M1: Urine Sediments (Part 3: Casts) Flashcards by Geno Alinsub

Sole site of casts?

Kidney

How well did you know this?

Not at all

Perfectly

They are formed within the** lumens of the distal convoluted tubules** and collecting ducts, providing a microscopic view of conditions within the nephron

Casts

How well did you know this?

Not at all

Perfectly

Formed when proteins precipitate & gel in the lumen

Casts

How well did you know this?

Not at all

Perfectly

Shape of of casts that is representatiave of tubular lumen?

cylindrical with parallel sides and somewhat rounded ends

they may contain additional elements present in the filtrate.

How well did you know this?

Not at all

Perfectly

the cast matrix dissolves quickly in what concentration of urine?

dilute, alkaline urine

How well did you know this?

Not at all

Perfectly

COMPOSITION AND FORMATION

major constituent of casts is?

uromodulin

How well did you know this?

Not at all

Perfectly

COMPOSITION AND FORMATION

Other proteins present in the urinary filtrate, such as (blank) and (blank), are also incorporated into the cast matrix.

Albumin and Immunoglobulins

How well did you know this?

Not at all

Perfectly

COMPOSITION AND FORMATION

1/3 of cast is made up of?

Tamm Horsfall protein/uromodulin

forms the matrix of all casts

How well did you know this?

Not at all

Perfectly

COMPOSITION AND FORMATION

Forms a meshwork of fibrils that may trap cells and
granules

Tamm Horsfall protein/uromodulin

How well did you know this?

Not at all

Perfectly

COMPOSITION AND FORMATION

2/3 of cast is made up of ?

Albumin and Globulin

How well did you know this?

Not at all

Perfectly

5 factors involved in casts formation ?

Lower pH
Increased ionic concentration
Stasis (decrease in flow)
Obstruction of the nephron by cells or cell debris
Proteinuria (increase in albumin and globulin)

How well did you know this?

Not at all

Perfectly

factors involved in casts formation

this means there is decrease in flow

stasis

How well did you know this?

Not at all

Perfectly

What equipment was used that have provided a step- by-step analysis of the formation of the uromodulin protein matrix?

Electron microscope

How well did you know this?

Not at all

Perfectly

Familiarize the process of cast formation or memorize up to u

Uromodulin protein aggregates into protein fibrils attached to RTEs
The protein fibrils interweave until a solid structure is formed
Urinary elements attach to the solid matrix
Protein fibrils detach from the RTE
Cast is excreted into the urine

How well did you know this?

Not at all

Perfectly

Casts formation takes shape in what part of RTE?

Tubules

How well did you know this?

Not at all

Perfectly

T or F

As the cast forms, urinary flow within the tubule increases as the lumen becomes blocked

F (As the cast forms, urinary flow within the tubule **decreases **as the lumen becomes blocked)

How well did you know this?

Not at all

Perfectly

T or F

The accompanying dehydration of the protein fibrils and internal tension may account for the wrinkled and convoluted appearance of older hyaline casts

How well did you know this?

Not at all

Perfectly

Formation of casts at the junction of the ascending loop of Henle and the** distal convoluted tubule **may produce structures with?

Tapered ends

referred to as cylindroids, same isgnificance as casts

How well did you know this?

Not at all

Perfectly

The presence of urinary casts is termed?

Cylinduria

How well did you know this?

Not at all

Perfectly

The appearance of a cast is also influenced by?

a. the materials present in the filtrate at the time of its formation
b. the length of time it remains in the tubule
c. both
d. NOTA

c. both

How well did you know this?

Not at all

Perfectly

T or F

Any elements present in the tubular filtrate, including cells, bacteria, granules, pigments, and crystals, may become embedded in or attached to the cast matrix

How well did you know this?

Not at all

Perfectly

Type of Casts

Basis of all types of casts
Most frequently seen cast which consists almost entirely of uromodulin.

Hyaline cast

How well did you know this?

Not at all

Perfectly

Type of Casts: hyaline casts

appearance?

colorless in unstained sediments
Homogenous matrix
low refractive index similar to that of urine

How well did you know this?

Not at all

Perfectly

Type of Casts: hyaline casts

what stain is used in hyaline casts to produce a pink color

Sternheimer-Malbin stain (SM stain)

pink kasi logo ng sm enetrtainment basta yun

How well did you know this?

Not at all

Perfectly

# T or F The morphology of hyaline casts is varied

# Type of Casts: hyaline casts morphology of hyaline casts is varied, consisting of what following shapes?

* normal parallel sides and rounded ends * cylindroid forms * wrinkled or convoluted shapes

# Type of Casts: hyaline casts Shape of hyaline casts a. Normal parallel sides and rounded ends b. Star shaped and Stick form c. Cylindroid e. Wrinkled or convoluted shape f. a, b, c only g. a, c, e only h. ALL i. NOTA

g. a, c, e only

# Type of Casts: hyaline casts normal value (reference range) of hyaline casts?

0-2/LPF

# Type of Casts: hyaline casts Pathological conditions where hyaline casts are increased?

* Acuteglomerulonephritis * Pyelonephritis * Chronic renal disease * Congestive heart failure | **PACC**u pakyu

# Type of Casts: hyaline casts Non-pathological conditions where hyaline casts are increased?

* Strenuous exercise * Dehydration * Heat exposure * Emotional stress (me rn) | hedds

# Type of Casts: hyaline casts Sources of error?

mucus, fibers, hair, increased lighting

# Type of Casts Composed of RBC and WBC casts

Cellular casts

# Types of casts: Cellular casts Protein matrix with RBCs

RBC Cast

# Types of casts: Cellular casts * Appears orange red under LPO * Extremely fragile, degenerates to granular casts

RBC Cast

# T or F WBC may be seen in healthy individuals after strenuous exercise or activities

F (RBC)

# Types of casts: Cellular casts (RBC) Clinical significance The presence of RBC casts is much more specific since it indicates ?

bleeding within the nephron

# Types of casts: Cellular casts (RBC) Clinical significance RBC casts are primarily associated with damage to?

glomerulus

# Types of casts: Cellular casts (RBC) Damage to glomerulus is termed as?

Glomerulonephritis

# Types of casts: Cellular casts (RBC) RBC casts associated with glomerular damage are usually associated with (2) conditions

proteinuria and dysmorphic erythrocytes

# Types of casts: Cellular casts (RBC) Appearance?

* Granular, dirty, brown casts representing hemoglobin degradation * products such as methemoglobin may also be present

# Types of casts: Cellular casts (RBC) Granular, dirty, brown casts is associated with what condition?

acute tubular necrosis

# Types of casts: Cellular casts (RBC) Condition often caused by the toxic effects of massive hemoglobinuria that can lead to renal failure

acute tubular necrosis

# Types of casts: Cellular casts (RBC) Granular, dirty, brown casts in microscopic view should be in conjunction with other (2) pathologic findings such as?

RTE cells, Positive reagent strip test for blood

# Types of casts: Cellular casts Cast matrix with WBCs

WBC Cast

# Types of casts: Cellular casts The appearance of WBC casts in the urine signifies infection or inflammation within the nephron

WBC cast

# Types of casts: Cellular casts (WBC) Clinical significance WBC is frequently assocaited with what (2) conditions?

pyelonephritis (kidney infection), non-bacterial inflammations such as acute interstitial nephritis

# Types of casts: Cellular casts (WBC) WBC most frequently seen in WBC casts?

Neutrophils

# Types of casts: Cellular casts (WBC) may appear granular, and, unless disintegration has occurred, multilobed nuclei will be present

Neutrophils | It is particularly helpful for differentiating WBC casts from RTE casts

# Types of casts: Cellular casts (WBC) are present in cases of pyelonephritis, but are not present with acute interstitial nephritis

Bacteria

# T or F eosinophil casts are not present in appropriately stained specimens for WBC casts

F (**may be present** in appropriately stained specimens; Hansel and Wright’s stains_

# Types of casts: Cellular casts (WBC) Eosinophils may be present in WBC using what 2 stains?

Hansel and Wright's stain

# Types of casts: Cellular casts (WBC) Casts tightly packed with WBCs may have what border?

Irregular borders ## Footnote These structures should be carefully examined to determine that a cast matrix is present

# T or F WBCs frequently form clumps, and these do not have the same significance as casts

# Types of casts RTE cast: Cast matrix containing RTE cells

Epithelial cell casts

# Types of casts: Epithelial cell cast Clinical significance Casts with RTE cells represent the presence of what conditions?

Advanced tubular destruction

# Types of casts: Epithelial cell cast produces urinary stasis along with disruption of the tubular linings

advanced tubular destruction

# Types of casts: Epithelial cell cast Epithelial cells are also associated with a. heavy metal b. allograft rejection c. parasitic infection d. a and c only e. a and b f. ALL g. NOTA

e. a and b | also seen with WBC casts in cases of pyelonephritis ## Footnote * heavy metal * chemical or drug-induced toxicity * viral infections * allograft rejection

# Types of casts: Epithelial cell cast Source of error?

WBC clumps

# Types of casts: Epithelial cell cast are seen in cases of hepatitis

Bilirubin-stained RTE cells

# Types of casts * Cast matrix with multiple cell types

Mixed Cellular cast

# Types of casts: Mixed Cellular cast Familiarze the following mixed cellular casts most frequently encountered

* RBC and WBC casts in glomerulonephritis * WBC and RTE cell casts in pyelonephritis * WBC and bacterial casts in pyelonephritis.

# Types of casts: Mixed Cellular cast following mixed cellular casts most frequently encountered: RBC + WBC casts = ?

RBC + WBC casts = glomerulonephritis

# Types of casts: Mixed Cellular cast following mixed cellular casts most frequently encountered: WBC + RTE = ?

WBC + RTE = pyelonephritis (kidney infection)

# Types of casts: Mixed Cellular cast following mixed cellular casts most frequently encountered: WBC + bacterial casts = ?

WBC + bacterial casts = pyelonephritis

# T or F When mixed casts are present, there should also be hetereogenous casts and all of the cell types will be the primary diagnostic marker.

F (OPPOSITE; When mixed casts are present, there **should also be homogenous casts of at least one of the cell types**, and * they will be the *primary diagnostic marker*.) | MEANING: dapat may isang casts ang lamang ## Footnote ex.1 in glomerulonephritis, the predominant casts will be RBC ex.2 pyelonephritis, the predominant casts will be WBC

# Types of casts: Mixed Cellular cast predominant casts in glomerulonephritis

RBC casts

# Types of casts: Mixed Cellular cast predominant casts in pyelonephritis

WBC casts

# T or f bacteria are often incorporated into WBC casts and provide little additional diagnostic significance.

# Types of casts Cast matrix that contains fat droplets or oval fat bodies

Fatty cast

# Types of casts most frequently associated with the nephrotic syndrome, but are also seen in toxic tubular necrosis, diabetes mellitus, and crush injuries

Fatty cast

# Types of casts: Fatty cast Fatty casts' appearance are a. low refractile unde rbirght field microscope b. highly refractile under phase constrast microscope c. highly refractile under birght field microscope d. A and B e. ALL f. NOTA

c. highly refractile under birght field microscope

# Types of casts: Fatty cast Confirmation of fatty casts is performed using what equipment and stain?

Equipment: polarized microscopy Stain: Sudan III or Oil Red O fat stain (SO FAT STAIN)

# Types of casts: Fatty cast demonstrates characteristic Maltese cross formations under polarized light

Cholesterol

# Types of casts: Fatty cast stain orange with fat stains

triglycerides and neutral fats

# T or F Fats do not stain with Sternheimer-Malbin stains

# Types of casts: Fatty cast Sources of error?

Fecal debris

Familiarize the phases of dissolution

1. Hyaline 2. Cellular 3. Granular 4. Loosely 5. Finely 6. Waxy Hyaline --> Cellular --> Granular --> Loosely --> Finely --> Waxy

# Types of casts Final phase of the dssolution of the fine granules of the granular casts

Waxy casts

# Types of casts brittle, highly refractive cast matrix

Waxy cast | Refractile with rigid texture, frequent cracks and convolution “brittle"

# Types of casts: Waxy casts Waxy casts are representative of extreme urine stasis, indicating what condition?

chronic renal failure

# T or F Waxy casts are more easily visualized than hyaline casts because of their higher refractive index

# Types of casts: Waxy casts Clinical significance

* Tubular inflammation & degeneration * Nephroticsyndrome * Extreme stasis of urine flow * Chronic renal failure

# Types of casts: Waxy casts Sources of error?

Fibers and fecal material

# Types of casts * 2 to 6x diameter of a normal cast * Renal failure casts, ______ casts like waxy casts represent extreme urine stasis or tubular atrophy/dilatation.

Broad cast

# Types of casts: Broad cast Broad casts are formed in?

Collecting ducts or distended distal tubules

# Types of casts: Broad cast T or F When the flow of urine to the larger collecting ducts becomes severely compromised, casts form in this area and appear narrow

F (When the flow of urine to the larger collecting ducts becomes severely compromised, casts form in this area and appear **broad**)

# Types of casts: Broad cast 2 most commonly senn broad casts

Granular and Waxy

# Types of casts: Broad cast Bile-stained broad, waxy casts are seen as the result of the tubular necrosis caused by?

Viral hepatitis

# Type of casts From disintegrated cellular cast

Granular cast

# Type of casts Cast matrix with small, fine granules or large, coarse granules

Granular Cast

# Type of casts Appearance of granular casts frequently seen in the urinary sediment and may be of pathologic or non- pathologic significance

Coarsely and finely granular casts

# Type of casts: Granular cast Identify if non-pathologic or pathologic condition Lysosomes excreted by RTE cells during normal metabolism

non-pathologic

# Type of casts: Granular cast Identify if non-pathologic or pathologic condition: Lysosomes excreted by RTE cells during normal metabolism

non-pathologic

# Type of casts: Granular cast Increased cellular metabolism occurring during periods of strenuous exercise accounts for the transient increase of granular casts that accompany the increased hyaline casts

non-pathologic

# Type of casts: Granular cast Identify if non-pathologic or pathologic condition: Glomerulonephritis

pathologic condition

# Type of casts: Granular cast Identify if non-pathologic or pathologic condition: Pyelonephritis

pathologic condition

# Type of casts: Granular cast Identify if non-pathologic or pathologic condition: Tubule-interstitial disease

pathologic condition

# Type of casts: Granular cast Identify if non-pathologic or pathologic condition: Renal allograft rejection

pathologic condition

# Type of casts: Granular cast Identify if non-pathologic or pathologic condition: protein aggregates filtered by the glomerulus

pathologic condition

# Type of casts: Granular cast What phenomenon which allows the casts to remain in the tubules must be present for granules to result from disintegration of cellular casts.

Urinary stasis

# Type of casts: Granular cast Sources of error?

clumps of small crystals, fecal debris, columnar RTE cells

# T or F When granular casts remain in the tubules for extended periods, the granules further develops, and the cast matrix develops a waxy appearance.

F (When granular casts remain in the tubules for extended periods, the **granules further disintegrate**, and the cast matrix develops a waxy appearance) ## Footnote structure becomes more rigid, the ends of the casts may appear jagged or broken, and the diameter becomes broader.

Familiarize other casts mentioned

1. Hemosiderin casts 2. Crystal casts 3. Pigmented casts:

# other casts What casts to these belong: Urates, calcium oxalates & sulfonamides

Crystal casts

# other casts Cast matrix with coloration due to pigment incorporation

Pigmented casts

# other casts 3 examples of pigmented casts?

bilirubin, hemoglobin, myoglobin

# other casts: pigmented cast Goldenbrown; Obstructive jaundice

bilirubin casts

# other casts: pigmented cast Yellow to red; Glomerular disease

hemoglobin

# other casts: pigmented cast red brown; acute renal failure

Myoglobin cast

What are the telescoped sediments?

* Elements of glomerulonephritis * Elements of nephrotic syndrome * RBCs, RBC casts, cellular casts, broad waxy casts, lipid droplets, oval fat bodies, fatty casts * Collagen vascular disease (lupus nephritis) * Subacute Bacterial Endocarditis

M1: Urine Sediments (Part 3: Casts) Flashcards

(110 cards)