The Identification and Clinical Significance of Casts

Schreiner, George E.

doi:10.1001/archinte.1957.00260030036004

Cited by 23 publications

(4 citation statements)

References 17 publications

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“…The demonstration of leucocytes in casts from some neonates proves that at least some leucocytes enter the urine proximal to the collecting tubes, as these casts were not of the broad type. I n older children and adults the presence of leucocytes in casts is suggestive of a pathological condition (9,13). I n neonates, however, the passage of leucocytes through the epithelial lining is probably made pos-sible by the exfoliation and renewal of cells a t this age.…”

Section: Discussionmentioning

confidence: 99%

The Cellular Excretion in the Urine of Normal Newborn Infants

K¹

1959

Acta Paediatrica

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Summary Urine sediment counts were made in 380 specimens collected from 114 male and 27 female infants during the first 10 days after birth. In some the Addis counts were calculated. This method is considered inaccurate and erroneous in infants, however, and it is advocated that the findings should be expressed in cells per cubic millimetre. The counts found in the norma, l newborn infants are tabulated and the results are discussed. The range of normal sediment counts found exceeds that set for older children and adults in earlier publications.

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Section: Discussionmentioning

confidence: 99%

The Cellular Excretion in the Urine of Normal Newborn Infants

K¹

1959

Acta Paediatrica

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“… 1 , 3 , 7 , 12 , 13 Waxy casts have been associated with CKD. 14 – 16 However, waxy casts can be identified in nonglomerular forms of CKD, in patients of acute tubular injury, and in the absence of overt proteinuria. 7 , 15 , 17 Thus, vacuolar casts seem to be more specific indicators of presence of either a chronic or a severe acute proteinuric glomerular disease.…”

Section: Discussionmentioning

confidence: 99%

Urinary Vacuolar Casts Are a Unique Type of Casts in Advanced Proteinuric Glomerulopathies

Rosenbloom,

Ramanand,

Stark

et al. 2024

Kidney360

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Background Identification of casts by urinary sediment microscopy is a valuable diagnostic clinical tool for the evaluation of kidney disease. Vacuolar casts are an unrecognized unique type of casts characterized by the presence of non-polarizable, clear vesicles of various sizes contained within a cast matrix, different from lipid casts, erythrocyte casts, or any other casts. We aimed to gain better understanding of the clinical relevance of these casts by establishing a multinational collaborative group to search for cases in which vacuolar casts were identified. Methods Leveraging an educational social media platform, we conducted a multinational observational study extracting cases of patients who presented with urinary vacuolar casts during evaluation for impaired kidney function. Parameters assessed included degree of proteinuria and kidney dysfunction, clinical and histopathological diagnosis, and severity of renal parenchymal scarring on biopsy. A control group of cases without vacuolar casts was included for comparison. Results Forty-six cases with urinary vacuolar casts were compiled from 6 countries. Nephrotic range proteinuria (82%), glomerular etiology (98%) and advanced chronic kidney disease stage (62% 3B-5) were salient features. Histopathological diagnosis was available in 26 (57%) cases. Combining clinical and pathological diagnoses, diabetic nephropathy (48%), arterionephrosclerosis (30%), podocytopathies (15%) and proliferative glomerulonephritides (15%) accounted for most cases. Vacuolization of tubules or podocytes was present in 61% of the specimens. When compared to cases with histopathological diagnoses in which vacuolar casts were not found (n=186), cases with vacuolar casts more frequently had a glomerular etiology (100% vs 71%, p=0.002), had greater proteinuria (median urine protein-to-creatinine 10.3 vs 2.2 g/g, p<0.001) and had greater proportion of patients with ≥ 30% glomerular obsolescence (46% vs 20%, p = 0.003). Conclusions Thus, urinary vacuolar casts are strongly associated with advanced glomerulopathies with severe proteinuria. Future studies should examine their origin, composition, and prognostic value.

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“…It is highly specific, allowing one to differentiate serum creatinine increase due to a nephrotoxicity from other causes of creatinine increases [36][37][38], It is however less sensitive than tubular markers and difficult to use in a routine fashion [38]. Finally, urinary casts [7,17,36,41] and urinary elimina tion of tubular brush border [9,10,28,48] and lysosome [9,31,48] enzymes and low molecular weight proteins [2,5,14,18,21,29,36,[38][39][40]48] have been used as indicators of tubular aminoglycoside nephrotoxicity in experimental animals [1,3,10,31,49] and in man [5,9,14,18,21,28,36,[38][39][40]. p2m, one of the most widely used tubular markers of aminoglycoside nephrotoxicity in man [5,14,21,36,38,…”

Section: Discussionmentioning

confidence: 99%

“…Since often the urinary [Tm is above the normal range before starting the aminoglycosides [39][40][41][42], it is necessary to evaluate an arbitrarily chosen increase above the baseline. Urinary p2m can be related to creati nine and reported as an index [14,42,45] or expressed as total amount per day [21,24,39,40] or as urinary concen tration of a random sample [5].…”

Section: Discussionmentioning

confidence: 99%

Tobramycin and Amikacin Nephrotoxicity

Gatell¹,

SanMiguel²,

Zamora³

et al. 1985

Nephron

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108 patients who received tobramycin or amikacin could be evaluated for nephrotoxicity in a prospective randomized trial. Both groups had similar illnesses, and causative agents, concurrent drug administration, ages, sex ratios, initial serum creatinine and aminoglycoside levels and total dose and duration of therapy. Using urinary concentration of β₂microglobulin (β₂m) as a marker, nephrotoxicity was detected in 13 (22.4%) of 58 patients given tobramycin and 13 (26%) of 50 given amikacin (n.s.). Using serum creatinine as a marker, nephrotoxicity was detected in 3 (5.2%) of 58 patients given tobramycin and in 7 (14%) of 50 given amikacin (n.s.). The whole group of 108 patients was used to compare the usefulness of serum creatinine levels versus urinary concentration of β₂m. An elevation of serum creatinine was detected in 10 of 108 patients (9.3%). In 5 of these 10 patients the β₂m remained normal, suggesting a functional renal failure. In 21 of the 108 patients (19.4%) the β₂m increased while the serum creatinine remained normal, suggesting an aminoglycoside nephrotoxicity which would have remained undetected if only serum creatinine had been measured. In the remaining patients (77 of the 108; 71.3%) serum creatinine and urinary concentration of β₂m both remained normal throughout the treatment. In conclusion no statistically significant differences were found between tobramycin and amikacin nephrotoxicity. Urinary β₂m is more sensitive than serum creatinine and furthermore it allows one to differentiate aminoglycoside nephrotoxicity from functional renal failure.

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The Identification and Clinical Significance of Casts

Cited by 23 publications

References 17 publications

The Cellular Excretion in the Urine of Normal Newborn Infants

The Cellular Excretion in the Urine of Normal Newborn Infants

Urinary Vacuolar Casts Are a Unique Type of Casts in Advanced Proteinuric Glomerulopathies

Tobramycin and Amikacin Nephrotoxicity

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