Casts

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Chronic Pyelonephritis -(Chronic Pyelitis and Pyonephrosis - PH 1730)
(Be able to identify this slide as being abnormal and identify the casts.)

This slide emphasizes the presence of protein casts in the tubules. (See Fig. 46-6, p. 700, Fig. 46-11, p. 706). The damaged tubules have leaked proteins which have coagulated into the round pink casts. (Pyelitis means the renal pelvis is infected and pyonephrosis means hydronephrosis which has become infected. You do not have to know these two terms). Do not confuse casts in tubules with hyalinized glomeruli even though they are similar in appearance.

Kidney tubules containing casts (40X2.0) Kidney tubules containing casts (100X2.0)

Casts are very numerous, are of different sizes, and in these slides, contain no cells or nuclei.
Hyalinized glomeruli in our slides are fewer in number, of equal sizes, and contain a few cell nuclei.

Kidney tubules containing casts (400X2.8)

The outward pressure from a cast in a tubule
causes atrophy (thinning) of the tubule cells
from their normal cuboidal shape to a thin flat
squamous shape. Inflammation is evident from
the presence of many inflammatory cells (small dark blue)
between the tubules

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