Urinary microscopy
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Interpretation
| Syndrome | Urine Sediment | Urine Analysis |
|---|---|---|
| Prerenal AKI | bland, hyaline casts, a few fine granular casts, occasional renal tubular epithelial cells | ± protein |
| ATN | renal tubular epithelial cells and casts, course granular casts, "muddy brown" casts | ± protein |
| AIN | white blood cells and casts, renal tubular epithelial cells and casts, red blood cells and occasional casts | ±protein, +leukocyte esterase, + blood |
| Nephritic syndrome | dysmorphic RBCs (acanthocytes), red cells and casts, white cells and casts | + protein, ++ blood |
| Nephrotic syndrome | lipid droplets, oval fat bodies, birefringent Maltese cross, lipid laden casts, cholesterol crystals | +++protein |
| Crystalline nephropathy | crystals, renal tubular epithelial cells, white and red cells, may have white cells engulfing crystals | ± blood, ± LE |
| Osmotic nephropathy | swollen renal tubular epithelial cells with cytoplasmic vacuoles, renal tubular epithelial cell and granular casts | ±protein |
Urinary Casts
| Cast | Causes |
|---|---|
| Acellular Casts | |
| Hyaline | non-specific |
| Granular | prerenal AKI, ATN, exercise |
| Waxy | advanced CKD |
| Fatty | nephrotic syndrome |
| Pigment | AKI from rhabdomyolysis or hemolysis, ATN |
| Cellular Casts | |
| RBC | glomerulonephritis |
| WBC | pyelonephritis, proliferative glomerulonephritis |
| Epithelial cell | prerenal AKI, ATN, glomerulonephritis, nephrotic syndrome |
Further Reading
- Cavanaugh C, Perazella MA. Urine Sediment Examination in the Diagnosis and Management of Kidney Disease: Core Curriculum 2019. Am J Kidney Dis. 2019 Feb;73(2):258-272. doi: 10.1053/j.ajkd.2018.07.012. Epub 2018 Sep 21. PMID: 30249419.
