Maltese Cross Sign Nephrotic Syndrome

Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.

Maltese cross sign nephrotic syndrome. Fatty casts with maltese cross sign. Renal disease such as nephrotic syndrome produces a fatty cast composed of cholesterol that also has a maltese cross appearance on light microscopy. Formed by the breakdown of lipid rich epithelial cells these are hyaline casts with fat globule inclusions yellowish tan in color. It s also important to remember that one of the secondary changes in individuals with nephrotic syndrome is that the liver will increase lipoprotein synthesis which results in hyperlipidemia.

A 66 year old man presented with edema which had developed over the previous month. If these casts contain a lot of cholesterol then under polarized light they will take on a classic maltese cross appearance. Maltese cross the classic maltese cross pattern is evident in fatty casts with polarized microscopy because of the birefringence of the lipid. They are pathognomonic for high urinary protein nephrotic syndrome.

Nephrotic syndrome is characterized by a massive renal loss of protein 3 5 g day resulting in edema hypercoagulability antithrombin iii deficiency and an increased risk of infection loss of immunoglobulins typical laboratory findings of nephrotic syndrome include hyperlipidemia and fatty casts on urinalysis the most common causes of nephrotic syndrome in adults are focal segmental. The urinary sediment showed fatty casts panel a with typical maltese crosses under polarized light panel. Hypoalbuminemia hyperlipidemia and lipiduria. This is often referred to as a maltese cross sign because of the resemblance of the tetrad to the cross on peripheral blood smear.

Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine. Massive edema urine 3 5 grams of protein on 24 hour urine. Fatty casts with maltese cross sign. Consider nephrotic syndrome in patients particularly young children with unexplained edema or ascites.

Round particles producing birefringent maltese crosses under polarized light are commonly seen in the urinary sediment of patients with a nephrotic syndrome. Focal segmental glomerulosclerosis. Maltese crosses are due to cholesterol which is increased in nephrotic syndrome.