Maltese Cross Sign Nephrotic Syndrome

Renal disease such as nephrotic syndrome produces a fatty cast composed of cholesterol that also has a maltese cross appearance on light microscopy.

Maltese cross sign nephrotic syndrome. Nephrotic syndrome is a collection of signs and symptoms indicating damage to the glomerular filtration barrier. Can be secondary to. The following are baseline essential investigations urine sample shows proteinuria. Recurrent infections and or general fatigue lethargy poor appetite weakness or episodic abdominal pain may cause presentation to a doctor.

Clinical signs of nephrotic syndrome include. Focal segmental glomerulosclerosis. Hypercoagulability may manifest as venous or arterial thrombosis eg deep vein thrombosis myocardial infarction. This is often referred to as a maltese cross sign because of the resemblance of the tetrad to the cross on peripheral blood smear.

Images in clinical medicine from the new england journal of medicine maltese crosses in the nephrotic syndrome. The appearance of the maltese crosses is due to the birefringence of lipid droplets which consist mainly of cholesterol esters. Notably our patient had only moderate proteinuria no clinical signs of a nephrotic syndrome and the. Podocyte injury or decreased glomerular filtration barrier integrity.

They are pathognomonic for high urinary protein nephrotic syndrome. If cholesterol or cholesterol esters are present they are associated with the maltese cross sign under polarized light. Round particles producing birefringent maltese crosses under polarized light are commonly seen in the urinary sediment of patients with a nephrotic syndrome. It is characterized by massive proteinuria 3 5 g 24 hours hypoalbuminemia and edema.

Lipiduria is most frequently observed in nephrotic syndrome where it is passed as lipoproteins along with other proteins. 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. The classic maltese cross pattern is evident in fatty casts with polarized microscopy because of the birefringence of the lipid. It is also examined for active casts.

Which is more a feature of active nephritis. Lipiduria or lipuria is the presence of lipids in the urine. The arms of the maltese crosses seen in these patients with gross proteinuria are symmetrical figure 2. In adults the most common causes of nephrotic syndrome include focal segmental glomerulosclerosis fsgs and membranous nephropathy.

Formed by the breakdown of lipid rich epithelial cells these are hyaline casts with fat globule inclusions yellowish tan in color. Fatty casts with maltese cross sign. Treat underlying etiology in secondary causes.