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Oam cylinders. Casts in the urine: a sign of renal pathology
Urinalysis is one of the most important studies reflecting the state of human health. Urine is filtered by the kidneys from the blood, that is, the composition of urine can show how much a person’s filtration system is able to cope with the task assigned to it.
Thus, by comparing blood and urine indicators, you can see the balance of the presence of substances in them. For example, protein should be absent in the urine of a healthy person, but in the blood, on the contrary, should be present in sufficient quantities. The same applies to any substances that make up the blood: urea, creatinine, uric acid, potassium, sodium, and so on.
Therefore, when studying the form of laboratory urine test results, it is important to know what these or other indicators mean, what normal values are typical for a healthy person, and what deviations from normal values indicate.
For example, when considering the research result obtained in the clinic, many people wonder: casts in the urine - what does this mean? Should they be present in urine and if so, what is their rate? And if not, what actions need to be taken and which specialist should I contact to eliminate the pathological phenomenon?
Cylinders - what are they?
The kidneys consist of glomeruli - glomeruli, each of which has membranes, the openings of which are capable of passing through molecules to be excreted from the body. Larger molecules, such as those that make up proteins, are released back into the bloodstream.
If the kidney membranes are damaged, protein leaks into the urine. And when several protein cells are connected to each other using epithelium or fat, cylinders are formed in the urine. The norm provides for the complete absence of both protein and casts in urine.
Normal casts in urine
The presence of casts in the urine can only occur if it already contains protein. And since a healthy person should not have protein in the urine, therefore, casts in the urine are a deviation from the norm.
It is also noteworthy that casts are formed when there is sufficient protein content in the urine. That is, with physiologically caused proteinuria, for example, after eating a large amount of protein foods or during intense physical activity, cylinders do not form.
Not always, even if there is a large amount of protein in the urine (macroproteinuria), casts in the urine may appear. This depends on the degree of acidity of the latter: the higher it is, the more cylinders will be recorded in urine containing protein during analysis. Moreover, in an alkaline environment, cylinders may quickly dissolve or not form at all. Therefore, cylindruria is not considered in nephrology as a specific sign of a particular disease, but is considered only as an additional factor.
Hyaline casts
There are several types of cylinders based on their molecular composition. Hyaline casts in urine consist exclusively of protein. Normally, they can be present in the urine if their indicator in the analysis does not exceed 1-2 units in the preparation. In the case where there are increased cylinders in the urine, it is necessary to continue the examination until a disease is identified that affects the filtration process of the kidneys.
Hyaline casts are not always a marker of the disease, but their appearance is a good reason to diagnose the urinary system to exclude the following diseases:
- pyelonephritis;
- glomerulonephritis;
- abacterial nephritis.
Grainy cylinders
Granular casts in urine also consist exclusively of protein molecules, but they get their name due to their appearance. Casts begin to form in the renal tubules, where they remain in the process of impaired filtration, being not returned back into the bloodstream. They cover the walls of the tubule, and their fragments end up in the urine.
Thus, these cylinders are a kind of cast of the renal tubule. Like hyaline casts, this indicator can indicate pathological processes occurring in the kidneys:
- about pyelonephritis;
- glomerulonephritis;
- diabetic nephropathy;
- amyloidosis.
Waxy cylinders
When hyaline and granular casts in the urine remain in the renal tubules for a long time, they gradually begin to stick together, forming a dense viscous mass, like plasticine or wax.
The appearance of wax cylinders can never be provoked by physiological processes; they always turn out to be markers of kidney damage, and at a rather serious stage.
Waxy casts in urine appear in the following diseases:
- glomerulonephritis in a malignant form;
Red blood cell casts
Protein is not the only substance that should not penetrate urine, remaining in the bloodstream. Blood cells - red blood cells - are also never detected in a laboratory test of the urine of a healthy person. If blood is present in it in any quantity, this indicates that the kidney vessels are damaged and internal bleeding is occurring. This may be the result of injury or a disease of the vascular tissue, such as systemic lupus erythematosus.
If red blood cells combine with protein, then the study reveals red blood cell casts in the urine. Considering that the fact of the presence of red blood cells in urine indicates the fragility of the kidney vessels, the diseases that cause this phenomenon are associated with this fact:
- glomerulonephritis (usually acute);
- renal artery thrombosis;
- kidney infarction;
- kidney cancer
Leukocyte casts
During inflammatory processes of bacteriological origin, a large number of leukocytes are formed in the urine. When they combine with protein, leukocyte casts appear. The presence of the latter in the urine almost always gives good reason to diagnose pyelonephritis.
Epithelial casts
When the protein combines with the epithelial cells lining the inner walls of the kidney tubules, epithelial casts are formed.
They are a marker of a pathological process aimed at the destruction of kidney tissue and its scarring. This happens in autoimmune processes, nephritis and nephrosis. And when epithelial casts appear in urine after kidney transplantation, there is reason to suspect the process of rejection of the donor organ by the body.
Thus, any pathological processes occurring in the urinary system can be shown by a urine test. Cylinders are a marker of diseases that subsequently, without timely and proper treatment, can lead to organ failure and disability.
Therefore, it is necessary to submit urine for laboratory testing at least once a year, and more often if there are symptoms of kidney disease (swelling, lower back pain, changes in the amount of urine excreted, its color, smell).
For the diagnosis of various diseases, urine analysis is one of the important and informative studies, which allows the composition of urine to identify deviations that indicate the development of pathological processes.
The presence of casts in the urine indicates pathology in the kidneys and urinary system. What does the presence of casts in urine mean, what disorders does the detection of one or another type of them indicate? We will tell you in more detail in this article.
Often, a urine test reveals sediment in the fluid with cylindrical particles that should not normally be present. The appearance of casts in the urine is called cylindruria.
But what does it mean? In general, these particles enter the urine from the renal epithelium, and their presence indicates the pathology of this particular organ.
Often, such a deviation is discovered when a person goes to the doctor for a medical examination or when specific complaints arise. To obtain more accurate data regarding the size, shape and number of cylinders, the following is carried out:
- urine test according to Nechiporenko;
- Zimnitsky test (allows you to evaluate the excretory function of the kidneys);
- daily urine output collection;
- research using the Reberg-Tareev method (filtration rate is determined);
- urine protein analysis.
Analysis standards
Urine is a slightly acidic liquid (pH 5.5-7.0). The presence of pathological casts in the urine is indicated by increased acidity of the urine, as well as proteinuria (the appearance of protein).
Normally, single cylindrical hyaline microparticles (1 or 2) may appear. The detection of many casts in urine (hyaline and other types) during a general urinalysis indicates pathological processes occurring in the kidneys and urinary tract.
In general, the appearance of cylindrical microparticles already indicates a pathological process that develops in the renal tubules.
Therefore, after identifying them, it is necessary to conduct a kidney examination. There are different types of casts, each individual type indicates a specific disease, with the exception of hyaline casts, a small amount of which appears in the urine of healthy people due to physical overexertion, fast walking and running.
The appearance of casts in the urine of pregnant women is especially dangerous; the acceptable indicators for them are 1-2 hyaline bodies in the field of view.
It is of greater importance in cases of nephropathy and toxicosis, or in cases of nervous and physical stress. Cylinderoids are sometimes found in urine - cylindrical particles consisting of mucus.
In general, a distinction is made between true and false cylinders. The first group includes sedimentary elements of the hyaline, granular, epithelial, comatose, hemoglobin, as well as waxy, erythrocyte type and cylindroids. The category of false ones includes: leukocyte, mucus, urate particles.
Hyaline casts
In general, hyaline casts in the urine are also found in healthy people; this is due to physical activity or nervous strain.
But their high rates already indicate various ailments in the body. They are formed only in an acidic environment. Under alkaline conditions, cylinders do not form or dissolve. However, this does not mean that there is no disease.
Hyaline casts consist exclusively of proteins released from the blood plasma in the kidneys. The latter, after passing through the distal part of the tubules, acquire a cylindrical shape.
A factor in this phenomenon may be impaired renal function, but it is also observed in other diseases. The presence of such sedimentary particles in the patient’s urine indicates such pathological phenomena as:
- glomerulonephritis;
- pyelonephritis;
- congestive cardiovascular failure;
- arterial hypertension;
- interstitial nephritis and other diseases characterized by increased protein content in the urine.
The appearance of hyaline sediment can also be caused by the use of diuretic drugs. In men, excessive consumption of meat products can lead to increased urine acidity. As a result, physiological proteinuria develops, which is manifested by the presence of hyaline casts.
In pregnant women, an increased number of hyaline casts in the urine indicates glomerulonephritis or pyelonephritis in a latent form. But such a violation in the last trimester of pregnancy indicates impaired renal function.
The detection of waxy casts in urine is a sign of serious diseases caused by impaired renal function. Waxy cylinders in urine look like a shapeless mass similar to wax. They have a yellowish tint, are opaque, and are slightly shorter than hyaline ones.
These particles are formed from hyaline and granular protein formations that are retained and denatured (destroyed under the influence of various factors) in the kidney tubules.
The reason for their formation is stagnation or obstructed outflow of urine. First, hyaline casts, while in the renal tubules, collect lipids and turn granular, and then an increasing number of destroyed epithelial cells settle on them.
The presence of such sediment in the patient’s urine indicates serious diseases, such as:
- malignant glomerulonephritis;
- amyloidosis;
- acute glomerulonephritis;
- chronic kidney disease (in later stages);
- nephrotic syndrome;
- chronic renal failure.
The presence of waxy particles in the urine of children and pregnant women is especially dangerous; it requires immediate identification of the source of the pathological process for further therapy.
Particles of this type, found in urine sediment, are distinguished by clear contours and opacity. Granular cylinders are formed from a yellow mass consisting of damaged kidney epithelial cells.
They have an uneven surface, the graininess is caused by light-refracting fat particles deposited on these particles.
The presence of such proteins in urine is detected by analysis using osmic acid. The presence of granular (granular) casts in urine signals pathological phenomena in the kidneys.
They are formed in the kidney tubules as a result of glomerulonephritis (any form). The cause of their appearance can be amyloidosis, pyelonephritis and viral diseases that are accompanied by kidney damage.
The presence of granular proteins in the sediment also indicates problems such as diabetic nephropathy; they are also found in cases of fever and lead poisoning.
Red blood cell casts appear due to severe diseases. They are formed from proteins and red blood cells, the latter enter the renal tubules due to disruption of the vascular wall of the renal glomeruli. These are very fragile compounds, so sometimes they may not be detected as a result of a general analysis.
These particles have a yellow-brown tint and have smooth contours. The appearance of this type of cylinders is associated with renal diseases such as glomerulonephritis, kidney tumors of various natures, renal infarction, renal vein thrombosis, etc.
The presence of epithelial casts in the urine indicates severe kidney damage, which is accompanied by glomerular degeneration. They are formed from proteins and epithelial cells that appear in the tubules as a result of the death of the epithelial layer.
Such particles are formed due to:
- nephrosis;
- acute nephritis;
- acute tubular necrosis;
- amyloidosis.
After a kidney transplant, the appearance of epithelial casts signals graft rejection. This type of sediment is also found in cases of poisoning with acetylsalicylic acid preparations, as well as heavy metals (mercury).
This type of sediment is formed from proteins and leukocytes and is found quite rarely; most often their appearance is caused by pyelonephritis. The detection of leukocyte casts indicates the development of inflammatory or infectious diseases in the kidneys.
They are also found in allergic nephritis, as well as acute post-streptococcal glomerulonephritis. Particles of this type of sediment are similar to epithelial cells, so as not to confuse them, urine analysis is carried out using staining.
Pigment cylinders
In texture, these elements are similar to granular cylinders and are distinguished by a yellow-brown or brown tint, due to the presence of blood in their composition.
The reason for the appearance of these microparticles may be hemoglobinuria, which develops as a result of transfusion of blood plasma of an inappropriate group to a patient. The formation of this type of sediment is sometimes associated with diseases accompanied by intoxication of the body.
Casts in urine in children
The release of casts in the urine of a child is a serious signal about the development of various kidney diseases. Elevated levels of hyaline microparticles may indicate diseases not related to the kidneys. These include measles, mumps, whooping cough, polio, chickenpox and rubella.
A provoking factor for the appearance of hyaline-type casts in a child’s urine can be high temperature. At subfebrile temperatures (37-38), protein excretion increases, and at febrile temperatures (38.5-39) and in conditions of insufficient fluid intake, it will lead to dehydration of the body.
The presence of granular microparticles in a child’s urine is a symptom of a disease such as latent glomerulonephritis. In this case, the glomeruli of the kidneys, which are responsible for the formation of primary urine, blood filtration and reverse osmosis, are affected.
A symptom that threatens the health of children is the appearance of a cylindrical, waxy-type sediment in the urine.
It indicates destruction of the epithelial layer of the tubules and is accompanied by symptoms of nephrotic syndrome. Identification of these particles requires an urgent examination of the child to determine the root cause and treat the kidneys.
The appearance of pigment-type casts in the urine of small children is sometimes a symptom of a very rare disease - paroxysmal nocturnal hemoglobinuria Marchiafava-Micheli, in which red blood cells are destroyed.
Conclusion
In general, the detection of casts in the urine, regardless of their type, indicates the presence of a pathological process, since they should not exist at all.
The presence of epithelial, leukocyte, granular, waxy, erythrocyte and other types of cylindrical microparticles is an important indicator for the doctor, since most of them indicate kidney disease.
The presence of these particles in the urine of pregnant women, young children and the elderly is especially dangerous.
Therefore, after detecting sediment particles of any type in urine, it is necessary to conduct a full examination and diagnosis of the disease to establish the root cause, the stage of development of the disease and develop a treatment plan.
Casts are microscopic impressions of the renal tubule cavity. The presence of casts in the urine is commonly called cylindruria. They are formed when the filtration activity of the kidneys is insufficient, caused by some pathology, and have a specific shape and size. Depending on the etiology and composition, they can serve as an indirect symptom of kidney pathology or a specific area of the urinary tract.
Casts in urine - what does it mean?
Normally, urine is defined as a substance with a slightly acidic reaction - from 5.5 to 7.0 pH. Cylinders are formed and detected in urine with a pronounced acidic reaction. This is characterized by the presence of an increased amount of protein - .
With an alkaline reaction of urine, casts either do not form at all or quickly dissolve, which complicates testing. The alkaline reaction itself is a pathology and indicates kidney problems.
The process of formation of cylinders at the mouths of the renal tubules is directly related to disease and dysfunction of the kidneys. The norm allows the presence of only single protein (hyaline) cylindrical bodies - no more than 1-2 in the field of view. The presence of other types of cylindrical bodies during microscopic examination of urine is unacceptable.
In the video about what cylinders in urine mean:
Detection methods
Cylindruria is often detected during a general urinalysis. It is prescribed as a standard procedure for determining the patient’s health level for various diseases, as well as during a comprehensive examination.
For a specific examination, the following may be carried out:
- urine analysis according to Nechiporenko (more accurate and complete than a general analysis);
- collection of daily urine output;
- (to determine the excretory function of the kidneys);
- Reberg-Tareev test (velocity determination);
- clinical examination of urine for protein.
Analysis according to Nechiporenko is more often carried out in hospitals, as it gives more accurate results. In an outpatient setting, it is an additional research method and is prescribed when the general clinical urine analysis is insufficiently informative. The quantitative content of cylinders in 1 ml of urine along with sediment is revealed.
Daily urine output is collected for qualitative and quantitative urine testing. This allows you to determine how well your kidneys are functioning. The number of cylinders in the urine collected per day is measured, their chemical composition and physical parameters are determined, which contributes to a more accurate diagnosis.
The Zimnitsky test is performed not to determine the number of casts in the urine, but to determine the level of kidney function.
The specific gravity and density of urine are calculated, which suggests certain diseases:
- specific gravity from 1002 to 1008 - remission of chronic pyelonephritis, renal failure;
- a specific gravity over 1025 indicates severe acute pyelonephritis, dehydration, and uric acid diathesis in children.
The Reberg-Tareev test allows you to assess the excretory capacity of the kidneys. Used for differential diagnosis of kidney lesions of various etiologies, affecting functional features or tissues directly.
A clinical urine test for protein is performed to determine the level of proteinuria. In addition to this study, an ultrasound examination of the kidneys and bladder is often prescribed.
Types and reasons of education
The cylinders can be formed by: protein, desquamated epithelial cells of the renal tubules, erythrocytes. After physical exercise or during a diet with a predominance of animal (protein) foods, single cylindrical protein bodies (hyaline cylinders) can be detected in the urine.
Types of casts in urine
Hyaline
Hyaline casts are formed by a special protein produced by the epithelial cells of the kidney tubules. They are colorless, completely or semi-transparent, have rounded ends and are quite often detected by microscopic analysis of urine.
In men, hyaline casts may appear due to the large amount of meat products consumed in the diet. This increases the acidity of the urine and often leads to physiological proteinuria. In addition, hyaline cylindrical bodies appear after intense physical activity.
In the urine analysis of a pregnant woman, an increased content of hyaline casts most likely indicates a latent course of pyelonephritis or.
It may also indicate a violation of the filtration, concentration, and excretory functions of the kidneys, which is very typical for the last trimester of pregnancy.
In a child, an increased content of hyaline casts may indirectly indicate a number of diseases not directly related to the kidneys:
- polio;
- mumps (mumps);
- rubella;
- chickenpox;
- measles;
- whooping cough.
When the temperature rises to subfebrile (37-38°C) levels, the percentage of protein excretion increases, and with febrile (38.5-39°C) levels and insufficient drinking, dehydration of the child’s body may develop. Therefore, high temperature can also serve as a provoking factor for the formation of hyaline casts in the urine in children.
Hyaline casts in urine 
Grainy
The composition of granular casts is very similar to hyaline casts: they are also based on protein produced by the tubular epithelium. In this case, disintegrated epithelial cells of the tubule cavity “stick” to the homogeneous surface of the hyaline bodies, forming a granular structure. They are determined in case of serious pathologies of the renal tubules, accompanied by their degenerative changes.
In children and pregnant women, the presence of granular casts most often indicates a hidden course of glomerulonephritis, in which damage occurs to the glomeruli of the kidneys, which are responsible for filtering the blood, the formation of primary urine and reverse osmosis.
In adults, the presence of granular casts may also indicate glomerulonephritis, but often in the course of further differential diagnosis other tubulopathies are determined:
- general damage to the tubular apparatus;
- increased tortuosity of the distal or proximal tubules;
- nephrolithiasis (kidney stone disease);
- polyuria - excretion of large amounts of fluid; characteristic of diabetic kidney damage.
Waxy
They are formed by protein denatured in the wide lumens of the renal tubules. Much shorter than hyaline, opaque, have a yellowish tint. The formation of waxy casts is associated with stagnation or poor urine flow.
Against the background of these conditions, the initially formed hyaline cylinders are first transformed into granular ones, but as they remain in the lumen of the tubule, more and more destroyed cells of the lining epithelium settle on their surface.
If waxy casts in the urine are elevated in all groups of patients, this indicates destructive changes in the epithelial layer of the renal tubules.
A frequently associated condition is nephrotic syndrome:
- severe proteinuria;
- massive swelling of the face and limbs;
- hypoproteinemia (decreased protein concentration in blood plasma);
- hyperlipidemia (increased cholesterol levels in the blood).
This condition is especially dangerous for pregnant women and children, so the detection of waxy casts in the urine requires immediate further examination in order to identify the primary pathology.
Waxy casts in urine 
Pathological
By and large, all casts found in urine should be called pathological, since normally they should not exist. You can consider separately the presence of erythrocyte, leukocyte, and epithelial casts. For all groups of patients, especially pregnant women, young children and the elderly, the presence of the casts described below in the urine is a serious signal for a comprehensive examination.
Erythrocyte
Their origin is associated with the layering of red blood cells - erythrocytes - on the hyaline base. The appearance of red blood cell casts in the urine is often accompanied by the presence of blood impurities in the urine (hematuria) and indicates its renal origin.
The presence of erythrocyte cylindrical bodies is a sign of:
- renal vein thrombosis;
- exacerbations;
- acute glomerulonephritis;
- fornical bleeding;
- malignant neoplasm in the kidney cavity.
Leukocyte
Their appearance is associated with severe inflammatory processes, accompanied by significant pyuria (the presence of leukocytes in the urine). Most often, leukocyte casts are detected in the urine of patients with acute chronic pyelonephritis, complicated by purulent formations. Extremely rare in children.
Epithelial
The epithelial variety of cylinders is extremely rare.
Their appearance is associated with severe degenerative changes in the glomeruli and tubules of the kidney, which can be caused by:
- rejection;
- heavy metal poisoning (for example, lead);
- overdose of drugs (for example, salicylates).
Epithelial cylinders in urine 
Pigment
Pigment cylinders are cylindrical bodies of rich yellow, brown, yellow-brown color, having a fine-grained structure.
For the most part they consist of hemoglobin, which has a free sediment during some pathological reactions of the body:
- When transfusion of incompatible blood.
- With myoglobinuria - under the influence of the myoglobin pigment, released during the pathological breakdown of muscle protein.
- In case of poisoning with toxic substances.
- For extensive injuries.
In pregnant women, in extremely rare cases, it can develop against the background of anemia caused by malnutrition. In children, the appearance of pigmented hemoglobin casts in the urine may be associated with an ultra rare disease - paroxysmal nocturnal hemoglobinuria Marchiafava-Micheli.
First of all, cylindruria indicates damage and degenerative changes in the parenchyma (body) of the kidney. It is generally accepted that the type of cylindrical bodies is not of particular importance, since if they are present, it is necessary to conduct a comprehensive examination and differential diagnosis.
Shown:
- Ultrasound examination of the kidneys and urinary tract.
- X-ray using a radiopaque contrast agent.
- or CT.
It is important to study the cylinders in order to determine the composition, since sometimes there are false cylindrical bodies - cylindroids formed from mucus. They may be present in the urine and do not indicate the presence of renal pathologies.
Urine casts are a type of sediment in the fluid during urination that has a cylindrical shape.
Different types of cylinders make it possible to recognize diseases of the lower zone of the genitourinary tract (etc.), as well as developing disorders of the functional capabilities of the kidneys.
Cylinders detected during a urine test, which include red blood cells, indicate an aggravated diffuse infection.
If bacterial casts were detected in the urine, this indicates the presence of a bacterial infection. In addition, the cylinders carry only those harmful microorganisms that provoked the onset of the disease.
Introduction to the topic
Cylinders always imply renal origin. Their appearance occurs in the distal nephron. Their presence in the fluid sediment during urination is directly related to the protein sediment in the lumen of the channels.
The basis of the cylinders of protein origin includes Tamm-Horsfall uroprotein, which is produced by the epithelium of the convoluted tubules of the kidneys, and aggregated serum proteins.
In addition, the cylinders can have an exclusively protein or cellular composition.
Protein-based cylinders, including cellular components, are externally covered with erythrocytes, epithelial cells and leukocytes.
This is what wax cylinders look like in a child's urine
Granular - the protein base is covered with particles of dying cells. It must be remembered that in urine with alkali they easily disintegrate. Their volume and shape fully correspond to the shape of the kidney tubules and collecting ducts.
It is extremely necessary to thoroughly examine them, since all the components of the cylinders originate from kidney tissue (most rarely, they can come from the lower urinary tract).
Often, hyaline cylinders can be found in urea, which are created from transparent homogeneous tissues excluding cellular components.
They are also present during urination in healthy people who have recently engaged in physical activity. Therefore, they do not have valuable diagnostic information.
If the presence of waxy and/or granular casts was detected in the urine during testing, this indicates serious problems with the functioning of the kidneys.
Basically, the presence of almost any cylinders in the urine indicates a violation of the functional abilities of the kidneys. Therefore, after passing urine, you should undergo a full diagnosis in order to begin treatment on time.
Each cylinder has its own composition and meaning
The wide variety of species of cylinders makes it necessary to clearly distinguish and classify formations when.
They are coagulated plasma serum protein, which passed through the renal globules and was not reabsorbed in the proximal sections of the canals, but, moving through the distal zones, received the shape and volume of the lumen of the canals, namely cylindrical.
Protein coagulation, as well as the appearance of hyaline casts, is affected by the oxidized environment of urine and tubular secretions. Their presence in alkaline urine is excluded.
The more protein tissues are filtered in the tangles and the less they are reabsorbed in the proximal channels, the more cylinders of this type are created.
This explains why patients with a diagnosis, which is also accompanied by increased, notice more active production of cylinders during urination.
They are like grain
Granular casts are created from reformed epithelial cells of the proximal zones of the tubules. They are characterized by a grainy (granular) appearance, which is where their name comes from.
Granular casts in the urine are found in various kidney diseases: as well as acute glomerulonephritis, renal, etc.
This type of cylinder includes a homogeneous, shapeless and structureless material that has some resemblance to wax 
yellow tint.
Waxy casts are produced in the distal zones of the tubules due to atrophy and degeneration of the tubular epithelium of these sections.
This is due to serious kidney damage (for example, with moderate malignancy), as well as the last stages of kidney disease and the chronic type.
Therefore, most often, their presence during urination indicates an unfavorable outcome.
Red blood cell casts
Leukocytes, in turn, during the period of pronounced leukocyturia of extensive origin.
Pigment formations
Their formation in urine is due to the manifestation of various types of hemoglobinuria. It is activated by transfusion of incompatible plasma groups or from exposure to toxic substances on the body.
Such cylinders contain brown blood pigments.
Cylinders
They are mucus filaments that are rounded at one end and rounded at the other. Often observed in urine at the final stage of the nephrotic process.
It must be remembered that all cylinders can be detected and remain for a long time exclusively in acidic urine. In alkaline urine the reaction does not occur or is rapidly destroyed.
For this reason, during microscopy of liquid sediment during urination, it is either not found at all, or is found, but in small quantities.
You should also know that urine may contain pseudo-cylinders, which are created from clots and have an external resemblance to hyaline casts and a sediment of uric acid salts, which are red in color. They look like blood cylinders.
What diseases can be diagnosed?
The presence of each cylinder indicates the presence of a specific disease.
Hyaline casts in the urine indicate the following disorders and pathologies:
- the presence of pathologies associated with the kidneys (and of acute origin, in the organ);
- congestive heart failure;
- hyperthermic effects;
- use of diuretics;
- constant physical activity;
- high blood pressure.
Grainy:
- the presence of viral infections;
- fever;
- diabetic nephropathy;
- lead poisoning of the body.
Waxy cylindruria:
- chronic liver enzyme deficiency;
Red blood cells: 
- hypertension of malignant type;
- renal infarction;
- renal vein thrombosis;
Epithelial (the rarest):
- amyloidosis;
- viral type infection;
- intoxication of the body due to excess salts of heavy metals;
- rejection of a transplanted kidney;
- overdose effect of salicylates.
Provoking factors
There are a number of unfavorable factors that several times accelerate the degree of formation of cylinders in urine.
Among them:
- the presence of cells in the fluid during urination;
- osmotic pressure 200-400 mOsm/kg;
- depressed glomerular filtration activity;
- urine having a concentrated composition;
- the presence of individual proteins (hemoglobin, Bence Jones, etc.);
- albumen.
This is worth paying attention to!
If a person is completely healthy and does not have any kind of disease associated with the functional ability of the kidneys, then in the liquid When urinating, only hyaline casts can be detected(the quantity does not exceed 2 in the preparation).
Other types of cylinders are not detected in absolutely healthy people. Their presence can be detected by.
This helps specialists significantly narrow the scope of their diagnostic search and much more quickly determine what kind of disease the patient is suffering from, and therefore prescribe the necessary treatment or supportive therapy.
If casts are found in the urine, you should stop using any pharmacological agents that negatively affect the kidneys. You also need to give up all bad habits, especially alcohol abuse.
The casts in the urine are sediment elements. They are casts of the renal tubules, as they are formed in them and repeat their shape. The condition in which these sedimentary elements are found in urine is called cylindruria. Rarely is it a variant of the norm. In most cases, the presence of cylindrical elements in the sediment is a consequence of impaired functioning of the organs of the urinary system.
Casts in urine
Cylinders: what are they?
Normally, human urine sediment does not contain cylindrical particles. If they are detected, this becomes a reason for further comprehensive examination of the patient.
When a doctor says that there are cylinders in the urine, not every person knows what this means. This phenomenon in itself is not a disease. It often warns of possible kidney diseases or pathologies of the lower genitourinary tract.
Cylinders are divided into 2 groups:
- True. These include hyaline, epithelial, granular, erythrocyte, waxy, hemoglobin and comatose particles.
- False. This includes mucus, leukocyte and urate elements.
Each disease is characterized by different types of sediment.
The cylindrical particles are formed from protein and other components of urine. Precipitate formation occurs in an acidic environment. In alkaline urine, cylindrical elements appear extremely rarely and are not a cause for concern.
If the analysis shows that the casts in the urine are increased, a more thorough diagnosis is required. To determine their number, shape and size, the following procedures are carried out:
- analysis for the presence of protein in urine;
- determination of renal excretory function;
- urine test according to Nechiporenko;
- determination of filtration speed;
- daily collection of urine output.
Cylindruria can be detected by chance during a medical examination or detected after the patient consults a doctor due to the occurrence of symptoms of the disease.
What are casts in urine?
Normal casts in urine
The urine of a healthy adult is slightly acidic. Acceptable pH level is 5.5-7. With increased acidity, sediment particles appear, and proteinuria (increased protein) is often observed.
A variant of the norm is the presence of 1-2 hyaline elements in urine. But if there are more of them, this indicates a pathological process.
There are normally no casts in the child’s urine. If 1-2 hyaline microparticles are detected, this may be a consequence of physical activity suffered shortly before emptying the bladder. This phenomenon is sometimes observed due to increased body temperature and severe emotional shock. If the sediment forms a large number of non-hyaline microparticles, the most likely cause is kidney disease.
In women, during pregnancy, the acid-base balance in the body is sometimes disturbed. Toxicosis occurs. These factors affect the chemical composition of urine. If hyaline casts are found in the urine during pregnancy (no more than 2 pieces), this does not always warn of a pathological process. When toxicosis passes, the sediment disappears.
To monitor the condition of the body and detect a possible disease at an early stage, it is necessary to submit urine for laboratory analysis every six months for preventive purposes.
Hyaline casts
If the sediment particles are hyaline, there is a lot of protein and kidney cells in the urine. This type of sediment element is the most common.
You need to know what hyaline microparticles are and what their presence in urine warns about. This will help to detect the existing disease in time and begin therapy.
When the kidneys become functionally impaired, protein is released from the blood plasma. It forms a sedimentary liquid with cylindrical elements. Urine becomes concentrated. The specific shape of the microparticles is a consequence of the passage of the protein through the distal section.
Hyaline elements are homogeneous and transparent. They are not painted and have a rounded end.
If the urine analysis shows hyaline casts, this may indicate pathologies such as:
- pyelonephritis;
- glomerulonephritis;
- interstitial nephritis;
- arterial hypertension;
- cardiovascular failure.
The cause of the appearance of hyaline elements in the sediment may be the use of diuretics.
In men who eat a lot of meat products, the acidity of their urine increases. This causes the formation of sediment.
Hyaline particles can only be detected in acidic urine. In an alkaline environment, elements of this type quickly dissolve or are not formed. With a neutral acid-base balance, no more than 2 hyaline cylindrical microparticles can be detected.
Hyaline casts in urine
Grainy cylinders
If the sediment elements are granular, pathologically altered renal epithelium is present in the urine. His cells are degenerate, decayed and deformed. They are formed from a yellow mass, characterized by opacity and a clear outline. They can be detected during analysis using osmic acid.
Cylindruria of a granular appearance always indicates the presence of a disease or pathological condition. These particles cannot be detected in the urine of a healthy person.
Grain means an uneven surface. It occurs due to the settling of fat particles, which refract light and give the cylinders a lumpy appearance.
This type of sediment warns of the possible presence of pathologies such as:
- glomerulonephritis;
- viral diseases characterized by kidney damage;
- amyloidosis;
- pyelonephritis;
- fever;
- diabetic nephropathy.
Cylindruria granular in appearance may be a consequence of lead poisoning.
Grainy casts in urine
Waxy cylinders
When the renal tubules thin or necrosis, pathological cylinders are found in the urine, resembling a wax ball in appearance. These elements are formed from granular and hyaline microparticles. They are opaque, yellow in color and appear as a shapeless mass. Waxy casts are shorter than hyaline casts.
If urine tests are taken regularly, including by children, the cylindrical shape of the sediment can be detected in time. The resemblance of microparticles to wax balls is a sign of dangerous violations. This type of sedimentary fluid occurs due to pathologies such as:
- CRF (chronic renal failure);
- amyloidosis;
- nephrotic syndrome;
- glomerulonephritis of malignant type;
- late stages of chronic kidney disease;
- acute form of glomerulonephritis.
Waxy cylindruria is a consequence of poor outflow or stagnation of urine. At the same time, urine is concentrated and has a pungent odor.
Waxy casts in urine
Red blood cell casts
The presence of red blood cell casts in urine is a sign of dangerous disorders. The condition requires additional diagnostics and early identification of the cause of the appearance of this type of sediment.
Red blood cell microparticles are composed of protein and red blood cells. The latter are released due to a violation of the integrity of the walls of blood vessels in the renal glomeruli.
These sedimentary elements have clear boundaries and are yellow-brown in color. They are fragile and disintegrate quickly. Therefore, they are difficult to detect in urine. To do this, the biological material must be fresh.
Cylindruria of the erythrocyte type warns of diseases such as:
- renal vein thrombosis;
- glomerulonephritis;
- kidney infarction;
- malignant or benign kidney tumors.
Red blood cell casts in urine
Sometimes cylindroids may be found in the urine. This is a special type of sediment consisting mainly of mucus. It warns about inflammatory processes in the urinary tract. A small amount of cylindroids is allowed in the urine of a healthy person.
