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As such it is of little use in isolation and even in clinical context, interpretation should be cautiously undertaken. In the absence of an active urinary sediment it is unlikely that an intrinsic cause is present, how- ever, where suspected, the cause should be investigated as this may change the immediate management of the patient. However, it is worth remembering that although further investigation may point to a particular diagnosis often nephrology colleagues may also require histological confrmation. Appropriate further investigations will include viral serol- ogy as well as serological analysis as outlined in Table 8. Under certain cir- cumstances further evaluation may be necessary and require histological confrmation. Surgical exci- numerous, fine vacuoles and birefringent eosino- sion is necessary if the tumor is causing clinical philic material.

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