Casts in the Urine

Differential Diagnosis

Hyaline casts as indicative of:

  • Glomerulonephritis

  • Pyelonephritis

  • Chronic renal disease

  • Congestive heart failure

  • Strenuous exercise

Red blood cell casts as indicative of:

  • Glomerulonephritis

  • Strenuous exercise

White blood cell casts as indicative of pyelonephritis

Epithelial cell casts as indicative of renal tubular damage

Granular casts as indicative of:

  • Stasis of urine flow

  • UTI

  • Strenuous exercise

Waxy casts as indicative of stasis of urine flow

Fatty casts as indicative of nephrotic syndrome

Suggested Additional Lab Testing

Serum or plasma BUN or creatine is useful to assess general renal function.

If there is a concern for infection, complete blood count (CBC) with white blood cell (WBC) count and differential may be useful.

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