Casts

Hyaline cast

Hyaline cast, note refractile fiber in the top left corner

Hyaline cast, several RBCs present

Hyaline cast and numerous squamous epithelial cells

Cylindroid. One end resembles a cast; the other end resembles a mucus filament

Hemoglobin cast

Clinical significance of RBC casts

RBC casts are associated with damage to the glomerulus or glomerulonephritis, bleeding into the nephron, and lupus

Tips for describing RBC casts

Casts have parallel sides with rounded edges and are degenerated into a yellow-brown homogeneous structure

WBC cast

Broad WBC cast with many free-floating WBCs, two RBCs and budding yeast present

Degenerating WBC cast. WBCs, RBCs, a hyaline cast, a RTE, and artifact fibers are also present

Bacterial cast. Mixed granular cast with bacteria embedded. Note bacteria surrounding the cast. These are uncom

Clinical significance of WBC casts

Can indicate renal inflammation, infection, acute pyelonephritis, or interstitial nephritis. The presence of casts can distinguish pyelonephritis (upper UTI) from cystitis (lower UTI)

Renal epithelial cell cast

Cast with oval fat bodies

Clinical significance of Epithelial cell casts

Most associated with acute tubular necrosis, advanced tubular destruction, and heavy metal or drug toxicity

Granular cast

Granular cast with squamous epithelial cell and RBC

Granular cast. Note RBCs, WBCs, and bacteria

One granular cast. Numerous sperm present

One granular cast and two hyaline casts

One granular cast with four squamous epithelial cells. Note highly refractile artifact

Clinical significance of granular casts

Can indicate urinary stasis, tubular disease, glomerulonephritis, pyelonephritis, or may be seen in stress or after exercise

Fatty cast. Note oval fat bodies within the matrix

Clinical significance of fatty casts

Maltese cross formations can be seen with cholesterol under polarization

Waxy cast located in the center with four granular casts to the side

Waxy cast

Waxy cast w fragmented end and notches on its side. WBCs are also present

Broad granular cast

Clinical significance of waxy cast

Indicate urinary stasis, chronic renal failure, or end-stage renal disease

Clinical significance of broad casts

Represent extreme urinary stasis and renal failure