Granular casts

Brown, muddy granular casts (highly indicative of ATN) Proteinuria (glomerulonephritis or allergic interstitial nephritis) Eosinophiluria (acute interstitial nephritis)... 

Color, yellow character, hazy glucose (-) ketones (-) specific gravity 1.020 pH 5.0 (+) protein coarse granular casts, 5 to 10/low-powered field white blood cell (WBC) count, 5 to 10/high-powered field red blood cell (RBC) count, 2 to 5/high-powered field no bacteria nitrite (-) blood small osmolality 325 mOsm urinary sodium 77 mEq/L (77 mmol/L) creatinine 63 mg/dL (5569 pmol/L)... 

Renal Effects. Blood urea nitrogen and serum electrolyte levels were normal in several individuals overcome by unknown concentrations of hydrogen sulfide gas in a pelt room (Audeau et al. 1985). One of these four patients had protein and blood in the urine initially, which was not detected upon later testing. Albumin and some granular casts were noted in the urine in another patient, but these findings were transient (Audeau et al. 1985). 

Granular casts White blood cell casts Red blood cell casts Crystals Urate Phosphate... 

The granular cast iron of the company ERVIN AMSTEEL was chosen to include another type of material, having been described for arsenic removal from water [3,4] before. 

Renal effects have been observed in both male and female rats in a chronic-duration oral study. Male Fischer 344 rats exposed to 1,4-dichlorobenzene at 150 and 300 mg/kg/day for 2 years exhibited nephropathy, epithelial hyperplasia of the renal pelvis, mineralization of the collecting tubules in the renal medulla, and focal hyperplasia of the tubular epithelium. Each of these effects was associated with hyalin droplet formation. There were also increased incidences of nephropathy in female Fischer 344 rats dosed with 1,4-dichlorobenzene at 300 and 600 mg/kg/day. Histopathologically, the nephropathy was characterized by degeneration and regeneration of the tubular epithelium, tubular dilatation with attenuation and atrophy of the epithelium, granular casts in the tubules of the outer stripe of the medulla, thickening of the basement membranes, and minimal accumulation of interstitial collagen (NTP 1987). 

Additional studies of decalin exposure in rats have characterized the specific sequence of renal alterations first the variable occurrence of light-microscopically evident proximal convoluted tubule epithelial cell necrosis, presumably a reflection of cellular injury associated with excessive protein accumulation (hyaline droplets) then the occurrence of granular casts at the junction of the inner and outer bands of the outer zone of the medulla and finally, chronic nephrosis, occurring secondary to tubular obstruction by granular casts. It is not... 

In humans, acute pyridine intoxication affects the central nervous system, leading to dizziness, headache, nausea and anorexia. There is one case report of lethality after a high dose. Further symptoms include abdominal pain and pulmonary congestion. Pyridine was hepatotoxic in Fischer 344 and Wistar rats and caused an increase in granular casts and renal tubule hyaline degeneration in male Fischer 344 rats. Inhalation of pyridine can cause necrotic damage of the nasal epithelium. In rats and rabbits, pyridine is an inducer of CYP2E1 in the liver and kidney. 

Experimental exposiue of neomycin in calves has reported both nephrotoxicity and ototocity (demonstrated clinically). The clinical pathological observations included granular casts in urine, proteinuria and low specific gravity, azotemia, decreased creatinine clearance, polyuria, and polydipsia. The histopathological findings included renal tubular epithelial degeneration and necrosis (Crowell et al, 1981). 

A 57-year-old man with a history of alcohol abuse developed acute respiratory failure and was given lorazepam up to 18 mg/hour during alcohol withdrawal (17). On day 43 (cumulative intravenous lorazepam dose 4089 mg, containing about 220 ml of polyethylene glycol 400), he developed oliguric acute tubular necrosis with proteinuria and granular casts. 

Acute tubular necrosis (exogenous toxins) Aminoglycosides, amphotericin, cisplatin, radiocontrast agents, methoxyflurane, outdated tetracyclines, cephalosporins, mithramycin, calcineurin inhibitors, pentamidine, IVIG, ifosfamide, zoledronate, cidofovir, adefovir, tenofovir FENa>2%, UOsm <350, urinary sediment contains granular casts, renal epithelial cells... 

Acute tubular necrosis (endogenous toxins-rhabod myolysis) Lovastatin (statins), ethanol, barbiturates, diazepam Elevated CPK, granular casts... 

The nephrotoxicity of (3-lactams, such as cephaloridine, is characterized by decreased glomerular filtration rate, proteinuria, enzymuria, urinary granular casts, impaired abihty of renal cortical shces to accumulate organic ions and to synthesize glucose [27]. 

Examination of the urine revealed macroscopic blood and granular casts. Her serum biochemistry was abnormal with hyperkalemia and an elevated urea and creatinine. She ultimately required dialysis but recovered sufficient renal function within 3 days to allow cessation of dialysis therapy. In view of the close association between the exposure to the Jeyes... 

In a chronic study, weanling Sprague-Dawley rats (20 animals of each sex per exposure group) were fed (ad libitum) diets containing 0, 0.005, 0.05, 0.5, 5.0, or 50 mg kg octachlorostyrene in diet (fed ad libitum) for 12 months. While there was some mortality, it did not appear to be related to treatment. Similarly, tumor incidence was infrequent and appeared unrelated to treatment. However, 5.0 and 50 mg kg exposures resulted in kidney effects (e.g., dose-related dilation of proximal tubules and cytoplasmic eosinophilia along with granular casts and proteinaceous losses), and induction of aniline hydroxylase and aminopyrine demethylase activities in hepatic microsomes of both sexes. At the highest exposure level only (50 mg kg ), there was a... 

The interstitium of the kidney is also susceptible to injury from a variety of causes. Although acute interstitial nephritis is most commonly caused by medications (see Chap. 46), infections (e.g., streptococcal, leptospirosis, hantavirus, and human immimodeflciency virus), selected autoimmune disorders (systemic lupus erythematosus or mixed connective tissue disease) also may produce a similar syndrome. The presence of white blood cells (WBCs), WBC casts, and coarse granular casts in the urine aU suggest interstitial inflammation. The presence of eosinophUia and eosinophiluria also strongly suggest the presence of an interstitial nephritis. Occasionally low to moderate proteinuria can be seen on urinalysis. 

Major functions of the distal nephron include the regeneration of bicarbonate, the excretion of acid (hydrogen ion), the secretion of potassium, and the reabsorption of water. Damage to this portion of the nephron may present as significant acidemia and either hypo-or hyperkalemia, depending on the mechanism of injury. For example, amphotericin B produces small pores in the luminal membrane of distal tubular cells. These pores allow small molecules such as potassium to leak out the molecules are then wasted in the urine. Consequently, amphotericin B nephrotoxicity is characterized by hypokalemia secondary to renal potassium wasting. ATN is associated with urinary sediment characterized by the presence of tubular cells, coarse granular casts, and rarely, RBC casts. 

Renal failure can occur within days of initiating therapy, particularly with a short-acting NSAID such as ibuprofen. Urine volume and sodium concentration are usually low, edema and/or weight gain is noticeable, and BUN, serum creatinine, and potassium are typically elevated. The urine sediment is usually unchanged from baseline, but may show granular casts. 

Patients with nephrogenic diabetes insipidus often have polydipsia and polyuria (see Chap. 49). They adapt well to their urinary-concentrating defect and these concerns are usually minimal. Acute tubular necrosis is frequent in the setting of acute hthium toxicity. Urinalysis may show moderate proteinuria, a few red and white blood cells, and granular casts. Renal function usuahy returns to baseline values after hthium concentrations are reduced to the therapeutic range. Nephrotoxicity may develop insidiously and be recognized by rising BUN or creatinine concentrations or the onset of hypertension. The urinalysis may show mild proteinuria and a few red and white blood cells. 

Cellular, granular casts Glomerular filtration rate... 

Hallmark histopathologic lesions, including granular casts at subchronic time-points and linear papillary mineralization at chronic stages, should be observed. 

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