Diagnostic feature of CRF is -
Ans. is 'a' i.e., Broad casts in urine Casts -o Urinary casts are formed only in the distal convoluted tubuleQ (DCT) or the collecting ductQ (distal nephron),o The proximal convoluted tubule and loop ofhenle are not the locations for cast formation.o Casts are formed through the solidification of materials in the tubules of nephrons.o Later the material is flushed out of the kidney upon the production of more urine leaving a small solidified microscopic cylinder that can also contain what ever other materials that might be within the tubules of the kidneys at the time of cast formation.o The microscopic detection of various types of casts can often be helpful diagnostic tool in the study of various types of renal diseases.Urinarv Casts and their characteristic featuresHyaline castso These are the most common type of casts and they can be found in normal urine samples.o They consists almost entirely of Tamm Horsfall protein,o Zero-to Two hyaline casts per low power field is considered normaLo Increased numbers of Hyaline casts can occur with exercise, heat exposure, dehydration, fever, congestive heart failure and diuretic.Renal tubular epithelial ceil castso These casts results when the epithelial cells o f the renal tubules are being excreted along with the casts.o These are rarer casts, can in theory indicate a serious situation involving the possible breaking down of the lining of the renal tubules themselves.o Renal tubular epithelial casts are most suggestive of tubular injury as in acute tubular necrosis.o They are also found in other disorders including eclampsia, heavy metal poisoning, ethylene glycol intoxication (most of these cases lead to acute tubular necrosis). o These casts are fairly common and occur in both pathological and non pathological condition.o Granular casts can result eitherfrom the breakdown of cellular casts to a point where the cells that once were within them are no longer distinguishable or they can result from the inclusion of aggregates of plasma proteins, fibrinogen or immune complexes within the cast upon formation.Granular castso They can be further divided into coarse gran ular casts andfine gran ular casts,o Fine granular casts can appear in non pathological conditions such as vigorous exercise, but the presence of coarse granular cast is abnormal and presents in wide variety of clinical diseases.o They are common in renal parenchymal disease.Broadcastso These casts originate from dilated chronically damaged tubules or the collecting ducts therefore thev are called renal failure casts.o These are formed in collecting duct as a result of urinary stasis.o Broad casts are two to six times the size of other types of casts.o Broad casts or renal failure casts are usually seen in patients with advanced renal failure.Waxy castso Waxy casts are cylinders of smooth highly refractive material.o Waxy casts are seen in final stages of degeneration offline granular casts. Since the granules need time to degrade, this implies nephron obstruction.o Waxy casts are seen in chronic renal diseases associated with renal failure seen in diabetic nephropathy, malignant hypertension, glomerulonephritis.
Broad casts in urine
Elevated blood urea
Proteinuria
Bleeding diathesis
Chronic Kidney Disease and Uremia