Biomarkers of Acute Renal Failure

August 2009

Hyaline casts are formed by Tamm Horsfall protein, which has precipitated inside of individual tubule lumens. Tamm Horsfall protein is, in fact, the most common protein in the normal human urine, and is secreted by cells in the thick ascending limb. It has a peculiar characteristic of aggregating to form a gel when it is concentrated in urine. If there’s nothing else around when it gels, it forms these hyaline casts, which are normal and only indicate that the patient may have had somewhat concentrated urine at the time it was collected. If there are other cells or structures in the urine at the time Tamm Horsfall protein precipitates, they will be trapped. In fact, Tamm Horsfall protein is the glue that holds casts together.

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Hyaline Casts

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• Introduction
• Acute Kidney Injury
• Common Causes of Acute
• Progression From Pre-renal to Acute Tubular Necrosis
• Towards a Kidney Troponin
• Origin of Formed Elements in Urinalysis
• Urinanalysis: A Traditional Biomarker of AKI
• Hyaline Casts
• Renal Epithelial Cell Cast
• Leukocyte Cast
• RBC Cast
• Pigmented Cast
• Granular Cast
• Other Helpful Indices
• Potential Sources of Urinary Biomarkers
• NGAL as a Biomarker
• Studies Support NGAL as a Biomarker of AKI in the Following Situations
• Mayo Renal Laboratory Urinary NGAL Normals
• Normal Urinary NGAL Levels are Not Dependent on Age, but are Higher in Women than Men
• Ongoing Mayo Clinic Clinical Validation Study
• Ongoing Mayo Clinic Clinical Validation Study: Preliminary Results
• Study
• Other Potential Markers on the Horizon
• Mayo Clinic Goals
• Conclusions
• References
• Questions?