Maltese Cross Sign Nephrotic Syndrome

The appearance of the maltese crosses is due to the birefringence of lipid droplets which consist mainly of cholesterol esters.

Maltese cross sign nephrotic syndrome. Focal segmental glomerulosclerosis. It is characterized by massive proteinuria 3 5 g 24 hours hypoalbuminemia and edema. Fatty casts with maltese cross sign. They are pathognomonic for high urinary protein nephrotic syndrome.

The arms of the maltese crosses seen in these patients with gross proteinuria are symmetrical figure 2. Nephrotic syndrome is a collection of signs and symptoms indicating damage to the glomerular filtration barrier. Hypercoagulability may manifest as venous or arterial thrombosis eg deep vein thrombosis myocardial infarction. It has also been reported as a sign following fat embolism.

Can be secondary to. When lipiduria occurs epithelial cells or macrophages contain endogenous fats. Round particles producing birefringent maltese crosses under polarized light are commonly seen in the urinary sediment of patients with a nephrotic syndrome. 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.

Images in clinical medicine from the new england journal of medicine maltese crosses in the nephrotic syndrome. The classic maltese cross pattern is evident in fatty casts with polarized microscopy because of the birefringence of the lipid. Treat underlying etiology in secondary causes. Podocyte injury or decreased glomerular filtration barrier integrity.

The following are baseline essential investigations urine sample shows proteinuria. It is also examined for active casts. This is often referred to as a maltese cross sign because of the resemblance of the tetrad to the cross on peripheral blood smear. In adults the most common causes of nephrotic syndrome include focal segmental glomerulosclerosis fsgs and membranous nephropathy.

Notably our patient had only moderate proteinuria no clinical signs of a nephrotic syndrome and the. Recurrent infections and or general fatigue lethargy poor appetite weakness or episodic abdominal pain may cause presentation to a doctor. Which is more a feature of active nephritis. Maltese crosses are due to cholesterol which is increased in nephrotic syndrome.

Lipiduria is most frequently observed in nephrotic syndrome where it is passed as lipoproteins along with other proteins. Lipiduria or lipuria is the presence of lipids in the urine. Clinical signs of nephrotic syndrome include.