“Fireworks” in Fatty Urine

An unusual urine sample with macroscopic fat droplets (Fig. 1A) was obtained by cystoscopy from a 59-year-old male patient with abdominal pain.Laboratory testing revealed triglycerides in the urine (55.8 mg/dL [0.63 mmol/L]) and fat layer (250.5 mg/dL [2.83 mmol/L]).Microscopic evaluation showed spherulites (diameter: 20 to 30 m) embedded in fat droplets (Fig. 1B-D).These crystals were absent in cystoscopy gel and fluids.Kidney function analysis did not explain the lipiduria (estimated glomerular filtration rate: 56 mL/min/1.73m 2 , albumin/creatinine ratio: 7.1 mg/g [0.8 mg/mmol]).