Pathological casts in the urine are increased. Casts in urine - what does this mean? Each cylinder has its own composition and meaning

Cylinders in urine are casts of proteins or cell elements that form in the lumens of the renal tubules. Almost always we are talking about organic kidney damage - nephritis or nephrosis, if cylindrical protein casts are present in the urine.

Cylinders consisting of protein and protein adhering to it may be found in urine. Also rare, but found, are cylindroids and pseudocylindroids.

Casts in urine

Even if a person is healthy, during a microscopic examination, hyaline casts are detected in his urine. If their number is single, this does not go beyond the limits, because the body secretes about 100 mg of protein per day. These casts are composed of whey protein that has coagulated and been filtered by the glomerulus but is not reabsorbed by the proximal tubules. As the folded protein moves through the tubular lumen, it becomes cylindrical in shape. Coagulation occurs due to the high concentration of protein in the lumens of the tubular fluid and its acidic reaction. Provided that the reactions in the liquid are alkaline, coagulation does not occur and cylinders are not formed. If the reaction is sharply acidic, then the protein casts are very quickly destroyed and therefore urine is not detected during the study.

The more plasma protein passes through the glomerular filters and the less is reabsorbed in the proximal tubular sections, the more hyaline casts are found in the urine.

If the patient suffers, then he is prone to such a phenomenon as cylindruria. It is detected by microscopic examination of urine sediment.

If degeneration of epithelial cells occurs, granular casts appear in the urine. Their origin is easy to explain. So, after that. As the protein coagulates in the tubules, it becomes covered with debris of dead epithelial cells from the proximal tubular sections. Moreover, this coating resembles grains, hence the name - granular cylinders in urine. They are darker than the first ones, their surface is granular.

In addition, waxy protein casts are sometimes found in urine. They are short, wide, and yellow in color. Such cylinders are composed of a homogeneous structureless material that resembles wax.

Casts in urine can only be detected during a microscopic examination of its sediment.

Cylindruria - causes

If the patient has any form, it may be found in his urine hyaline protein casts. In this case, we may not even be talking about renal damage.

Waxy ones are detected if the tubular epithelium dies in the lumens of the distal sections. It is very bad if they appear in urine waxy cylinders. This may be evidence of dystrophy or atrophy of the tissues that line the distal tubular sections. Most often, this indicates the presence of severe forms, or chronic kidney disease in the final stages.

If found red blood cell protein casts, you should think about what is of renal origin. If the patient has severe symptoms, then they appear in the urine. leukocyte casts.

If epithelial casts pathologically found in the urine, this may indicate problems associated with the kidneys, because they are not found in a healthy person. But as soon as tests reveal such cylinders, additional examination is prescribed for severe degenerative changes in the tubular apparatus of the kidneys, for example, nephrosis.

Hemorrhagic fever is characterized by the appearance in urine fibrin formations from protein. As soon as the patient begins to recover, the tests improve.

A general urine test provides enough information for an experienced physician to identify various kidney diseases that are difficult to detect. Due to latent inflammatory processes occurring in the renal tubules, accumulated protein, fat particles, epithelial cells, red blood cells and white blood cells form casts, which are detected as pathological casts in the urine. The main reason for the formation, as well as the component of these casts, is protein, since it acts as an adhesive material.

What types of casts are there in urine?

Depending on what pathological processes occur in the human urinary system, various pathological cylinders appear in the urine. Therefore, the laboratory assistant indicates which cylinders were detected in the general urine analysis, namely:

• hyaline or granular;
• leukocyte or erythrocyte;
• pigmented;
• epithelial or waxy.

Taking into account the shape of the identified pathological cylinder, the external symptoms of the disease, the urologist determines the degree of damage, whether the process is chronic or acute in the body.

The norm of casts in urine suggests the detection of only 1-2 hyaline casts.

What do casts in urine indicate?

Depending on what type of cylinder is detected during a urine test, the doctor has the opportunity to determine the presence of a number of diseases, namely:

1. Hyaline casts, which consist only of proteins, are found in pyelonephritis, glomerulonephritis, and interstitial nephritis. Since minor proteinuria is possible even in a healthy person (during physical exertion, stress, in pregnant women), the established norm of casts in the urine suggests the presence of only this type.
2. Granular casts - the reason for the appearance of casts in the urine of this type is due to the presence of acute and chronic glomerulonephritis, pyelonephritis, diabetic nephropathy, renal amyloidosis, and a number of viral diseases with fever.
3. Waxy - indicate severe kidney disease (malignant glomerulonephritis).
4. Red blood cell casts - will allow a specialist to determine changes in kidney cells (renal infarction), kidney tumor, renal vein thrombosis. The presence of this type of cylinders often makes it possible to determine the cause of blood in the urine.
5. Leukocyte casts – found in pyelonephritis.
6. Epithelial - will help determine kidney transplant rejection, acute nephritis or nephrosis.
7. Pigment casts – with hemoglobinuria and myoglobinuria.

Having studied the test results, the specialist begins treatment for casts in the urine, which involves the use of therapy aimed at eliminating the infection, which mostly causes inflammatory processes in the kidneys.

If malignant neoplasms are suspected, additional studies are carried out.

Cylinders are elements of cylindrical sediment (a kind of cast of renal tubules), consisting of protein or cells, and may also contain various inclusions (hemoglobin, bilirubin, pigments, sulfonamides). Based on their composition and appearance, there are several types of cylinders (hyaline, granular, erythrocyte, waxy, etc.).

Normally, renal epithelial cells secrete the so-called Tamm-Horsfall protein (absent in blood plasma), which is the basis of hyaline casts. Hyaline casts can be found in urine in all kidney diseases. Sometimes hyaline casts can be found in healthy people. As a pathological symptom, they acquire significance when they are constantly detected and in significant quantities, especially when erythrocytes and renal epithelium are superimposed on them.

Grainy cylinders are formed as a result of destruction of tubular epithelial cells. Their detection in a patient at rest and without fever indicates renal pathology.

Waxy cylinders are formed from compacted hyaline and granular cylinders in tubules with a wide lumen. They occur in severe kidney diseases with predominant damage and degeneration of the tubular epithelium, more often in chronic than in acute processes.

Red blood cell casts are formed when erythrocytes are layered on hyaline cylinders, leukocytes - leukocytes. The presence of red blood cell casts confirms the renal origin of hematuria.

Epithelial casts(rarely) formed when the tubular epithelium is detached. Occurs with severe degenerative changes in the tubules at the onset of acute diffuse glomerulonephritis, chronic glomerulonephritis. Their presence in a urine test a few days after surgery is a sign of rejection of the transplanted kidney.

Pigment (hemoglobin) casts are formed when pigments are included in the cylinder and are observed with myoglobinuria and hemoglobinuria.

Cylinders- long formations consisting of mucus. Single cylindroids are found in urine under normal conditions. A significant number of them occur during inflammatory processes of the mucous membrane of the urinary tract. They are often observed when the nephritic process subsides.

Reference values: hyaline cylinders – single, the rest – absent

Hyaline casts in urine:

• renal pathology (acute and chronic glomerulonephritis, pyelonephritis, kidney stones, renal tuberculosis, tumors);
• congestive heart failure;
• hyperthermic conditions;
• high blood pressure;
• taking diuretics.

Granular casts (nonspecific pathological symptom):

• glomerulonephoritis, pyelonephritis;
• diabetic nephropathy;
• viral infections;
• lead poisoning;
• fever.

Waxy cylinders:

• chronic renal failure;
• kidney amyloidosis;
• nephrotic syndrome.

Red blood cell casts (hematuria of renal origin):

• acute glomerulonephritis;
• kidney infarction;
• renal vein thrombosis;
• malignant hypertension.

Leukocyte casts (leukocyturia of renal origin):

• pyelonephritis;
• Lupus nephritis in systemic lupus erythematosus.

Epithelial casts (most rare):

• acute tubular necrosis;
• viral infection (for example, cytomegalovirus);
• poisoning with salts of heavy metals, ethylene glycol;
• overdose of salicylates;
• amyloidosis;
• kidney transplant rejection reaction.

M. V. Markin " General clinical tests of blood, urine, their indicators, reference values, changes in parameters in pathology", Novosibirsk, 2006

In the normal state of the human body urine must not contain draft or other impurities. Pathological processes lead to the filtration functions of the kidneys being impaired. As a result, some formations appear in the urine.

The most basic accumulations of substances are casts in urine . Such formations are characteristic of pathologies of the urinary system. Their structure and shape make it possible to diagnose one or another type of disease.

What do you mean by cylinders?

Urine contains a large number of different substances. The health of the human body is assessed by their content. When pathological processes occur in the body, the concentration of substances changes.

One of the important parameters when studying urine is the content of the cylinders. What it is ? Casts refer to accumulations of substances that settle after urination. The connecting link and main condition for the formation of cylinders is protein in urine . They serve as glue to form clumps.

The second important condition for the formation of clusters is increased acidity. An acidic environment is favorable not only for their formation, but also for long-term storage. Alkali, on the contrary, leads to the rapid dissolution of accumulations.

Based on the type of substances that make up cylinders , highlight different kinds :

• hyaline;
• grainy;
• waxy;
• leukocyte or erythrocyte;
• pigmentary;
• cylindroid.

In healthy people cylindrical accumulations should not be detected in urine at all, or the hyaline form may be contained in a minimum volume, no more than 1-2 pieces in the field of view. When their concentration increases, a condition occurs cylindruria . This condition means renal dysfunction, because. their formation occurs precisely in the renal tubules. The nature of the disease can be determined by the external form and quantity of these substances.

Detection of accumulations in a child’s urine should alert parents. What to do when they are detected in a child? Formation processcasts in urine It has pathological causes. In this situation, you should contact your pediatrician and find out the cause of the pathology.

Preparing children for urine testing

The simplest and most common way to identify cylinders serves as a general urine test . Proper preparation and collection of a urine sample plays a major role in conducting tests and obtaining correct data. Very often parents neglect these rules, which leads to distorted results.

Infants

Young children do not yet know how to control the process urination , so it is not easy for parents to collect a urine sample from them. For such purposes, it is best to use special urinals. They are sold at any pharmacy and are very convenient.

Before attaching the urine bag to the baby, you should wash the genitals. Then remove the protective film and glue the urinal to the baby. Peel off as it fills. Urine can be donated directly into a urine bag or transferred into a sterile container.

You can use the old method - hold the baby over a clean container. It must be remembered that the baby often begins to poop at the same time as urination. You need to cover the anus with cotton wool or a napkin.

It is prohibited to squeeze urine out of diapers or diapers. This sample will contain a lot of excess impurities and lint from the fabric. There are no dietary restrictions during this period.

Children under 1 year

Children who are a little older are already starting to eat complementary foods. Therefore, you should exclude coloring foods from your diet before taking the test. No other preparation is required.

The process of collecting a urine sample should also begin with genital hygiene. For girls, washing occurs from front to back, with obligatory wiping with a cotton swab between the labia. For boys, it is important to wash the glans by retracting the foreskin.

At this age, you can also use a urine bag, or you can hold the child over a clean container and pour the resulting sample into a sterile container. Almost all babies already know how to sit after six months. Many parents use children's potties to collect urine. This is prohibited. No matter how clean the pot is washed, bacteria will always remain in it. This collection method leads to incorrect results. research

Preschool children

A preschool child has excellent control over his urination process. Parents have virtually no difficulties collecting urine during this period.

The preparation of children is as follows:

• exclude coloring foods, fatty and spicy foods the day before the analysis;
• avoid physical activity;
• do not take medications.

Sample collection consists of the following steps:

• a morning urine sample is required for analysis;
• carry out hygiene procedures;
• Pour the first portion into the toilet, then collect the middle portion into a container, and pour the remainder into the toilet again. If the child does not yet know how to stop while urinating, it is permissible to give a sample collected from general urine;
• take the urine sample for testing no later than 1.5 hours after collection.

Compliance with all rules for the preparation and collection of urine will avoid the entry of bacteria and other particles into the sample. If the collection is violated, it is better to repeat the entire procedure again.

Deciphering childhood pathologies by types of cylinders

The norm of cylinders in the urine of a childsimilar to adults. No type of accumulation should be detected in urine . Their presence means the development of certain diseases.

When studying the composition and properties of urine, the laboratory technician determines not only their volume, but also their structure. Cylinders can consist of different substances and cells. This or that type of substance has different reasons for its formation and characterizes certain types of diseases.

Hyaline

This type of cylinders is a formation of proteins. Due to the passage of blood through the kidneys, protein from the plasma is not absorbed due to failures in the filtration abilities of the kidneys and penetrates into the urine. Passing through the tubules, such accumulations take cylindrical form. The higher the protein concentration, the greater the number of clusters formed.

Hyaline castshave no color and can be almost transparent. This is the only type of accumulation, the presence of which is allowed in a healthy person in a single quantity.

Most often, the identification of such accumulations indicates the development of proteinuria in diseases such as pyelonephritis , glomerulonephritis, nephritis, etc. Besides hyaline education can be increased in urine consumption of large amounts of proteins, with high levelsphysical activityok, in case of poisoning or elevated body temperature and dehydration.

The child has increased valuehyaline castsmay be a symptom of diseases not related to the urinary system:

• polio;
• mumps;
• rubella;
• chickenpox;
• measles;
• whooping cough.

Grainy

The basis granular appearance of cylindersconstitutes the same protein from kidney tubules , but dead ones additionally stick to itepithelial cellstubules. Thanks to this they gain granular or granular form.

These formations appear in cases of serious pathologies of the urinary system, which are associated with damage to the tissue of the glomeruli of the kidneys. In children this is most often means latent form of glomerulonephritis or diabetic nephritis.

Waxy

Waxy formations forms are formed as a result of the combination of hyaline and granular accumulations. Due to stagnation of urine in the tubules, the cylinders stick together tightly and turn into a homogeneous mass resembling wax. Such clusters are larger in size without a clear shape and yellowish in color.

What does it mean when detected in urinewaxy cylinders? The presence of such formations in the urine indicates serious illness. kidney . Such pathologies include malignant glomerulonephritis, chronic renal failure, etc. This condition is very dangerous for the child and requires immediate medical attention to identify the cause.

Comatose

Comatose-type accumulations are also called Kültz cylinders. The main cause of their appearance is diabetic coma. Most often, the shape of such formations is short and wide; narrow and long formations are extremely rare. Some of these cylinders have a hyaline formation, and some may be covered with a granular mass of a matte or shiny appearance.

Such formations are typical only during exacerbation of diabetes and do not apply to other diseases.

Cylinders

These accumulations consist of mucus. They are very similar to hyaline casts, but have a longer shape and branching. May have partial coverage with urates.

In single quantity cylindroids can be found in a healthy person. When their concentration is high, inflammatory processes are diagnosed.

Red blood cells

The erythrocyte form of cylinders is formed from clusters of red cells.may independently form clots or adhere to hyaline or granular casts.

This type of accumulation is very fragile and is practically not detected during urine examination. The main reason for their formation is hematuria or increased number of red blood cells in the urine. This pathology develops with various tumors on the kidneys, cancer, exacerbations of glomerulonephritis, kidney infarctions or organ thrombosis.

Leukocyte

Leukocyte variety of cylinders occurs when proteins and leukocytes accumulate. It is characteristic of severe inflammation in the urinary organs with an increase in the concentration of leukocytes in the urine.

Such accumulations are quite rare in children. They appear in severe forms of pyelonephritis.

Epithelial

With the accumulation of proteins and dead epithelial cells epithelial accumulations are formed. Such formations indicate severe pathologies kidneys and the death of glomerular tissue. Factors that caused such degenerative changes may include:

• organ rejection after donor kidney transplantation;
• severe intoxication of the bodyheavy metals;
• overdose of medications.

Hemoglobin

The hemoglobin type of cylinders is also called pigment type. Such cylinders have a yellow, brown or brown tint. They are formed from free hemoglobin cells. Hemoglobinuria or increased concentration of hemoglobin can occur after a transfusion of an incompatible blood type or when the body is poisoned with toxic substances.

In children such cylinders can form due to a very rare disease - paroxysmal nocturnal hemoglobinuria Marchiafava-Micheli.

Finding casts in a baby’s urine is a dangerous sign. Parents should immediately contact their pediatrician. Doctor Assess the child’s condition and make recommendations:

• It is possible that a poor test result is due to improper collection of the urine sample. In this case, it is necessary to re-take the test in compliance with all the rules;
• If particle accumulations are detected again, additional testing must be carried out.instrumental diagnostics which will help determine the exact cause;
• making a diagnosis will allow you to choose the right treatment;
• self-medication is prohibited;
• It is necessary to follow all doctor’s recommendations regarding drug dosages and course of treatment.

Conclusion

Casts in the urine are a pathological condition. In a healthy child, the presence of only isolated accumulations of the hyaline type is allowed. A high concentration of other types of formations indicates serious kidney disease.

Urine casts are very small casts of the renal tubule cavity. The presence of these indicates some health problems. Cylindruria occurs due to insufficient filtration of the kidneys. As a rule, this is associated with some pathology.

They are detected during a general urinalysis (abbreviated as OAM). This test is recommended for absolutely all people who come to a medical facility. The CBC and complete blood count (abbreviated as CBC) help identify many of the patient’s health problems. Also, OAM and OAC are a standard procedure for a comprehensive examination.

Casts in the urine of a child

Urine normally has a slightly acidic reaction. The pH value should not exceed seven, the minimum value is five and a half. Cylinders form in the urine, which is acidic. In addition, TAM may show increased amounts of protein.

The process of formation of these microscopic bodies indicates the presence of kidney problems. Normally, casts can be contained in urine, but no more than two in the field of view.

Types and reasons

Casts in urine can be formed in several ways:

• protein;
• epithelial cells;
• red blood cells.

It is also very important to note that strong physical activity or a protein diet is the reason for the detection of single hyaline casts in the urine.

There are three groups of cylinders in total:

• hyaline;
• granular;
• waxy.

In this case, granular ones are divided into several types:

• erythrocyte;
• leukocyte;
• epithelial.

Hyaline

Hyaline casts in urine are the most common type. Externally they are transparent and homogeneous. The ends of the cylinders are rounded. It is very important to know that single (up to two) hyaline casts identified as a result of a urine test are a normal phenomenon for a healthy body. As mentioned earlier, the reason for this is physical activity and a protein diet. If more of them are found in the urine, then the reasons may be:

• jades;
• kidney tuberculosis;
• dehydration;
• pathologies of the cardiovascular system (cardiovascular system);
• liver diseases and so on.

Grainy

Granular casts in urine can be of two types:

• coarse-grained;
• fine-grained.

They appear as a result of damage to the kidney tubules. In this case, cellular elements disintegrate. If this type of cylinders is found in the urine, this indicates serious problems with the kidneys:

• glomerulonephritis;
• sclerotic changes;
• nephrolithiasis;
• development of malignant neoplasms in the kidneys and so on.

Waxy

Waxy casts in urine are completely different in appearance from other types, as they have a dense structure and look like wax. This is a very bad sign during research; this type of cylinders indicates that some tubules are completely atrophied and there is no urine flow in them.

Waxy casts may be detected during urine examination in the following cases:

• thermal;
• chronic severe form of glomerulonifritis;
• kidney amyloidosis;
• toxic kidney damage and so on.

Red blood cells

Now briefly about red blood cell casts in urine. They are formed as follows: erythrocyte structures are layered or adhered to hyaline structures. The erythrocyte element can be distinguished from the structure of the cylinder itself. This helps recognize hematuria (that is, the presence of casts in the urine). There are cases when they are homogeneous. In this case, the reason may be:

• acute glomerulonephritis;
• vein thrombosis and so on.

The presence of red blood cells is always a pathology. Externally, this type has the following features:

• brownish color;
• edges may be torn;
• The cylinders are quite fragile.

To identify red blood cell casts, it is necessary to examine only fresh material. They talk about kidney and urinary tract diseases.

Leukocyte

Pathological casts in the urine can make it clear to the doctor what kind of pathological process is taking place in the patient’s urinary system. The laboratory technician who conducts the analysis must indicate what type of casts are found in the urine. Now briefly about another type - the leukocyte cylinder.

The detection of this form indicates serious diseases, among which are pyelonephritis, sepsis, lupus nephritis, and so on. They are formed as a result of the adhesion of leukocytes to the hyaline matrix. Leukocyte casts are quite difficult to detect, and when examining urine sediment, they can be confused with the epithelial type, which we will talk about right now.

Epithelial

An epithelial cast is a protein structure that is formed by compaction of epithelial cells. What causes them? The reason for their formation lies in the decay and dystrophic change of the tubules. The detection of this type indicates degenerative kidney damage.

They may appear in the urine of a patient with kidney failure who has recently had a transplant. Their detection indicates that the transplant is rejected by the body. However, this is not the only reason for their appearance in the urine. They appear when:

• acute tubular nephropathy;
• glomerulonephritis;
• terminal states and so on.

It is also important to note that the appearance of this type of cylinders for patients with glomerulonephritis is a very bad sign (damage to the tubular apparatus and the addition of secondary nephrotic syndrome).

Pigment

This species consists of blood pigments that are brown in color. Pigment cylinders are formed in several cases:

• when transfusion of incompatible blood;
• when exposed to toxic substances, and so on.

We remind you once again that all cylinders can only be identified in urine with an acidic reaction, since alkaline has a destructive effect on them. In urine with an alkaline reaction, they may not be detected at all or may be present, but in small quantities.

When examining sediment, do not forget that there may also be pseudo-cylinders formed by mucus or uric acid.