

The presence of urinary casts is termed?

A

Cylinduria

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20
Q

The appearance of a cast is also influenced by?

a. the materials present in the filtrate at the time of its formation
b. the length of time it remains in the tubule
c. both
d. NOTA

A

c. both

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21
Q

T or F

Any elements present in the tubular filtrate, including cells, bacteria, granules, pigments, and crystals, may become embedded in or attached to the cast matrix

A

T

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22
Q

Type of Casts

  • Basis of all types of casts
  • Most frequently seen cast which consists almost entirely of uromodulin.
A

Hyaline cast

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23
Q

Type of Casts: hyaline casts

appearance?

A
  • colorless in unstained sediments
  • Homogenous matrix
  • low refractive index similar to that of urine
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24
Q

Type of Casts: hyaline casts

what stain is used in hyaline casts to produce a pink color

A

Sternheimer-Malbin stain (SM stain)

pink kasi logo ng sm enetrtainment basta yun

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25
Q

T or F

The morphology of hyaline casts is varied

A

T

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26
Q

Type of Casts: hyaline casts

morphology of hyaline casts is varied, consisting of what following shapes?

A
  • normal parallel sides and rounded ends
  • cylindroid forms
  • wrinkled or convoluted shapes
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27
Q

Type of Casts: hyaline casts

Shape of hyaline casts
a. Normal parallel sides and rounded ends
b. Star shaped and Stick form
c. Cylindroid
e. Wrinkled or convoluted shape
f. a, b, c only
g. a, c, e only
h. ALL
i. NOTA

A

g. a, c, e only

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28
Q

Type of Casts: hyaline casts

normal value (reference range) of hyaline casts?

A

0-2/LPF

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29
Q

Type of Casts: hyaline casts

Pathological conditions where hyaline casts are increased?

A
  • Acuteglomerulonephritis
  • Pyelonephritis
  • Chronic renal disease
  • Congestive heart failure

PACCu pakyu

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30
Q

Type of Casts: hyaline casts

Non-pathological conditions where hyaline casts are increased?

A
  • Strenuous exercise
  • Dehydration
  • Heat exposure
  • Emotional stress (me rn)

hedds

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31
Q

Type of Casts: hyaline casts

Sources of error?

A

mucus, fibers, hair, increased lighting

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32
Q

Type of Casts

Composed of RBC and WBC casts

A

Cellular casts

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33
Q

Types of casts: Cellular casts

Protein matrix with RBCs

A

RBC Cast

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34
Q

Types of casts: Cellular casts

  • Appears orange red under LPO
  • Extremely fragile, degenerates to granular casts
A

RBC Cast

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35
Q

T or F

WBC may be seen in healthy individuals after strenuous exercise or activities

A

F (RBC)

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36
Q

Types of casts: Cellular casts (RBC)

Clinical significance

The presence of RBC casts is much more specific since it indicates ?

A

bleeding within the nephron

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37
Q

Types of casts: Cellular casts (RBC)

Clinical significance

RBC casts are primarily associated with damage to?

A

glomerulus

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38
Q

Types of casts: Cellular casts (RBC)

Damage to glomerulus is termed as?

A

Glomerulonephritis

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39
Q

Types of casts: Cellular casts (RBC)

RBC casts associated with glomerular damage are usually associated with (2) conditions

A

proteinuria and dysmorphic erythrocytes

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40
Q

Types of casts: Cellular casts (RBC)

Appearance?

A
  • Granular, dirty, brown casts representing hemoglobin degradation
  • products such as methemoglobin may also be present
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41
Q

Types of casts: Cellular casts (RBC)

Granular, dirty, brown casts is associated with what condition?

A

acute tubular necrosis

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42
Q

Types of casts: Cellular casts (RBC)

Condition often caused by the toxic effects of massive hemoglobinuria that can lead to renal failure

A

acute tubular necrosis

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43
Q

Types of casts: Cellular casts (RBC)

Granular, dirty, brown casts in microscopic view should be in conjunction with other (2) pathologic findings such as?

A

RTE cells, Positive reagent strip test for blood

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44
Q

Types of casts: Cellular casts

Cast matrix with WBCs

A

WBC Cast

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45
Q

Types of casts: Cellular casts

The appearance of WBC casts in the urine signifies infection or inflammation within the nephron

46
Q

Types of casts: Cellular casts (WBC)

Clinical significance

WBC is frequently assocaited with what (2) conditions?

A

pyelonephritis (kidney infection), non-bacterial inflammations such as acute interstitial nephritis

47
Q

Types of casts: Cellular casts (WBC)

WBC most frequently seen in WBC casts?

A

Neutrophils

48
Q

Types of casts: Cellular casts (WBC)

may appear granular, and, unless disintegration has occurred, multilobed nuclei will be present

A

Neutrophils

It is particularly helpful for differentiating WBC casts from RTE casts

49
Q

Types of casts: Cellular casts (WBC)

are present in cases of pyelonephritis, but are not present with acute interstitial nephritis

50
Q

T or F

eosinophil casts are not present in appropriately stained specimens for WBC casts

A

F (may be present in appropriately stained specimens; Hansel and Wright’s stains_

51
Q

Types of casts: Cellular casts (WBC)

Eosinophils may be present in WBC using what 2 stains?

A

Hansel and Wright’s stain

52
Q

Types of casts: Cellular casts (WBC)

Casts tightly packed with WBCs may have what border?

A

Irregular borders

These structures should be carefully examined to determine that a cast matrix is present

53
Q

T or F

WBCs frequently form clumps, and these do not have the same significance as casts

54
Q

Types of casts

RTE cast: Cast matrix containing RTE cells

A

Epithelial cell casts

55
Q

Types of casts: Epithelial cell cast

Clinical significance

Casts with RTE cells represent the presence of what conditions?

A

Advanced tubular destruction

56
Q

Types of casts: Epithelial cell cast

produces urinary stasis along with disruption of the tubular linings

A

advanced tubular destruction

57
Q

Types of casts: Epithelial cell cast

Epithelial cells are also associated with

a. heavy metal
b. allograft rejection
c. parasitic infection
d. a and c only
e. a and b
f. ALL
g. NOTA

A

e. a and b

also seen with WBC casts in cases of pyelonephritis

  • heavy metal
  • chemical or drug-induced toxicity
  • viral infections
  • allograft rejection
58
Q

Types of casts: Epithelial cell cast

Source of error?

A

WBC clumps

59
Q

Types of casts: Epithelial cell cast

are seen in cases of
hepatitis

A

Bilirubin-stained RTE cells

60
Q

Types of casts

  • Cast matrix with multiple cell types
A

Mixed Cellular cast

61
Q

Types of casts: Mixed Cellular cast

Familiarze the following mixed cellular casts most frequently encountered

A
  • RBC and WBC casts in glomerulonephritis
  • WBC and RTE cell casts in pyelonephritis
  • WBC and bacterial casts in pyelonephritis.
62
Q

Types of casts: Mixed Cellular cast

following mixed cellular casts most frequently encountered:

RBC + WBC casts = ?

A

RBC + WBC casts = glomerulonephritis

63
Q

Types of casts: Mixed Cellular cast

following mixed cellular casts most frequently encountered:

WBC + RTE = ?

A

WBC + RTE = pyelonephritis (kidney infection)

64
Q

Types of casts: Mixed Cellular cast

following mixed cellular casts most frequently encountered:

WBC + bacterial casts = ?

A

WBC + bacterial casts = pyelonephritis

65
Q

T or F

When mixed casts are present, there should also be hetereogenous casts and all of the cell types will be the primary diagnostic marker.

A

F (OPPOSITE; When mixed casts are present, there should also be homogenous casts of at least one of the cell types, and * they will be the primary diagnostic marker.)

MEANING: dapat may isang casts ang lamang

ex.1 in glomerulonephritis, the predominant
casts will be RBC

ex.2 pyelonephritis, the predominant casts will be WBC

66
Q

Types of casts: Mixed Cellular cast

predominant casts in glomerulonephritis

67
Q

Types of casts: Mixed Cellular cast

predominant casts in pyelonephritis

68
Q

T or f

bacteria are often incorporated into WBC casts and provide little additional diagnostic significance.

69
Q

Types of casts

Cast matrix that contains fat droplets or oval fat bodies

A

Fatty cast

70
Q

Types of casts

most frequently associated with the nephrotic syndrome, but are also seen in toxic tubular necrosis, diabetes mellitus, and crush injuries

A

Fatty cast

71
Q

Types of casts: Fatty cast

Fatty casts’ appearance are
a. low refractile unde rbirght field microscope
b. highly refractile under phase constrast microscope
c. highly refractile under birght field microscope
d. A and B
e. ALL
f. NOTA

A

c. highly refractile under birght field microscope

72
Q

Types of casts: Fatty cast

Confirmation of fatty casts is performed using what equipment and stain?

A

Equipment: polarized microscopy

Stain: Sudan III or Oil Red O fat stain (SO FAT STAIN)

73
Q

Types of casts: Fatty cast

demonstrates characteristic Maltese cross formations under polarized light

A

Cholesterol

74
Q

Types of casts: Fatty cast

stain orange with fat stains

A

triglycerides and neutral fats

75
Q

T or F

Fats do not stain with Sternheimer-Malbin stains

76
Q

Types of casts: Fatty cast

Sources of error?

A

Fecal debris

77
Q

Familiarize the phases of dissolution

A
  1. Hyaline
  2. Cellular
  3. Granular
  4. Loosely
  5. Finely
  6. Waxy

Hyaline –> Cellular –> Granular –> Loosely –> Finely –> Waxy

78
Q

Types of casts

Final phase of the dssolution of the fine granules of the granular casts

A

Waxy casts

79
Q

Types of casts

brittle, highly refractive cast matrix

A

Waxy cast

Refractile with rigid texture, frequent cracks and convolution “brittle”

80
Q

Types of casts: Waxy casts

Waxy casts are representative of extreme urine stasis, indicating what condition?

A

chronic renal failure

81
Q

T or F

Waxy casts are more easily visualized than hyaline casts because of their higher refractive index

82
Q

Types of casts: Waxy casts

Clinical significance

A
  • Tubular inflammation & degeneration
  • Nephroticsyndrome
  • Extreme stasis of urine flow
  • Chronic renal failure
83
Q

Types of casts: Waxy casts

Sources of error?

A

Fibers and fecal material

84
Q

Types of casts

  • 2 to 6x diameter of a normal cast
  • Renal failure casts, ______ casts like waxy casts represent extreme urine stasis or tubular atrophy/dilatation.
A

Broad cast

85
Q

Types of casts: Broad cast

Broad casts are formed in?

A

Collecting ducts or distended distal tubules

86
Q

Types of casts: Broad cast

T or F

When the flow of urine to the larger collecting ducts becomes severely compromised, casts form in this area and appear narrow

A

F (When the flow of urine to the larger collecting ducts becomes severely compromised, casts form in this area and appear broad)

87
Q

Types of casts: Broad cast

2 most commonly senn broad casts

A

Granular and Waxy

88
Q

Types of casts: Broad cast

Bile-stained broad, waxy casts are seen as the result of the tubular necrosis caused by?

A

Viral hepatitis

89
Q

Type of casts

From disintegrated cellular cast

A

Granular cast

90
Q

Type of casts

Cast matrix with small, fine granules or large, coarse granules

A

Granular Cast

91
Q

Type of casts

Appearance of granular casts frequently seen in the urinary sediment and may be of pathologic or non- pathologic significance

A

Coarsely and finely granular casts

92
Q

Type of casts: Granular cast

Identify if non-pathologic or pathologic condition

Lysosomes excreted by RTE cells during normal metabolism

A

non-pathologic

93
Q

Type of casts: Granular cast

Identify if non-pathologic or pathologic condition:

Lysosomes excreted by RTE cells during normal metabolism

A

non-pathologic

94
Q

Type of casts: Granular cast

Increased cellular metabolism occurring during periods of strenuous exercise accounts for the transient increase of granular casts that accompany the increased hyaline casts

A

non-pathologic

95
Q

Type of casts: Granular cast

Identify if non-pathologic or pathologic condition:

Glomerulonephritis

A

pathologic condition

96
Q

Type of casts: Granular cast

Identify if non-pathologic or pathologic condition:

Pyelonephritis

A

pathologic condition

97
Q

Type of casts: Granular cast

Identify if non-pathologic or pathologic condition:

Tubule-interstitial disease

A

pathologic condition

98
Q

Type of casts: Granular cast

Identify if non-pathologic or pathologic condition:

Renal allograft rejection

A

pathologic condition

99
Q

Type of casts: Granular cast

Identify if non-pathologic or pathologic condition:

protein aggregates filtered by the glomerulus

A

pathologic condition

100
Q

Type of casts: Granular cast

What phenomenon which allows the casts to remain in the tubules must be present for granules to result from disintegration of cellular casts.

A

Urinary stasis

101
Q

Type of casts: Granular cast

Sources of error?

A

clumps of small crystals, fecal debris, columnar RTE cells

102
Q

T or F

When granular casts remain in the tubules for extended
periods, the granules further develops, and the cast matrix develops a waxy appearance.

A

F (When granular casts remain in the tubules for extended
periods, the granules further disintegrate, and the cast matrix develops a waxy appearance)

structure becomes more rigid, the ends of the casts may appear jagged or broken, and the diameter becomes broader.

103
Q

Familiarize other casts mentioned

A
  1. Hemosiderin casts
  2. Crystal casts
  3. Pigmented casts:
104
Q

other casts

What casts to these belong: Urates, calcium oxalates & sulfonamides

A

Crystal casts

105
Q

other casts

Cast matrix with coloration due to pigment incorporation

A

Pigmented casts

106
Q

other casts

3 examples of pigmented casts?

A

bilirubin, hemoglobin, myoglobin

107
Q

other casts: pigmented cast

Goldenbrown; Obstructive jaundice

A

bilirubin casts

108
Q

other casts: pigmented cast

Yellow to red; Glomerular disease

A

hemoglobin

109
Q

other casts: pigmented cast

red brown; acute renal failure

A

Myoglobin cast

110
Q

What are the telescoped sediments?

A
  • Elements of glomerulonephritis
  • Elements of nephrotic syndrome
  • RBCs, RBC casts, cellular casts, broad waxy casts, lipid droplets, oval fat bodies, fatty casts
  • Collagen vascular disease (lupus nephritis)
  • Subacute Bacterial Endocarditis

AUBF (45 decks)

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