Maltese Cross Sign Nephrotic Syndrome

It is characterized by massive proteinuria 3 5 g 24 hours hypoalbuminemia and edema.

Maltese cross sign nephrotic syndrome. Maltese crosses are due to cholesterol which is increased in nephrotic syndrome. Hypercoagulability may manifest as venous or arterial thrombosis eg deep vein thrombosis myocardial infarction. Fatty casts with maltese cross sign. Images in clinical medicine from the new england journal of medicine maltese crosses in the nephrotic syndrome.

If cholesterol or cholesterol esters are present they are associated with the maltese cross sign under polarized light. Formed by the breakdown of lipid rich epithelial cells these are hyaline casts with fat globule inclusions yellowish tan in color. Notably our patient had only moderate proteinuria no clinical signs of a nephrotic syndrome and the. Maltese cross birefringence has been described in cryptococcus neoformans cholesterol ester storage disease babesiosis and in urine sediments of a patient with nephrotic syndrome and.

Renal disease such as nephrotic syndrome produces a fatty cast composed of cholesterol that also has a maltese cross appearance on light microscopy. Which is more a feature of active nephritis. This is often referred to as a maltese cross sign because of the resemblance of the tetrad to the cross on peripheral blood smear. Lipiduria or lipuria is the presence of lipids in the urine.

It has also been reported as a sign following fat embolism. The classic maltese cross pattern is evident in fatty casts with polarized microscopy because of the birefringence of the lipid. Clinical signs of nephrotic syndrome include. It is also examined for active casts.

Treat underlying etiology in secondary causes. Round particles producing birefringent maltese crosses under polarized light are commonly seen in the urinary sediment of patients with a nephrotic syndrome. Can be secondary to. Podocyte injury or decreased glomerular filtration barrier integrity.

When lipiduria occurs epithelial cells or macrophages contain endogenous fats. The arms of the maltese crosses seen in these patients with gross proteinuria are symmetrical figure 2. The appearance of the maltese crosses is due to the birefringence of lipid droplets which consist mainly of cholesterol esters. They are pathognomonic for high urinary protein nephrotic syndrome.

Recurrent infections and or general fatigue lethargy poor appetite weakness or episodic abdominal pain may cause presentation to a doctor. Nephrotic syndrome is a collection of signs and symptoms indicating damage to the glomerular filtration barrier. Focal segmental glomerulosclerosis.