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Granular & “Muddy Brown” Casts on Urine Microscopy
A. Finely granular cast B. slightly coarser granular cast
Granular & “Muddy ... Brown” Casts on ... Finely granular cast ... coarse (c) and muddy ... #Granular #MuddyBrown
Examples of varying granular and granular/waxy mixed casts: 
A: coarse granular/broad-waxy (and surrounding white blood cells);
granular/waxy mixed casts ... light granular/muddy ... granular, C and D: muddy ... #Granular #MuddyBrown ... #Casts #Urine #
Muddy Brown Granular Casts three ways - Brightfield, Darkfield, Phase Contrast.

Dr. Vipin Varghese @vipvargh

#Muddy #Brown #Granular
Muddy Brown Granular ... Casts three ways ... Varghese @vipvargh #Muddy ... Brown #Granular #Casts
Urine Microscopy - Casts
Acellular Casts
 • Hyaline Casts - Consists of only precipitated Tamm-Horsfell protein without
Urine Microscopy - Casts ... Acellular Casts ... • Hyaline Casts ... • "Muddy Brown ... suggestive of nephrotic sydnrome
Urinary Casts and Disease Associations
Hyaline - May be nonspecific; seen in normal individuals or during severe
Urinary Casts and ... breakdown of cellular casts ... "Muddy-brown" heme-granular ... casts are seen ... Fatty - Nephrotic syndrome
Atlas of Urine Microscopy Findings
 • Epithelial cells - Normal
 • Renal tubular cells - Acute
microscopy • Red cell casts ... • White cell casts ... disease • Granular casts ... renal disease • “Muddy ... brown cast” - Necrotic
Glomerular Diseases - Nephritic and Nephrotic Syndromes

Nephritic syndrome—due to GBM disruption. 
Hypertension. t BUN and creatinine.
and Nephrotic Syndromes ... Nephritic syndrome—due ... RBC casts in urine ... but in severe cases ... Nephritic #Nephrotic #Syndromes
Muddy Brown Casts in ATN
#Clinical #Path #Nephro #Urine #Microscopy #MuddyBrownCasts #ATN
Muddy Brown Casts
Nephritic vs Nephrotic Syndrome

Step 1: If the patient has hematuria and/or proteinuria, think about nephrotic/nephritic syndromes.
Step
Nephritic vs Nephrotic Syndrome ... nephrotic/nephritic syndromes ... hematuria (RBC casts ... Nephritic #Nephrotic #Syndrome
Core IM: Pearls on Contrast-Induced Nephropathy

Definition: 
 • no slam dunk criteria 
 • definition in
signs of ATN (muddy ... brown casts)