Urinary casts

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Male urinary system

Hyaline cast; Granular casts; Renal tubular casts; Waxy casts; Casts in the urine; Fatty casts; Epithelial casts

There are different types of casts. (See below.) The presence of a few "hyaline" casts is normal.

Abnormal results may include:

• Hyaline casts -- these casts are made of the protein itself. They are usually caused by dehydration, exercise, or diuretic medicines.
• Granular casts -- these casts include prominent granules and indicate an underlying kidney disease. However, they are non-specific and may be present with diverse kidney disorders.
• Fatty casts -- these result when fatty (lipid) material is incorporated into the cast from lipid-laden tubular cells. Fatty casts are seen in the condition of lipiduria (lipids in urine), usually as a complication of nephrotic syndrome .
• Red cell casts -- these signify bleeding into the tubule from the glomerulus. They are seen in many diseases affecting the glomerulus, such as IgA nephropathy , lupus nephritis , Goodpasture's syndrome , and Wegener's Granulomatosis. Red cell casts may degenerate and appear in the urine as reddish-brown, coarsely granular casts, called blood or hemoglobin casts.
• White blood cell (WBC) casts -- these are more common in interstitial cell kidney disease, such as interstitial inflammation, pyelonephritis, and parenchymal infection.
• Renal tubular epithelial cell casts -- these reflect damage to the tubules. They are seen in renal tubular necrosis (for example, caused by nephrotoxic drugs, heavy metal poisoning , or ethylene glycol ), viral disease (such as CMV nephritis), and with transplant rejection .
• Waxy casts -- these casts are associated with advanced kidney disease and chronic kidney failure .

This test may also show:

• Acute nephritic syndrome
• Glomerulonephritis - chronic
• Glomerulonephritis - post-streptococcal
• Glomerulonephritis - rapidly progressive
• Complicated urinary tract infection
• Necrotizing vasculitis
• Rhabdomyolysis
• Primary amyloid
• Secondary amyloid
• Systemic lupus erythematosus

Review Date: 02/03/2006
Reviewed By: Charles Silberberg, DO, Private Practice specializing in Nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network.