Maltese Cross Nephrotic Syndrome

Formed by the breakdown of lipid rich epithelial cells these are hyaline casts with fat globule inclusions yellowish tan in color.

Maltese cross nephrotic syndrome. Glomerular filtration barrier limits diffusion based on size charge and shape. 1 edema 2 proteinuria. Download citation images in clinical medicine. A 6 year old boy is brought to the emergency department by his mother due to swelling around his eyes and legs.

Formed from lipid droplets and indicative of nephrotic syndrome. They are pathognomonic for high urinary protein nephrotic syndrome. Maltese crosses are due to cholesterol which is increased in nephrotic syndrome. The classic maltese cross pattern is evident in fatty casts with polarized microscopy because of the birefringence of the lipid.

Round particles producing birefringent maltese crosses under polarized light are commonly seen in the urinary sediment of patients with a nephrotic syndrome. Nephrotic syndrome is a hallmark of glomerular disease and characterized by the presence of proteinuria in excess of 3 5 g 24 h hypoalbuminemia and variable amounts of hyperlipidemia hypertriglyceridemia and hypercholesterolemia lipiduria and edema 1 figure 1 in children nephrotic range proteinuria is defined by urinary protein excretion rates 40 mg h per meter 2. 4 symptoms of nephrotic syndrome. The urinary sediment showed fatty casts panel a with typical maltese crosses under polarized light panel b and was otherwise unremarkable with no sign of nephritis.

The following are baseline essential investigations urine sample shows proteinuria. Laboratory findings include proteinuria hypoalbuminemia and hyperlipidemia. Urinalysis demonstrates 4 protein and fatty casts with maltese cross sign. Which is more a feature of active nephritis.

Question 1 a patient presents with edema which is most noticeable in the hands and face. Dysfunction in any of these will cause nephrotic syndrome. If cholesterol or cholesterol esters are present they are associated with the maltese cross sign under polarized light. The mother reports that the patient recently recovered from an upper respiratory tract infection.

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