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URINALYSIS

URINALYSIS. UA Casts.

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URINALYSIS

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  1. URINALYSIS

  2. UA Casts

  3. Urinary casts are formed only in the distal convoluted tubule (DCT) or the collecting duct (distal nephron). The proximal convoluted tubule (PCT) and loop of Henle are not locations for cast formation. Hyaline casts are composed primarily of a mucoprotein (Tamm-Horsfall protein) secreted by tubule cells. The Tamm-Horsfall protein secretion (green dots) is illustrated in the diagram below, forming a hyaline cast in the collecting duct: Cast Formation

  4. Cast are molded in the lumen of the renal tubules • Formed in Distal and Collection tubules • Composed of plasma proteins of Glomerular Filtrate • Tamm-Horsfall Protein makes up matrix Cast Formation

  5. Named by how they appear • Convoluted • Broad • Granular (Finely or Coarsely granular) • Waxy Cast Names

  6. Named by what is in casts • Cells WBC, RBC, Renal Epithelial or Mixed • Substances Fat Hemoglobin Cast Names

  7. Casts

  8. Don’t mistake fibers for casts!!!! Fiber

  9. Low refractive Index Difficult to see Use low light Hyaline Casts

  10. Cylindroid Hyaline cast with tail Hyaline Casts

  11. Mucous Threads Phase Contrast Hyaline Cast

  12. Spermatozoa Tortuouse Cigar Shaped Phase Contrast Hyaline Cast

  13. Tortuous Interference Contrast Hyaline Cast

  14. Hyaline Cast • Triple Phosphate • Note how Hyaline Casts are barely visible Hyaline Cast

  15. Convoluted • Note cells on matrix Hyaline Cast

  16. Formed by the breakdown of cellular casts • In patients with renal disease the granules become more fine as they progress through the nephron and eventually become Waxy Granular Casts

  17. Cast Degeneration

  18. C Finely Granular Cast

  19. Higher refractive index than Hyaline cast • May be present in urine of healthy person after severe physical exercise • Found in all forms of renal disease Finely Granular Cast

  20. Granules may be disintegrated RBC’s due to reddish color Coarse Granular Cast

  21. Sternheimer-Malbin Stain Coarse Granular Cast

  22. Coarse Granular Cast

  23. Note mucous threads in background Coarse Granular Cast

  24. In early stage of evolving into waxy cast Notched margins Broad Finely Granular Cast

  25. High Refractive Index • Notched parallel margins • “Broken Off” ends • Chronic renal disease Waxy Cast

  26. High Refractive Index • Notched parallel margins • “Broken Off” ends • Chronic renal disease Waxy Cast

  27. High Refractive Index • Notched parallel margins • “Broken Off” ends • Chronic renal disease Waxy Cast

  28. SM Stain • High Refractive Index • Notched parallel margins • “Broken Off” ends • Chronic renal disease Waxy Cast

  29. Note Spheric lipid globules on surface • Notched parallel margins • “Broken Off” ends • Chronic renal disease Waxy Cast

  30. Casts that contain free fat or oval fat bodies • Fat appears as globular lipids of varying size • Often have a yellow tan color • Lipid has high refractive index • Lipid is birefringent • Maltese Cross in polarized light Fatty Casts

  31. Lipid globules on surface • RBC in background • Nephrotic Syndrome Fatty Cast

  32. Lipid globules on surface • RBC in background • Nephrotic Syndrome • Polarized Maltese Cross Fatty Cast

  33. Lipid globules on surface • RBC in background • Nephrotic Syndrome • Polarized Maltese Cross Fatty Cast

  34. Lipid globules on surface • RBC in background • Nephrotic Syndrome • Polarized Maltese Cross Fatty Cast

  35. Lipid globules on surface • RBC in background • Nephrotic Syndrome Fatty Cast

  36. Fatty Cast Polarized

  37. Broad Red Cell Casts

  38. Cellular Cast are named for the types of cells they contain Cast Formation in Nephron

  39. Cellular Cast formation

  40. Reddish color Hemoglobin Cast ??

  41. RBC in hyaline cast matrix • RBC more concentrated at one end RBC Cast

  42. RBC in hyaline cast matrix • Surrounding urine filled with PMN’s and RBC RBC Cast

  43. RBC in hyaline cast matrix RBC Cast

  44. RBC in hyaline cast matrix • Very difficult in this cast to see intact RBC’s • Hb granules RBC Cast

  45. Epi’s • WBC • Note yeast Cellular Cast Mixed

  46. Renal Tubular Cells Cellular Cast

  47. Cast Review

  48. Casts Overhead

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