CASTS AND

CRYSTALS IN
URINE
PRESENTED BY: GROUP NO. 9
 CASTS

 The solidification of protein within the space of tubules in the kidney, cylinder
like structures with parallel sides.

 Site of formation: Produced in the lumen of the distal convoluted tubule and
collecting ducts.
Requirement for formation of cast:

1. Sufficient protein concentration

2. Low pH(Acid) to favor precipitation
3. Sufficient, increased concentration of solute
4. Decreased rate of urine flow
Detection of casts Microscopically:

i. Low power(10x Objectives lens) and low light to find casts and high
power(40X Objectives lens) to identify
ii. Cylindrical body with parallel sides and rounded ends may be seen if casts
present in the urine
iii. Carefully, sometimes may be confused with other cylindroids, mucous threads
and rolled up squamous epithelial cells
TYPES OF CASTS ;

1) Hyaline casts; Colorless, transparent

2) Waxy casts; Cracked and more refractile has a rigid thick appearance
3) Fine granular casts; May resemble hyaline but also has small granular
4) Coarse granular casts; has larger granules, larger quantity
5) Fatty casts; Contain fat droplets, seen with oval fat bodies as a result of fat
degeneration
6) Cellular casts; contain RBC,WBC and Epithelial cell
Continued ……
 CRYSTALS

 Is salt that precipitate out of solution, when the salt concentration in urine is greater
than the solubility of salt in urine

 Factors influencing the types and numbers of urinary crystals in a given sample
o In vivo factors;
 Concentration and solubility of crystalllogenic substances contained in the specimen
 Urine pH

o In vitro factors;
 Urine pH(changes with standing and bacterial overgrowth)
Crystals in acid urine;

1) Amorphous urates; look like sand, least significant of the crystals

2) Uric acid ;diamond shaped, rhomboid
3) Calcium oxalate; envelope, may be dumbbell
4) Cystine; hexagonal plate,colorless,refractile
5) Tyrosine ;black sheaves of fine needles
6) Leucine; yellow, oil spheres
7) Bilirubin; fine needle like or flashlight like
8) Cholesterol; large , flat, hexagonal plates with one edge notched
Crystals in alkaline urine;

1) Amorphous phosphates; white precipitate look like sand

2) Triple phosphates; coffin lids
3) Calcium phosphate; small, flat plates, wedge shaped
4) Calcium carbonates ; dumbbells, tiny colorless granules in pairs
CONTINUED ……
Urine artifacts;

 Powder crystals
 Fibers
 Oil
 Hairs
CASTS AND CRYSTALS IN URINE