Urinalysis with microscopy
-Hyaline and fine granular casts often seen in pre-renal failure
-Tubular epithelial cells or casts: ATN, ( AIN)
-WBC CASTS, Urine eosinophils: AIN (Hansel’s stain)
-RBC, RBC CASTS: suggests Glomerulonephritis
+ blood on Dipstick but no RBCs on microscopic: consider Rhabdomyolysis, check serum CK level
Urinary Casts and Associated Pathologic Conditions, Table from AAFP 2005
| TYPE OF CAST | COMPOSITION | ASSOCIATED CONDITIONS |
|---|---|---|
|
Hyaline |
Mucoproteins |
Pyelonephritis, chronic renal disease |
|
May be a normal finding |
||
|
Erythrocyte |
Red blood cells |
Glomerulonephritis |
|
May be a normal finding in patients who play contact sports |
||
|
Leukocyte |
White blood cells |
Pyelonephritis, glomerulonephritis, interstitial nephritis, renal inflammatory processes |
|
Epithelial |
Renal tubule cells |
Acute tubular necrosis, interstitial nephritis, eclampsia, nephritic syndrome, allograft rejection, heavy metal ingestion, renal disease |
|
Granular |
Various cell types |
Advanced renal disease |
|
Waxy |
Various cell types |
Advanced renal disease |
|
Fatty |
Lipid-laden renal tubule cells |
Nephrotic syndrome, renal disease, hypothyroidism |
|
Broad |
Various cell types |
End-stage renal disease |
Reference
Am Fam Physician. 2005 Mar 15;71(6):1153-1162. Urinalysis: A Comprehensive Review. https://www.aafp.org/afp/2005/0315/p1153.html