Maltese Cross Sign Urine

Fatty casts formed by the breakdown of lipid rich epithelial cells these are hyaline casts with fat globule inclusions yellowish tan in color. Medical intelligence from the new england journal of medicine urinary lipid and the maltese cross. The assessment of the urine includes evaluation of its physical characteristics colour clarity and volume the measurement of biochemical parameters using dipstick tests urine ph blood glucose ketones bilirubin urobilinogen and protein and importantly the evaluation of the sediment by phase contrast microscopy.

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The urinalysis is an important step in the diagnostic work up of patients with kidney diseases.

Maltese cross sign urine. John now the. Fatty casts with maltese cross sign. Maltese cross like crystals in the urinary sediment of a diabetic patient. It is a heraldic cross variant which developed from earlier forms of eight pointed crosses in the 16th century.

Lipid droplets that may be seen in the urine. They are pathognomonic for high urinary protein nephrotic syndrome. Although chiefly associated with the knights hospitaller order of st. 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.

Under polarized light oval fat bodies demonstrate the maltese cross appearance. The appearance of the maltese crosses is due to the birefringence of lipid droplets which consist mainly of cholesterol esters. Or 300 350 mg mmol on spot urine protein to creatinine ratio. Round particles producing birefringent maltese crosses under polarized light are commonly seen in the urinary sediment of patients with a nephrotic syndrome.

If cholesterol or cholesterol esters are present they are associated with the maltese cross sign under polarized light. This phenomenon allows easy identification of birefringent specimens found in nature such as plankton starch grains and fatty molecules. The maltese cross is an interference figure formed by birefringent materials place between crossed linear polarizers. The maltese cross is a cross symbol consisting of four v or arrowhead shaped concave quadrilaterals converging at a central vertex at right angles two tips pointing outward symmetrically.

Lab medicine urinalysis maltese crosses are anisotropic or birefringent cholesterol rich fat droplets associated with finely granular renal casts which have a cruciform appearance by polarised light and are found both within and outside of the cells in the urine sediment of patients with nephrotic syndrome eclampsia renal toxicity fat embolism after crush injury and in fabry s disease due to aggregates of glycosphingolipids. A maltese cross can also form when an expanding beam of locally. Sign in create account. Urine studies proteinuria 3 3 5 g day.