Microscopic Examination of Urine - Urinary Casts

Question 1

Presence of urinary cast

Answer 1

Cylindruria

Question 2

The only elements found in the urinary sediment that are unique to the kidney

Answer 2

Casts

Question 3

It is where casts are formed

Answer 3

DCT and CD

Question 4

Magnification used to examine urinary casts

Answer 4

Low power magnification

Question 5

How to examine specimen for urinary casts?

Answer 5

Low-power scanning should be performed along the edges of the cover slip

Observe with reduced lighting, because the cast matrix has a low refractive index

Question 6

Cast matrix dissolves quickly in dilute, acidic urine. True or False?

Answer 6

False; alkaline

Question 7

The major constituent matrix of cast

Answer 7

Uromodulin

Question 8

Uromodulin protein is found in both normal and abnormal urine and is a major constituent of mucus. True or False?

Answer 8

True

Question 9

Casts can be detected by reagent strip protein methods. True or False?

Answer 9

False; not detected

Question 10

List the casts from least to most significant

Answer 10

Hyaline Cast→ Cellular cast→ Coarse granular cast → Fine granular cast → Waxy cast → Broad Cast

Question 11

Product of incomplete cast formation, or cast disintegration

Answer 11

Cylindroids

Question 12

It is where cylindroids are formed

Answer 12

ALH and DCT

Question 13

Shape of Cylindroids

Answer 13

Tapered at the end

Question 14

Factors promoting disintegration of casts in the urine sediment

Answer 14

Hypotonic and alkaline urine

Question 15

Factors enhancing cast formation

Answer 15

Acid pH, increased solute concentration, urine stasis, and increased plasma proteins (particularly albumin)

Question 16

Most frequently seen cast which consists almost entirely of uromodulin

Answer 16

Hyaline casts

Question 17

Hyaline casts is also known as

Answer 17

Pro-casts

Question 18

Appearance of hyaline casts in unstained sediments

Answer 18

Colorless

Question 19

Appearance of hyaline casts in stained sediments (Sternheimer-Malbin stain)

Answer 19

Pink color

Question 20

Microscopy technique for visualization of hyaline casts

Answer 20

Phase microscopy

Question 21

Normal value of hyaline casts

Answer 21

0-2 /lpf

Question 22

Cast seen during bleeding in the nephron

Answer 22

RBC casts

Question 23

RBC cast is associated with

Answer 23

Glomerulonephritis

Question 24

Color of RBC casts

Answer 24

Orange-red color

Question 25

Manner of reporting for RBC casts

Answer 25

Number of RBC casts per lpf

Question 26

Casts that represents hemoglobin degradation products

Answer 26

Granular dirty brown casts

Question 27

Disease associated with granular dirty brown casts

Answer 27

Acute tubular necrosis

Question 28

The appearance of WBC casts in the urine signifies

Answer 28

Infection or inflammation within the nephron

Question 29

Casts frequently associated with pyelonephritis

Answer 29

WBC casts

Question 30

Primary marker for distinguishing pyelonephritis (upper UTI) from Cystitis (lower UTI)

Answer 30

WBC casts

Question 31

WBC casts are composed of

Answer 31

Neutrophils

Question 32

Helpful to enhance the nuclear detail needed for differentiating WBC cast from Epithelial cast

Answer 32

Staining and phase microscopy

Question 33

Bacterial casts containing bacilli both within and bound to the protein matrix are seen in

Answer 33

Pyelonephritis

Question 34

Confirmation of bacterial casts is best made by performing

Answer 34

Gram stain

Question 35

Casts containing RTE cells represent the presence of

Answer 35

Advanced tubular destruction

Question 36

Bilirubin-stained RTE cells are seen in cases of

Answer 36

Hepatitis

Question 37

Casts seen in conjunction with oval fat bodies and free fat droplets in disorders causing lipiduria

Answer 37

Fatty casts

Question 38

Fatty casts are most frequently associated with

Answer 38

Nephrotic syndrome

Question 39

Confirmation of fatty casts is performed using

Answer 39

Polarized microscopy Sudan III/Oil Red O fat stains

Question 40

Demonstrates characteristic Maltese cross formations under polarized light

Answer 40

Cholesterol

Question 41

Color of triglycerides and neutral fats after staining

Answer 41

Orange

Question 42

Fats do stain perfectly with Sternheimer-Malbin stains. True or False?

Answer 42

False; fats do not stain with Sternheimer-Malbin stains

Question 43

Predominant casts in cases of glomerulonephritis

Answer 43

RBC casts

Question 44

Predominant casts in cases of pyelonephritis

Answer 44

WBC casts

Question 45

Observing casts containing multiple cell types is not uncommon. True or False?

Answer 45

True

Question 46

Coarsely and finely granular casts are frequently seen in the urinary sediment and may be of pathologic or nonpathologic significance. True or False?

Answer 46

True

Question 47

Granular casts indicates

Answer 47

Disintegration of cellular casts and tubule cells

Question 48

Cast that represents extreme urine stasis

Answer 48

Waxy casts

Question 49

Cast that indicates chronic renal failure

Answer 49

Waxy casts

Question 50

Appearance of waxy casts

Answer 50

Brittle, highly refractive cast matrix, cast matrix appear fragmented with jagged ends and have notches in their sides

Question 51

Cast with ground glass appearance

Answer 51

Waxy casts

Question 52

Waxy casts are more easily visualized than hyaline casts. True or False?

Answer 52

True

Question 53

Why is it that waxy casts are more easily visualized than hyaline casts?

Answer 53

Waxy casts have higher refractive index

Question 54

Appearance of waxy casts with supravital stain

Answer 54

Homogenous, dark pink

Question 55

Often referred to as renal failure casts

Answer 55

Broad casts

Question 56

Broad casts may result from

Answer 56

Tubular distension Extreme urine stasis

Question 57

The presence of broad casts indicates

Answer 57

Destruction (widening) of the tubular walls

Question 58

Bile-stained broad, waxy casts are seen as the result of

Answer 58

Tubular necrosis caused by viral hepatitis

Question 59

Two most commonly seen broad cast

Answer 59

Granular cast Waxy cast