Calma, Paul Richard G.

BSMT 2B

TYPE OF CASTS SHORT DESCRIPTION CLINICAL SIGNIFICANCE PICTURES

Hyaline Cast This cast is almost entirely Increased Hyaline casts:
comprised of uromodulin. • Acute
Hyaline casts are colorless in glomerulonephritis
unstained sediments and • Pyelonephritis
have a refractive index close • Chronic renal disease
to that of urine; as a result, • Congestive heart failure
they are often overlooked if
specimens are not viewed in
subdued light.

RBC Cast RBC casts are immediately
visible at low magnification
due of their orange-red color.
They are more delicate than
other casts and may be
fragmented or have an
uneven shape due to tightly
packed cells clinging to the
protein matrix.
Although RBC casts are most
frequently connected with
damage to the glomerulus
(glomerulonephritis)
Moreover, any disturbance to
the nephron capillary structure
might result in their
development.

WBC Cast While WBC casts are visible at Pyelonephritis

low magnification, they • WBC Cast is a primary
are positively identified at marker for
high magnification. WBC casts distinguishing
are frequently composed of pyelonephritis from
neutrophils. As a result, they cystitis.
may appear granular and will
contain multilobed nuclei Nonbacterial inflammations
unless disintegration has • Acute interstitial
occurred. nephritis
Calma, Paul Richard G. BSMT 2B

RTE Cell Cast Renal tubular cells can Renal tubular damage
become attached to the
uromodulin matrix of casts
and act as nonspecific
markers of tubular damage.
Because of their high
refractive index, they are
easily visible under brightfield
microscopy. When the large
central nucleus and
distinctive shape of these
cells are visible, these casts
are easily identifiable.
Bacterial Cast It can be challenging to Pyelonephritis
distinguish bacterial casts
from granular casts, as packed
casts packed with bacteria
can resemble granular casts.
Their existence should be
considered when WBC casts
and a high concentration of
free WBCs and bacteria are
observed in the sediment.
The best method for
confirming bacterial casts is to
do a Gram stain on the dried
or cytocentrifuged sediment.
Calma, Paul Richard G. BSMT 2B

Granular Cast Casts with coarse and fine • Glomerulonephritis

granules are frequently • Pyelonephritis
observed in urine sediment • Stress and exercise
and may be pathogenic or
nonpathologic in nature.

Fatty Cast Fat droplets and oval fat • Nephrotic syndrome

bodies attached to protein • Toxic tubular necrosis
matrix • Diabetes mellitus
• Crush injuries

Waxy Cast Due to their higher refractive • Stasis of urine flow

index, waxy casts are more • Chronic renal failure
visible than hyaline casts. As a
result of the cast matrix's
brittle consistency, they
frequently seem fragmented
with jagged edges and
notches in their sides.
Calma, Paul Richard G. BSMT 2B

Broad Cast Broad casts indicate cast • Extreme urine stasis

formation in dilated tubules • Renal failure
or in the large collecting
ducts. All types of casts may
occur in the broad
form. However, when
associated with urinary stasis,
the most frequently
encountered broad casts are
granular and waxy.
Amorphous Substances Amorphous phosphates, like The presence of calcium
Crystals (Amorphous urates, amorphous urates, have a phosphate crystals in the urine
Amorphous phosphates) granular appearance. When of people who have kidney
present in large quantities stones may reflect the nature of
after specimen cooling, they the stone.
form a white precipitate that
does not dissolve when
warmed. The color of the
sediment and the pH of the *Amorphous phosphate
urine distinguish amorphous
phosphates from amorphous
urates.

* Amorphous urates

Calcium Oxalate Crystals Dihydrate crystal is the most The presence of the
Note: Dihydrate Calcium common form of calcium monohydrate form of calcium
Oxalate Crystal was found in oxalate crystals, which oxalate crystals in cases of
the lab demonstration appears as a colorless ethylene glycol (antifreeze)
Calma, Paul Richard G. BSMT 2B

octahedral envelope or as poisoning is the principal

two pyramids joined at their pathological importance of
bases. calcium oxalate crystals.

Dihydrate calcium oxalate crystals

Monohydrate calcium oxalate crystals

REFERENCES:

Amorphous Phosphate Crystals. (n.d.). Biron.com. Retrieved March 7, 2022, from https://www.biron.com/en/glossary/amorphous-phosphate-
crystals/

Strasinger, Susan K. & Di Lorenzo, Marjorie S. (2014). Urinalysis and Body Fluids. 6th Ed. Thailand: F.A. Davis Company.