WBC$Cast($

Granular'Cast'
$Acute$$
Typical$HUS$
Pyelonephri6s$

Waxy$
ESKD$

Normal BUN = 7-18

Normal BUN:Cr = 15
Cynthia Czawlytko

Acute$Renal$Failure$

Fa@y$
MCD$

Chronic$Renal$Failure$

BUN$and$Cr$at$ltered$at$the$tubule.$$BUN$is$reabsorbed,$
but$Cr$is$not.$$When$RAAS$is$ac;vated,$sodium$is$
reabsorbed,$water$and$BUN$follows$

+"obstruc*on,"eg:"endometrial"cancer,"stone"

Pre(Renal$
(!Blood$Flow)$

BUN/Cr:$>40$
U'Na+: $<20$
Uosm:$ $>500$
FeNa: $<1%$
!GFR$

Intrinsic$

Acute$Tubular$
Necrosis$
Oliguria"

Ischemic'ATN(!Blood$supply$results$
in$necrosis$of$tubule;$o\en$$preceded$
by$re(renal$azotemia.$$Proximal$
tubular$and$medullary$segment$of$
thick$ascending$limb$are$par6cular$
vulnerable.$Ischemia$#$coagula6ve$
necrosis$(preserved$architecture].$
Nephrotoxic'ATN($toxic$agents$may$
result$in$necrosis$of$tubules$(proximal$
tubule$is$par6cularly$suscep6ble).$$
Toxic$Agents$include$
Aminoglycosides$
Heavy$metals$(lead)$
Myoglobinuria$(crush$injury)$
Ethylene$glycol$
Contrast$dye$
Urate$(tumor$lysis$syndrome)$
$

Hyaline$Casts$

Muddy,$Granular$
Brown$Casts$

BUN/Cr:$<20$
U'Na+: $$>40$
Uosm:$ $<300$
FeNa: $>1%$
HyperK+$&$acidosis$("anion$gap)$

Allergic$Inters66al$
Nephri6s$
Oliguria,$fever,$rash$days$to$
weeks$a\er$star6ng$drug$
(NSAIDs,$penicillin,$diure6cs).$$
HSR$of$inters66um$and$
tubules.$$Inammatory$
inltrate$between$normal$
tubules.$$May$progress$to$
renal$papillary$necrosis,$
which$presents$as$gross$
hematuria$and$ank$pain;$
typically$caused$by$chronic$
analgesic$abuse,$DM,$Sickle$
Cell,$severe,$acute$
pyelonephri6s.$$

Eosinophils$
WBC$casts$

RBC$Cast$
PSGN$

4Azotemia'
5"SMALL"KIDNEYS"
5"(5)"SEDIMENT"
5"ISOTHENURIA"
5"PROTEIN"<3.5"gm"
'

Post(Renal$
!GFR,'azotemia,'oliguria.'''
Back'pressure'can'push'BUN'back'into'
the'blood.''Tubular'funcFon'remains'
intact'early'on'(FeNa'<1%,'Osm'>500.'''
With'longstanding'obstrucFon,'the'
tubule'will'be'damaged'"'intrinsic'
failure,'inability'to'reabsorb'BUN.$

Glomerulonephri6s$
Nephri6c$

Nephro6c$

Hematuria'

Proteinuria'

RBC$Casts$

Fa@y$Casts$

Waxy$or$Broad$
Casts$