How the Test is Performed The urine sample you provide may need to be from your first-morning urine. The sample needs to be taken to the lab within 1 hour. A clean-catch urine sample is needed. The clean-catch method is used to prevent germs from the penis or vagina from getting into a urine sample. To collect your urine, the provider may give you a special clean-catch kit that contains a cleansing solution and sterile wipes. Follow instructions exactly so that the results are accurate. How to Prepare for the Test No special preparation is needed. How the Test will Feel The test involves only normal urination. There is no discomfort. Why the Test is Performed Your provider may order this test to see if your kidneys are working properly. It may also be ordered to check for certain conditions, such as: Glomerular disease Interstitial kidney disease Kidney infections Normal Results The absence of cellular casts or presence of a few hyaline casts is normal. The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. What Abnormal Results Mean Abnormal results may include: Fatty casts are seen in people who have lipids in urine. This is most often a complication of nephrotic syndrome . Granular casts are a sign of many types of kidney diseases. Red blood cell casts mean there is a microscopic amount of bleeding from the kidney. They are seen in many kidney diseases. Renal? tubular epithelial cell casts reflect damage to tubule cells in the kidney. These casts are seen in conditions such as renal tubular necrosis , viral? disease (such as CMV nephritis ), and kidney transplant rejection . Waxy casts can be found in people with advanced kidney disease and chronic? kidney failure? . White blood cell (WBC) casts are more common with acute? kidney infections. Your provider will tell you more about your results. Risks There are no risks with this test. FAQ How do they test for casts in urine? Urinary casts are tiny tube-shaped particles that can be found when urine is examined under the microscope during a test called a urinalysis. Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. What does it mean to have a cast in your urine? They may be considered to represent a biopsy? of the kidney. If a cast is seen in the urine, kidney disease or in-involvement exists; the presence of casts indicates kidney (renal?) disease rather than lower urinary tract disease. Are casts in urine normal? Very few casts are seen in the urine of a person without renal? disease. A common exception is hyaline casts, which may often be seen in healthy patients or can be present after strenuous exercise or diuretic use. A significant number of urinary casts usually indicates the presence of renal? disease What are casts? Casts and splints are orthopedic devices that are used to protect and support fractured or injured bones and joints. They help to immobilize the injured limb to keep the bone in place until it fully heals. Casts are often made from fiberglass or plaster. Why urine become turbid on standing? Turbidity or cloudiness may be caused by excessive cellular material or protein in the urine or may develop from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator. Why are there fatty casts in nephrotic syndrome? By use of a polarizing microscope, one can see oval fat bodies and also fatty casts. These point to the nephrotic syndrome. They occur because of glomerular filtration of lipoproteins; the tubular cells that endocytose these lipoproteins then fall off into the urine. Where are casts formed? Casts are cylindrical bodies formed either in the distal convoluted tubules or the collecting ducts of the kidney. What types of casts are there

Urine Casts Test, Fatty Casts; White Blood Cell Casts

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 9 min read

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Casts in the urine; Fatty casts; Red blood cell casts; White blood cell casts Urinary casts are tiny tube-shaped particles that can be found when urine is examined under the microscope during a test called a urinalysis. Urinary casts may be made up of white...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

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Article Summary

Key Takeaways

This article explains How the Test is Performed in simple medical language.
This article explains How to Prepare for the Test in simple medical language.
This article explains How the Test will Feel in simple medical language.
This article explains Why the Test is Performed in simple medical language.

Educational health guideWritten for patient understanding and clinical awareness.

Reviewed content workflowUse writer and reviewer profiles for stronger trust.

Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

Fever with very low white blood cells or known immune suppression.
Unusual bruising, persistent bleeding, black stools, or severe weakness.
Shortness of breath, fainting, confusion, or rapidly worsening fatigue.

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Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

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Casts in the urine; Fatty casts; Red blood cell casts; White blood cell casts

Urinary casts are tiny tube-shaped particles that can be found when urine is examined under the microscope during a test called a urinalysis.

Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. The content of a cast can help tell your health care provider whether your kidney is healthy or abnormal.

Urinary Casts

Type	Description	Significance
Plain casts
Hyaline	Glycoprotein matrix consisting mainly of Tamm-Horsfall protein secreted by tubules	Nonspecific Can be present in normal urine or in patients with low urine flow (eg, due to dehydration, after diuretic therapy), physiologic stress, and acute renal disorder plus other abnormalities, or a chronic renal disorder (as broadcasts formed in dilated tubules)
Waxy	Glycoprotein matrix with degraded protein Formed in atrophic tubules Highly refractile with waxy appearance	Present in advanced chronic kidney disease
Casts with inclusions
RBC	Glycoprotein matrix with RBCs Often appears red-orange	Virtually pathognomonic of glomerulonephritis Occurs extremely rarely in patients with cortical necrosis or acute tubular injury or in runners with hematuria
Epithelial cell	Protein matrix variably filled with tubular cells	Occurs in acute tubular injury, glomerulonephritis, or nephrotic syndrome
WBC	Protein matrix variably filled with WBCs	Suggests pyelonephritis but can indicate other causes of tubulointerstitial infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation It May occur in proliferative glomerulonephritis
Granular	Glycoprotein matrix with protein or cellular debris Often appears “muddy brown”	Occasionally occurs after exercise or dehydration when renal function is normal More often indicates acute tubular necrosis
Pigment	Tubular cell or granular casts with pigment stain	Usually occurs in acute kidney injury due to hemolysis or rhabdomyolysis or in acute tubular necrosis
Fatty	Fat droplets or oval fat bodies (cholesterol produces a Maltese cross pattern in polarized light)	It May occur in various types of tubulointerstitial disorders In large numbers, strongly suggests that nephrotic syndrome
Mixed	Hyaline cast with various cells (eg, RBCs, WBCs, tubular cells)	Usually occurs in proliferative glomerulonephritis
Pseudocysts
	Clumped urates, WBCs, bacteria, hair, glass fragments, cloth fiber, or artifacts	Important not to confuse them with true casts, which are cylindrical and shaped like renal tubules

How the Test is Performed

The urine sample you provide may need to be from your first-morning urine. The sample needs to be taken to the lab within 1 hour.

A clean-catch urine sample is needed. The clean-catch method is used to prevent germs from the penis or vagina from getting into a urine sample. To collect your urine, the provider may give you a special clean-catch kit that contains a cleansing solution and sterile wipes. Follow instructions exactly so that the results are accurate.

How to Prepare for the Test

No special preparation is needed.

How the Test will Feel

The test involves only normal urination. There is no discomfort.

Why the Test is Performed

Your provider may order this test to see if your kidneys are working properly. It may also be ordered to check for certain conditions, such as:

Glomerular disease
Interstitial kidney disease
Kidney infections

Normal Results

The absence of cellular casts or presence of a few hyaline casts is normal. The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Abnormal results may include:

Fatty casts are seen in people who have lipids in urine. This is most often a complication of nephrotic syndrome .
Granular casts are a sign of many types of kidney diseases.
Red blood cell casts mean there is a microscopic amount of bleeding from the kidney. They are seen in many kidney diseases.
Renal tubular epithelial cell casts reflect damage to tubule cells in the kidney. These casts are seen in conditions such as renal tubular necrosis , viral disease (such as CMV nephritis ), and kidney transplant rejection .
Waxy casts can be found in people with advanced kidney disease and chronic kidney failure .
White blood cell (WBC) casts are more common with acute kidney infections.

Your provider will tell you more about your results.

Risks

There are no risks with this test.

FAQ

How do they test for casts in urine?

Urinary casts are tiny tube-shaped particles that can be found when urine is examined under the microscope during a test called a urinalysis. Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat.

What does it mean to have a cast in your urine?

They may be considered to represent a biopsy of the kidney. If a cast is seen in the urine, kidney disease or in-involvement exists; the presence of casts indicates kidney (renal) disease rather than lower urinary tract disease.

Are casts in urine normal?

Very few casts are seen in the urine of a person without renal disease. A common exception is hyaline casts, which may often be seen in healthy patients or can be present after strenuous exercise or diuretic use. A significant number of urinary casts usually indicates the presence of renal disease

What are casts?

Casts and splints are orthopedic devices that are used to protect and support fractured or injured bones and joints. They help to immobilize the injured limb to keep the bone in place until it fully heals. Casts are often made from fiberglass or plaster.

Why urine become turbid on standing?

Turbidity or cloudiness may be caused by excessive cellular material or protein in the urine or may develop from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator.

Why are there fatty casts in nephrotic syndrome?

By use of a polarizing microscope, one can see oval fat bodies and also fatty casts. These point to the nephrotic syndrome. They occur because of glomerular filtration of lipoproteins; the tubular cells that endocytose these lipoproteins then fall off into the urine.

Where are casts formed?

Casts are cylindrical bodies formed either in the distal convoluted tubules or the collecting ducts of the kidney.

What types of casts are there?

Types of casts

Can a cast be removed early?

Always remove any covering as soon as you can to avoid causing sweating, which could also damage the cast. Even if the plaster cast makes your skin feel very itchy, do not poke anything underneath it. This could cause a nasty sore and lead to infection.

How do I know if my cast is infected?

Infection. It’s normal for your cast to get smelly after you’ve worn it for a while. But if you notice a foul odor or a discharge coming from the cast, it could mean your skin underneath is infected. Get it treated right away.

How long does a cast stay on?

On average, plaster casts stay on for about six weeks. This time is sometimes longer or shorter, depending on your age, general health and type of fracture. During this time, x-rays are done to check that the bone is healing well.

What is the major constituent of casts?

The composition of hyaline casts has been investigated. The major constituent appears to be the urinary mucoprotein described by Tamm and Horsfall. Small amounts only of serum proteins are present.

What protein is found in all casts?

What are the important aspects of urine microscopy? Casts: Urinary casts are cylindrical structures that are formed from coagulated protein (Tamm-Horsfall protein) secreted by tubular cells. As their name implies, they are usually formed in the long, thin, hollow renal tubules and take their shape.

What is the main function of a cast?

A cast holds a broken bone in place as it heals. Casts also help prevent or decrease muscle contractions and are effective at providing immobilization, especially after surgery. Casts immobilize the joint above and the joint below the area that is to be kept straight and without motion.

Do doctors use casts anymore?

Doctors sometimes use casts and splints together. For example, they might stabilize a fracture with a splint first and replace it with a full case after the initial swelling goes down. Other fractures might need just a cast or just a splint.

What happens if you leave a cast on too long?

Compressing and damaging tendons and ligaments making them weaker and work less effectively; Amputation if the limb is cast too tight for too long and begins to die; and. Many other causes of medical malpractice.

Can you take an X-ray with a cast on?

In addition, x-rays can “see through” fiberglass better than through plaster. This is important because your doctor will probably schedule additional x-rays after your splint or cast has been applied. X-rays can show whether the bones are healing well or have moved out of place.

Do casts smell?

Unfortunately, a cast can start to stink, and often the smell can become quite bad. Once a cast starts to smell bad, it is unlikely that it will start to smell good. Cast odor tends to be most problematic in young children and athletes. Little kids have a hard time keeping the cast dry.

What happens if I take off my cast?

After the cast is removed, it is normal for there to be some discomfort in the bones and joints that were immobilized, for the arm or leg to be smaller than the other side, and for the skin to have some changes (dry skin and more hair). A few baths in warm water will soak off the dry, flaky skin.

How do I keep my cast from stinking?

Keep the smell under control

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

General physician, urologist, nephrologist, or gynecologist depending on symptoms.

What to tell the doctor

Write burning, frequency, fever, flank pain, blood in urine, pregnancy, diabetes, and previous UTI history.

Questions to ask

Is this UTI, stone, prostate problem, diabetes-related, or another cause?
Do I need urine culture before antibiotics?

Tests to discuss

Urine routine/microscopy
Urine culture for recurrent/severe infection or treatment failure
Blood sugar and kidney function when indicated
Ultrasound if stone/obstruction/recurrent symptoms

Avoid these mistakes

Avoid self-starting antibiotics; wrong antibiotic can cause resistance.
Seek urgent care for fever with flank pain, pregnancy, vomiting, confusion, or inability to pass urine.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Avoid heavy lifting, sudden bending, and prolonged bed rest.
Use comfortable posture and gentle movement as tolerated.
Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider

Tests to discuss with doctor

Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
Relevant blood, urine, imaging, or specialist tests only after clinical assessment

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first

If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story

Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician

A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests

Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse

If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

Understand this article easily

Article Summary

Key Takeaways

Seek urgent medical care if you notice

Emergency now

See a doctor

Learn safely

RX Patient Tools

How the Test is Performed

How to Prepare for the Test

How the Test will Feel

Why the Test is Performed

Normal Results

What Abnormal Results Mean

Risks

FAQ

How do they test for casts in urine?

What does it mean to have a cast in your urine?

Are casts in urine normal?

What are casts?

Why urine become turbid on standing?

Why are there fatty casts in nephrotic syndrome?

Where are casts formed?

What types of casts are there?

Can a cast be removed early?

How do I know if my cast is infected?

How long does a cast stay on?

What is the major constituent of casts?

What protein is found in all casts?

What is the main function of a cast?

Do doctors use casts anymore?

What happens if you leave a cast on too long?

Can you take an X-ray? with a cast on?

Do casts smell?

What happens if I take off my cast?

How do I keep my cast from stinking?

Why is my cast warm?

How do I keep my cast clean?

What are 3 reasons for applying for a cast?

Can a fracture heal without a cast?

Prepare before seeing a doctor

Which doctor may help?

What to tell the doctor

Questions to ask

Tests to discuss

Avoid these mistakes

Medicine safety and first-aid guide

Safe first steps

OTC medicine safety

Avoid these mistakes

Get urgent help if

Patient health record and symptom diary

Care roadmap for: Urine Casts Test, Fatty Casts; White Blood Cell Casts

Check danger signs first

Record the symptom story

Visit a qualified clinician

Do only useful tests

Follow up and return early if worse

Ask a health question safely

Frequently Asked Questions

References

Related Articles

Can you take an X-ray with a cast on?