Common Urinary Casts: Introduction, Identification Features, Normal Range and Clinical Singificance

Common Urinary Casts Introduction, Identification Features, Normal Range and Clinical Singificance

Introductions of Common Urinary Casts

Common Urinary casts in urine routine examination are completed in the following steps- First request the patient to bring a urine specimen. After the arrival of the specimen in the clinical laboratory, take nearly 5 ml of urine and centrifuge it. Put a drop of the mixed sediment part on a clean and grease-free glass slide and place a coverslip over it.  Examine the entire 22- by 22-mm coverslip systematically with the low power objective (10X ) and low light intensity. If any suspicious objects are encountered, examine with the high dry objective (40X). The common urinary casts faced during urine microscopy are hyaline cast, granular cast, fatty casts, waxy casts, white blood cells cast/WBC cast, and crystal casts.

Common Urinary Casts Definition, Identification Features, and Clinical Significance

Hyaline casts: The hyaline cast is a type of urinary cast that is simple and most commonly found, which is a cluster of urinary particles, such as cells, fat bodies, or microorganisms, held together by a protein matrix and found in the urine. It can be seen in both healthy and pathological conditions.

Hyaline cast Identification: Appear as clear, tiny tubule-shaped particles

Clinical Significance: Not a dangerous finding, Strenuous exercise, diuretic medications, severe vomiting, or fever.  But large amounts of hyaline casts may indicate kidney damage due to decreased blood flow to the kidneys.

Normal range : 0–2 casts per low power field (LPF) of the microscope

Granular Cast:  The granular cast is cast that contains either proteins, tubular cells, or leukocytes that have broken down.

Principal causes of formation: Exercise or dehydration, acute tubular necrosis.
Fatty Cast-Formation of the fatty cast: It is formed by the breakdown of lipid-rich epithelial cells, these are hyaline casts free globules of fat or oval fat bodies inclusions, yellowish-tan in color.

Clinical Significance: Fatty cast in urinary sediment is faced in various clinical conditions like the high urinary protein nephrotic syndrome, diabetic or lupus nephropathy or toxic renal poisoning, or larger-scale necrosis or epithelial cell death.

Stain: Fatty cast has globules of fat, either as triglyceride or neutral fat, that stains with fat stain, or as cholesterol, which will unify as a Maltese cross.

Identification features: There is the presence of refractile lipid droplets within the protein matrix of the cast.

Waxy Cast- Definition of Waxy Cast: It is a form of urinary cast consisting of homogeneous proteinaceous material that has a high refractive index, in contrast to the low refractive index of hyaline casts; waxy casts probably represent an advanced stage of the disintegrative process that results in coarsely and finely granular casts and are usually indicative of advanced renal disease. Source-Farlex Partner Medical Dictionary © Farlex 2012

Clinical Significance: Amyloidosis, postinfectious glomerulonephritis, and frequent association in Increased levels of serum creatinine

Identification Feature: Broken off or blunt ends, notched and sharp margins, lateral cracks, high refractive index, and a surface whose appearance is reminiscent of that of melted wax.

White blood cells (WBC) Cast:

WBC cast: White blood cell casts or WBC casts in routine urinalysis refer to a hyaline matrix cast bearing neutrophil inclusions.

Identification Features: WBCs in a cast

Stain: WBC cast stained with Naphtyl AS-D chloro-acetate esterase

Clinical Significance: Tubular disease, especially infection and acute pyelonephritis

Crystal Casts:  Crystal Casts are crystallized urinary solutes, such as oxalates, urates, or sulphonamides, etc, that may become enmeshed within a ketanaline cast during its formation. Clinical Significance: They show little clinical significance.

Common Urinary Casts Videos Links

The common urinary casts links videos of Urinary Sediment Microscopy are provided as follows-

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