The finding of casts is the most important observation from the microscopic examination of the

urinary sediment. Casts are normally formed within tubules from gellation of the Tamm-Horsfall
mucoprotein secreted by the tubule Microscopic Appearance of a Granular Cast
epithelia of the ascending loop of Henle.
The mucoprotein accounts for about 30 -
50 mg of total urine protein excreted per
day. Cast formation is favored by sluggish
flow, acid, and high protein content.
Sluggish flow permits the formation of
larger casts within larger collecting ducts.
Cells trapped in casts disintegrate to a
greater degree the slower the flow and the
longer the cast remains in the collecting
ducts. A granular cast is shown to the right,
below.

 Hyaline casts of Tamm-Horsfall

protein are present in normal urine.
 Red cell casts predominate in acute glomerulonephritis.
 White cell casts predominate in tubulointerstitial disease.
 Granular casts result from disintegration of cellular casts and may be coarsely or finely
granular depending on the degree of disintegration of the cellular elements.
 Broad, waxy casts represent complete disintegration of embedded components,
suggesting sluggish flow; the broad nature of these casts is due to their formation in
larger collecting ducts. These casts appear in more severe stages of renal disease and are
sometimes referred to as "renal failure casts".

Specific gravity is measured for the purpose of determining concentrating ability. The result has
meaning for this purpose only when the specimen has been collected following a 12 hour fluid
fast. Normal kidneys can concentrate urine so that the concentration of osmotically active
substances is 3 - 4 times greater than that of plasma. When concentrating ability is completely
lost, the osmolality of urine can be no greater than that of serum. Specific gravity is much easier
to measure than is osmolality and generally the two results correlate well. Normal specific
gravity of a concentrated urine specimen is greater than 1.025. The specific gravity of a urine
specimen from a fluid fasted patient with renal disease, sufficiently severe so that concentrating
ability is completely lost, is 1.010.
At end stage, diluting ability is minimal, and specific gravity becomes fixed at 1.010 regardless
of fluid intake.
Specific gravity results are not reliable when urine contains an appreciable amount of protein.
Osmolality must be measured in order to evaluate concentrating ability in urine specimens with a
high protein content.

Diluting ability, determined from the specific gravity or osmolality following a fluid load, is used
for evaluating Syndrome of Inappropriate ADH.

Drug Crystals
Many drugs excreted in the urine have
the potential to form crystals. Hence, a
review of the patients drug history is
prudent when faced with unidentified
urine crystals.

Most common among these are the sulfa

drugs. Both panels on the right are from
patients receiving trimethoprim-
sulfadiazine. The differing appearance
may relate to variation in drug
concentration, urine pH, and other
factors. The upper panel is from a feline
case, the lower from a horse. The inset in
the lower panel shows the crystals as
they appeared when polarized.

Other examples include radiopaque

contrast agents (Hypaque, Renografin)
and ampicillin which may precipitate in
acid urine as fine needle-like crystals
(not shown).