<P> The second-most common type of cast, granular casts can result either from the breakdown of cellular casts or the inclusion of aggregates of plasma proteins (e.g., albumin) or immunoglobulin light chains . Depending on the size of inclusions, they can be classified as fine or coarse, though the distinction has no diagnostic significance . Their appearance is generally more cigar - shaped and of a higher refractive index than hyaline casts . While most often indicative of chronic renal disease, these casts, as with hyaline casts, can also be seen for a short time following strenuous exercise . The "muddy brown cast" seen in acute tubular necrosis is a type of granular cast . </P> <P> Thought to represent the end product of cast evolution, waxy casts suggest the very low urine flow associated with severe, longstanding kidney disease such as renal failure . Additionally, due to urine stasis and their formation in diseased, dilated ducts, these casts are significantly larger than hyaline casts . </P> <Ul> <Li> They are cylindrical . </Li> <Li> They possess a higher refractive index . </Li> <Li> They are more rigid, demonstrating sharp edges, fractures, and broken - off ends . </Li> </Ul> <Li> They are cylindrical . </Li>

Which of the following sediments in a urine examination is rarely of any pathological significance