When nuclei degenerate, such leukocyte casts resemble renal tubular casts. White cell casts are also found in glomerulonephritis such as lupus nephritis, and in acute and chronic interstitial nephritis. White cell casts indicate the renal origin of leukocytes, and are most frequently found in acute pyelonephritis. Leukocyturia may indicate inflammatory disease in the genitourinary tract, including bacterial infection, glomerulonephritis, chemical injury, autoimmune diseases, or inflammatory disease adjacent to the urinary tract such as appendicitis 1 or diverticulitis. When properly observed in fresh urine, crystals may provide a clue to the composition of renal stones even not yet passed, the nidus for such stones, or, as such, have been associated with microhematuria. Yet crystalluria is uncommon (in warm, fresh urine) because of the normal presence of crystal inhibitors, the lack of available nidus, and the time factor. Urine is usually supersaturated in calcium oxalate, often in calcium phosphate, and acid urine is often saturated in uric acid. Large numbers of calcium oxalate crystals occur, as well, with acute renal failure following methoxyflurane anesthesia. In abundance, calcium oxalate and/or hippurate crystals may suggest ethylene glycol ingestion (especially if known to be accompanied by neurological abnormalities, appearance of drunkenness, hypertension, and a high anion gap acidosis). Such crystals are diagnostically useful when observed in warm, fresh urine by a physician evaluating microhematuria, nephrolithiasis, or toxin ingestion. Crystalluria is frequently observed in urine specimens stored at room temperature or refrigerated.
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