Maltese Cross Sign Nephrotic Syndrome

Treat underlying etiology in secondary causes.

Maltese cross sign nephrotic syndrome. Massive edema urine 3 5 grams of protein on 24 hour urine. Formed by the breakdown of lipid rich epithelial cells these are hyaline casts with fat globule inclusions yellowish tan in color. The arms of the maltese crosses seen in these patients with gross proteinuria are symmetrical figure 2. Fatty casts with maltese cross sign.

If cholesterol or cholesterol esters are present they are associated with the maltese cross sign under polarized light. They are pathognomonic for high urinary protein nephrotic syndrome. Focal segmental glomerulosclerosis. The urinary sediment showed fatty casts panel a with typical maltese crosses under polarized light panel.

Fatty casts with maltese cross sign. A 66 year old man presented with edema which had developed over the previous month. Urinalysis demonstrates 4 protein and fatty casts with a maltese cross sign. It is also examined for active casts.

The following are baseline essential investigations urine sample shows proteinuria. Which is more a feature of active nephritis. Nephrotic syndrome 11 4 2012 69 views 5 topic comments 36 please. The appearance of the maltese crosses is due to the birefringence of lipid droplets which consist mainly of cholesterol esters.

Nephrotic syndrome is defined as urinary excretion of 3 g of protein in a 24 hour urine sample due to a glomerular disorder plus edema and hypoalbuminemia. The classic maltese cross pattern is evident in fatty casts with polarized microscopy because of the birefringence of the lipid. Hypoalbuminemia hyperlipidemia and lipiduria. Podocyte injury or decreased glomerular filtration barrier integrity.

Maltese crosses are due to cholesterol which is increased in nephrotic syndrome. Acute poststreptococcal glomerulonephritis. Notably our patient had only moderate proteinuria no clinical signs of a nephrotic syndrome and the arms of the maltese crosses were asymmetric and irregular. Maltese crosses in the nephrotic syndrome a 66 year old man presented with edema which had developed over the previous month.

Focal segmental glomerulosclerosis.