Which of the following is indicative of renal tubular disease

Answer is B (Coarse granular casts) `Renal tubular casts' are characteristic of Acute tubular disease and interstitial nephritis but are not provided amongst the options. Coarse granular casts though non specific, can represent acute tubular necrosis and thus are the single best answer amongst the options provided. Muddy brown granular casts are characteristic of acute tubular necrosis. Hyaline casts as explained earlier are normal constituents of urine and may be found in - Concentrated urine - Febrile disease - After strenuous exercise - In the course of diuretic therapy They are thus not indicative of any form of renal disease. White cell casts indicate an interstitial type of renal disease such as interstitial nephritis and infective diseases like pyelonephritis but not a renal tubular disease. Cvstein oxalate cell casts are specific entities present only when excretion of these are raised and do not indicate a tubular disorder.