CASTS - Types of Casts (PDF)

IV. CASTS V. TYPES OF CAST A. Excretion or presence in urine is called ________ A. Hyaline cast B. Unique to the kidney - ____________ cast C. Represents a biopsy of a...

IV. CASTS V. TYPES OF CAST A. Excretion or presence in urine is called ________ A. Hyaline cast B. Unique to the kidney - ____________ cast C. Represents a biopsy of an individual tubule - ____________ of all cast D. The most difficult and the most important urinary - Most frequently encountered and most sediment constituent difficult cast to discover E. Primarily formed in the DCT and collecting ducts - Colorless and translucent F. Major constituent - NV - ______________ 0-2 / LPF G. Other proteins such as albumin and Ig are also - Physiologic causes incorporated in the cast matrix Stress H. Cylindroids have the same significance as cast Strenuous exercise I. Protein gels more readily under conditions of - Pathologic causes urine flow-stasis, acidity and presence of Na+ Glomerulonephritis and Ca Pyelonephritis J. A cast structure should have even and definite CHF outline, parallel sides and two rounded ends CKD K. Has a uniform diameter - 7-8x the diameter of RBC L. Examined under subdued light along the edges of coverslip C. CAST FORMATION B. RBC Cast A. _____________ - Indicates _________ within the _________ - Of uromodulin into individual protein fibrils - Easily identified by its orange-red color attached to RTE cells - Significance B. _____________ Glomerulonephritis - Of proteins fibrils to form a loose fibrillar Strenuous exercise network - Blood cast C. Further protein fibril interweaving to form solid Muddy brown cast structure Contains hemoglobin from lysed RBCs D. Possible attachment of urinary constituents to the Homogenous appearance with orange- solid matrix red color E. ________________ Same significance as RBC cast - Of protein fibrils from the epithelial cells F. _______________ C. WBC/Leukocytes/Pus Cast - Indicates ___________________ within the nephron - Resembles ______ casts Use phase contrast and supravital stain to distinguish - Significance Pyelonephritis 6 MT-AP NOTES COLLATED BY ANTHONY SIO, RMT. PLEASE DO NOT SPREAD IF NOT PERMITTED  Acute interstitial nephritis - Cells disintegrate when the cast is retained - Pseudoleukocyte cast in the tubule before being flushed out Not a true cast (DO NOT REPORT AS - Finely granular cast CAST) Sandpaper appearance Clump of WBC - Significance Seen in lower UTI Glomerulonephritis Pyelonephritis Stress Strenuous exercise D. Epithelial Cast - RTE - Cells viable on the cast matrix are smaller round and oval cells - Significance G. Fatty Cast Advance tubular destruction - Fat globules not stained by SM stain (only Tubular damage cast matrix is stained) - Methods to identify TAG & neutral fats= Lipid stains Chole= Polarizing microscope - Significance Nephrotic syndrome Toxic tubular necrosis DM Crush injuries E. Bacterial Cast - Identified by performing __________ - Significance Pyelonephritis H. Waxy Cast - __________________ form of all types of casts - Brittle, highly refractile, with jagged end F. Granular cast - Ground glass appearance - Granules are derived from the lysosomes of - Significance RTE cells during normal metabolism Stasis of urine flow (nonpathologic) Chronic renal failure 7 MT-AP NOTES COLLATED BY ANTHONY SIO, RMT. PLEASE DO NOT SPREAD IF NOT PERMITTED  - Few - Moderate - Many - HPF G. Abnormal crystals reporting - Averaged and reported /LPF H. Abnormal crystals generally require confirmation before they are reported VII. NORMAL ACID CRYSTALS I. Broad Cast A. Amorphous Urates - Often referred as _______________ - Ca2, Mg2, Na, K urates - Indicates destruction (widening) of the - Fluffy orange or pink sediment ______ due tubular walls to uroerythrin - Any type of cast can be broad - _____________ granules (microscopic) Most common are granular and waxy - Pseudocast - 2-6x wider than ordinary cast Clumps resemble granular cast - Significance - Turns into uric acid after adding acetic acid Extreme urine stasis - Turns into ammonium biurate after adding Renal failure ammonium hydroxide iii. MISCELLANEOUS CAST - Inc: A. Pigmented Cast ____ - Hyaline matrix with coloration due to pigment Chemotherapy incorporation - Soluble in ________________ - Incorporation of bilirubin (golden-brown) - Hemoglobin or myoglobin (yellow or red brown) B. Mixed Cellular Cast - Casts containing multiple cell types - Glomerulonephritis (RBC and WBC cast) - Pyelonephritis (WBC and RTE casts or WBC and bacteria casts) C. Crystal cast B. Uric Acid - Casts containing urates, calcium oxalates, - Product of ______ metabolism and sulfonamides are occasionally seen - Rhombic (diamond), 4 sided flat plate - Deposition of crystals in the tubule or (whetstone), lemon shaped collecting ducts - Wedges, barrel, rosettes, irregular plates, VI. CRYSTALS laminated forms are also seen A. _______________ - Hexagonal forms may be mistaken as - Excretion of crystals in the urine cystine crystals B. Most recognized but the most insignificant part of - Present at pH _____________ urine sediment (turgeon) - pH >5.7 C. Formed by precipitation of urine solutes (salts, in its ionized form as urate organic compounds, medication) - inc. D. Presence of crystals in fresh urine is most Lesch nyhan syndrome frequently associated with Concentrated spx Chemotherapy E. Factors that contribute to crystal formation Gout - ______ - Soluble in alkali - ___________ C. Calcium Oxalate - _____________ - _________________________________ F. Reporting - Dihydrate - Rare _____________ 8 MT-AP NOTES COLLATED BY ANTHONY SIO, RMT. PLEASE DO NOT SPREAD IF NOT PERMITTED