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Urinary casts
Imprints of kidney tubules. Single hyaline casts are acceptable; all other types always signal kidney disease.
Other names: Casts, cylindruriaSection: UrinalysisSpecialist: Primary care physician, nephrologistSample: UrinePart of: Urinalysis
Updated: September 17, 2026·MedProtect editorial team Reference information — not a diagnosis or a prescription
In shortCasts are “imprints” of kidney tubules made of protein and cells. Normal: hyaline casts 0–1 per field of view; all other types are absent. Granular, waxy and red-cell casts always signal kidney damage and are a reason to see a nephrologist.
What this marker is
Protein can accumulate in the lumen of a kidney tubule and solidify as a “cast” of its shape — that is a urinary cast. If cells get into the cast (red cells, leukocytes, epithelial cells), the cast is named after them.
Hyaline casts of pure protein occur singly even in healthy people — after exercise, fever, in concentrated urine. Cellular and waxy casts mean a pathological process in the kidneys and require workup.
Reference ranges
Group
Reference range
Hyaline casts
0–1 per field of view — acceptable
Granular casts
normally absent
Waxy casts
normally absent — a sign of severe chronic damage
Red-cell casts
normally absent — blood from glomeruli (glomerulonephritis)
Leukocyte casts
normally absent — inflammation in the kidney (pyelonephritis)
Epithelial casts
normally absent — tubular damage
Finding any casts other than single hyaline ones is a reason to show the test to a nephrologist or primary care physician, especially together with protein and red cells in urine. Ranges differ between laboratories.
Check your value
Enter the number from your lab report — see how it compares with the typical range. Mind the units shown in the chosen row.
An approximate comparison with a typical range, not a diagnosis. Ranges differ between laboratories — use the one on your report; a doctor interprets the result.
When it is high or appears: possible causes
GlomerulonephritisRed-cell and granular casts — blood and glomerular damage.
PyelonephritisLeukocyte casts — inflammation in kidney tissue.
Chronic kidney diseaseWaxy and broad casts — long-standing sluggish damage.
Nephrotic syndromeGranular and waxy casts together with heavy proteinuria.
Physiological causesSingle hyaline casts after exercise, fever, in concentrated urine.
What can skew the result
These factors can shift the result without any disease — keep them in mind before a retest:
Hard exercise (hyaline)High feverConcentrated urine with little drinkingLong storage — casts break down
How to prepare
A midstream sample of the first morning urine after cleaning the genital area, in a clean container, delivered to the lab within 1–2 hours. Details: Preparation: urine.
When a retest makes sense
A doubtful result is retested in 1–2 weeks with careful preparation. During treatment of a urinary tract infection, a follow-up is done 1–2 weeks after the course, as prescribed by the doctor.
Who usually reviews this result
An out-of-range result is usually reviewed by: Primary care physician, nephrologist. Bring your report and any previous results to the visit.
Names used on lab reports
Look for one of these names on your report: Urinary castsHyaline castsCylindruriaCasts
Several markers on your report?
The app reads your whole report — this marker together with its neighbors, not one by one.
Single hyaline casts (0–1, rarely up to 2 per field) are acceptable even in healthy people — after exercise, fever, with little drinking. Retest under usual conditions; if casts persist or grow, see a doctor.
How are waxy casts worse than hyaline?
Waxy casts form in dilated tubules during long urine stasis in the kidney — a sign of severe chronic damage. Hyaline casts are just solidified protein; single ones occur in healthy people.
Casts in a child’s urine — what to do?
Any casts in a child, except single hyaline ones, are a reason to see the pediatrician and nephrologist with kidney ultrasound and blood tests (creatinine, protein).
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