urinary casts are produced in kidney, specifically _______ ; ____ shape reflects where they are formed
distal convoluted tubules and collecting ducts
cylindrical
casts are formed via precipitation of _________ MUCOprotein, secreted by renal tubules
Tamm-Horsfall
characteristics of casts
- may or may not be present with protein
- parallel sides with rounded/blunt edges
- convoluted, straight or curved shape
- could be cylindrical with NO dark edges
broad casts are formed in ______ and signify _______
pathologically diluted or atrophied tubules or collecting ducts
renal failure
(4) things that casts always signify
glomerular damage
tubular damage
renal inflammation
renal infxn
count casts on _____ power magnification; MC seen on _____ part of slide
low power (10x) edges of cover slip
colorless, homogenous, transparent casts
hyaline casts
a few hyaline casts may be present in healthy urine; may be present in (2); may also be seen in ____ disease
excessive physical exercise
physiological dehydration
renal disease
RBC casts are always _____; indicates _____ is present
pathologic
hematuria
RBC casts may indicate
glomerular disease renal trauma renal inflammation severe pyelonephritis renal vein thrombosis
white cell and WBC casts are usually ______ in _____ matrix
neutrophils
protein
WBC casts present in INFECTIOUS and NON-INFECTIOUS ______ inflammation; (4)
renal acute pyelonephritis interstitial nephritis lupus nephritis some glomerular diseases
epithelial cell casts consists of only ______ cells;
renal tubule epithelial cells
epithelial cell casts may be present in (4)
- acute tubular necrosis after exposure to nephrontoxic agent (mercury, salycilates)
- viral infections
- due to damage from glomerular injury (nephritic syndrome)
- rejection of kidney allograft
granular casts may result from breakdown of ______, _____ or ____ ; divided in 2 categories — __ & ___
cellular casts
inclusion of aggregates of plasma proteins
immunoglobulin light chains
coarse and fine
granular casts usually signify _____, but also may be present after ____
CHRONIC renal diseases
strenuous exercise
____ casts represent end stage of cast evolution, suggest low urine flow associated with ________ or _____
waxy
long-standing kidney disease
renal failure
waxy casts usually have ____ edges, _____ and _____ ends
blunt edges
fractures
broken-off ends
waxy casts fall under umbrella of ____ casts
broad
conditions that waxy casts are found in (5)
nephritic syndrome renal amyloidosis diabetic neuropathy tubular inflammation and degeneration malignant HTN
____ casts are hyaline casts formed by lipid-rich renal epithelial cells; yellow-tan in color
fatty casts
fatty casts are present during fatty degeneration of renal epithelial cells in degenerative tubular diseases (4)
- nepHROTIC syndrome with heavy proteinuria
- diabetic nephropathy (Kimmelsteil-Wilson lesions)
- lupus nePHRITIS
- toxic renal poisoning
formation of casts at distal convoluted tubule may produce structures with tapering end called ______ ; usually classified as ____ casts
cylindroids
hyaline
confusing artifact that appears as thin, ribbon-like structure, fiber-like bands of line across field that have no particular form or shape
mucus
