Cast in Urine: Pathological Causes

A cast is a coagulum of mucoprotein that traps contents in the tubule lumen or collecting ducts during periods of urinary concentration or urinary stasis. Casts contain hyaline, RBCs, leukocytes, or epithelial cells, or they can be granular, waxy, fatty, or broad. A specific type of cast can be associated with a specific pathologic condition. For example, RBC casts are nearly diagnostic of glomerulonephritis or vasculitis. WBC casts suggest some type of interstitial renal disease or pyelonephritis, but may be seen with a number of glomerular disorders.

Multiple types of casts in urine have been identified, with each having some sort of diagnostic value to medical professionals.

Hyalin cast most common type of cast and are composed of solidified Tamm-Horsfall mucoprotein. They are formed during low urine flow states, concentrated urine, or urinary conditions, causing an acidic environment. Hyaline casts can be seen in healthy people and may increase in number during dehydration, exercise, or when using diuretic medication. During laboratory investigation, urine sample is viewed under the microscope for casts. They have a smooth textured appearance under a microscope

Pathologically, increased amount of hyaline casts are usually associated with

· Acute glomerulonephritis

· Pyelonephritis

· Chronic renal disease

· Congestive heart failure

· Meningitis

· Diabetic nephropathy

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