History

The present case is a women with an elevated urea and creatinine (around 11 mg/dL, 1000 umol/L).  The diagnosis of the patient is hepato-renal failure. The macroscopic aspect of the sediment was of a fine brownish deposit.

A poor renal perfusion associated with this condition can be responsible for a ischemic ATN sediment type 

This sediment is a nice exemple of  ischemic ATN sediment type. Meaning a dirty sediment containing : dirty brown cast, waxy cast, RTC cells cast, RTC cells with many necrotics (color identical as the dirty brown cast) , red blood cells etc. 

Pictures where taken with a 7Mpix mounted on an Olympus CX31 microscope. 

1: Muddy brown cast  (dirty brown hemoglobinuric pigment)

2: Waxy cast

3: Necrotic RTC cells

4: RTC-hyaline cast

Other pictures from the same sediment

Enlarged Waxy cast from a expanded tubule.   Different from the large waxy cast typical of an end stage renal failure. (size easely 3 times normal cast)