Vacuolar denatured cast, the unknown element in the urinary sediment

摘要

We are presenting the case of a 62-year-old male patient with history of diabetes mellitus, who attended the peritoneal dialysis clinic for follow up and blood work (blood cytology and blood chemistry) and urinalysis were obtained. The results of the blood work were as follows: haemoglobin 11.8 g/dl (12?15 g/dl), glucose 60 mg/dl (70?110 mg/dl), urea 85.5 mg/dl (10?50 mg/dl), creatinine 2.9 mg/dl (0.6–1.3 mg/dl), BUN 39.95 mg/dl (7?18 mg/dl), uric acid 4.2 mg/dl (2.6–7.2 mg/dl), total cholesterol 252 mg/dl (120?200 mg/dl) and triglycerides 220 mg/dl (70?150 mg/dl). The results of the urinalysis were proteinuria (>300 mg/dl) and haematuria (200 red blood cells/ l). Microscopy of the sediment confirmed the haematuria (10–15 erythrocytes/field under a high-dry lens) and also found oval fat bodies, fat droplets (lipiduria), yeasts, squamous, urothelial and kidney cells, and a large variety of casts, including waxy, red blood cell, granular, white blood cell, lipid and hyaline cases (Fig. 1), with the presence of a cast with a waxy matrix and large number of vacuoles that was identified as vacuolar denatured casts (Fig. 2), which is being of particularly rare.