Granular casts are cylindrical structures from the kidney tubules with a grainy texture, formed from the breakdown of cells or protein. A small number can appear after strenuous exercise or with dehydration and be harmless. In larger numbers, they can indicate kidney stress or damage, such as from acute kidney injury or chronic kidney disease. Their presence is read together with renal epithelial cells, protein, and kidney function tests. Persistent granular casts usually prompt a closer look at kidney health.

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