As we have covered before, RBC casts most often signify the presence of glomerulonephritis while WBC casts are indicative of an inflammatory process affecting the glomeruli or interstitium. Sometimes, casts can be seen which contain both red and white blood cells.
Here we see several examples of mixed cellular casts. All images are under brightfield illumination with Sternheimer-Malbin stain using Olympus 100x/1.25NA oil objective.
These mixed casts are usually associated with an acute proliferative glomerulonephritis or vasculitic process- that is, disorders in which there is intense inflammation and damage affecting the glomeruli.
When tubular epithelial cells are also within casts there is almost certainly some degree of acute tubular injury as well.
Post by Jay Seltzer
Reviewed by Anna Gaddy