URINALYSIS

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