Patients with edema do not necessarily have nephrotic syndrome, since other diseases—notably congestive heart failure and cirrhosis—can present in this fashion. The diagnosis of nephrotic syndrome is suggested, however, when urine dipstick reveals marked proteinuria. Urine microscopy may reveal oval fat bodies, lipid droplets, and fatty casts (which resemble “Maltese crosses” under polarized light), which reflect the presence of lipoproteins in the urine. The presence of dysmorphic red blood cells and red cell casts suggests the proteinuria is the result of an underlying glomerulonephritis.