Diagnostic methods, chemical, bacteriological and microscopical : a text-book for students and practitioners . omonic of amyloid de-generation of the kidney. It is true that they do appear earlier in this type ofkidney lesion, but it is to be remembered that they occur in all varieties ofchronic kidney disease. They are usually of bad prognostic omen as they in-dicate a very advanced process. 346 DIAGNOSTIC METHODS. Fibrinous Casts. These are very highly refractile, transparent, and always of a yellowishor brown color. They may be granular and have various cellular shapes vary
Diagnostic methods, chemical, bacteriological and microscopical : a text-book for students and practitioners . omonic of amyloid de-generation of the kidney. It is true that they do appear earlier in this type ofkidney lesion, but it is to be remembered that they occur in all varieties ofchronic kidney disease. They are usually of bad prognostic omen as they in-dicate a very advanced process. 346 DIAGNOSTIC METHODS. Fibrinous Casts. These are very highly refractile, transparent, and always of a yellowishor brown color. They may be granular and have various cellular shapes vary as do those of the hyaline types and they show a tendencyto become fractured, the fracture usually being ragged, while in the waxy castit is sharp-cut. Fibrinous casts usually appear in the acute renal conditions and disappearwhen this condition clears up. They do not have, therefore, the grave signifi-cance of the waxy cast and should be sharply differentiated. These casts arenot composed of fibrin as their name would indicate, but are so called onaccount of their brownish color, which resembles Fig. 109.—Fatty casts. {Hawk after Peyer.) Epithelial Casts. These casts are true hyaline casts which include so many renal epithelialcells that the hyaline matrix may be lost. For the name epithelial cast to beaccurate it is not necessary that more than a few cells be present. The cellsmay be well preserved or show marked fatty or granular degeneration. Thenuclei of these cells are round and vesicular so that they may be easily recognized. Distinct gradations exist between the true epithelial cast and the coarselygranular and fatty cast. This type of cast is indicative of a severe destructivelesion of the kidney epithelium. Fatty Casts. These casts are masses of epithelial cells which have so markedly degener-ated that little is recognized beyond the original outline of the cell and the THE URINE. 347 numerous fatty globules contained therein. They may be yellowish or blac
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