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Tamm-Horsfall protein

Last author update: 1 March 2015
Last staff update: 20 July 2022

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PubMed Search: Bladder Tamm-Horsfall protein

Monika Roychowdhury, M.D.
Page views in 2021: 2,481
Page views in 2022 to date: 721
Cite this page: Roychowdhury M. Tamm-Horsfall protein. website. Accessed August 17th, 2022.
Definition / general
  • Tamm-Horsfall protein (THP) is a high molecular weight glycoprotein discovered by Tamm and Horsfall (J Exp Med 1952;95:71)
  • Normally synthesized by thick ascending limb of loop of Henle, possibly distal convoluted tubules
  • Most abundant protein in urine of healthy individuals
  • May accumulate in renal parenchyma, perirenal soft tissue, renal hilar lymph nodes or bladder with pathologic conditions
  • Also known as uromodulin, from UMOD gene on #16 (Wikipedia)
  • THP deposits are present in 60% of cystectomy specimens, 4% of bladder biopsies
  • In bladder specimens with THP deposits, mean age is 61 years, range 45-78 years, 85% are men (Am J Surg Pathol 1994;18:615)
  • Inserted into luminal cell surface of renal tubules by glycosyl-phosphatidylinositol (GPI)-anchor, then excreted in urine at a rate of 50 - 100 mg/day
  • Stones may form due to defective urinary Tamm Horsfall protein, due to lack of sialic acid (Int J Biol Sci 2008;4:215)
  • Has a strong tendency to form macroaggregates of several million Daltons, particularly in highly tonic solutions
  • Forms the matrix of urinary casts and stones
  • Deposited in areas of necrosis, inflammation, fibrinous exudates, ulcer, crystalline material
  • May be host defense factor against Proteus mirabilis urinary tract infections (J Urol 2009;181:2332)
  • May have role in pathophysiology of interstitial cystitis (BJU Int 2009;103:1085)
  • Comprises matrix of urinary casts formed during acute kidney injury (Webpath tutorial) and matrix of urinary stones
  • Also present in deposits associated with interstitial kidney disease
  • Also associated with urothelial carcinoma, nephrogenic adenoma
Diagrams / tables

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Diagram of Tamm-Horsfall protein secretion (green dots), forming a hyaline cast in the collecting duct

Gross description
  • Large, waxy, pale or weakly eosinophilic mass
Microscopic (histologic) description
  • Glassy, PAS+ acellular material
  • May also appear as strands of eosinophilic material obscured by fibrinous exudates or necrotic tissue
Microscopic (histologic) images

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Nephronophthisis: end stage renal disease


Pyelonephritis - protein cylinder

Pyelonephritis immunostain

Positive stains
  • PAS, trichrome (pale blue)
  • Anti Tamm-Horsfall protein antibody
Electron microscopy description
  • Nonbranching 4 nm wide parallel fibrils
Electron microscopy images

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In lymphatics

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