Maltese Cross Sign Nephrotic Syndrome

Round particles producing birefringent maltese crosses under polarized light are commonly seen in the urinary sediment of patients with a nephrotic syndrome.

Maltese cross sign nephrotic syndrome. If cholesterol or cholesterol esters are present they are associated with the maltese cross sign under polarized light. Other symptoms may include weight gain feeling tired and foamy urine. Nephrotic syndrome is a collection of symptoms due to kidney damage. Complications may include blood clots infections and high blood pressure.

Maltese crosses in the nephrotic syndrome a 66 year old man presented with edema which had developed over the previous month. This includes protein in the urine low blood albumin levels high blood lipids and significant swelling. Formed by the breakdown of lipid rich epithelial cells these are hyaline casts with fat globule inclusions yellowish tan in color. Maltese crosses are due to cholesterol which is increased in nephrotic syndrome.

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