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IMAGES IN NEPHROLOGY
Year : 2015  |  Volume : 25  |  Issue : 6  |  Page : 383
 

Nail changes in a renal patient


Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication28-Oct-2015

Correspondence Address:
R Ram
Department of Nephrology, SVIMS, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.152727

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How to cite this article:
Lakshmi B S, Ram R, Kumar V S. Nail changes in a renal patient. Indian J Nephrol 2015;25:383

How to cite this URL:
Lakshmi B S, Ram R, Kumar V S. Nail changes in a renal patient. Indian J Nephrol [serial online] 2015 [cited 2020 Nov 26];25:383. Available from: https://www.indianjnephrol.org/text.asp?2015/25/6/383/152727


A 35-year-old male presented with breathlessness and anasarca. Investigations revealed proteinuria 4.5 g/day, serum albumin 1.9 g/dl and serum creatinine 8.2 mg/dl. He had a history of herbal medicine intake in an attempt to quit alcohol and smoking. Renal biopsy suggested minimal change disease with acute interstitial nephritis. He was managed with dialysis and prednisolone. His serum creatinine stabilized at 2.8 mg/dl and proteinuria reduced to 360 mg. His nails showed the changes of both half and half nail and Muehrcke's lines.

Half-and-half nail, also called Lindsay's nail, [Figure 1] is specific for renal failure.[1] The distal 20–60% of the nail is red, pink or brown. The rest of the nail has a dull, whitish, ground-glass appearance.[2] Muehrcke's lines (white arrow) are the smooth white bands that run parallel to the lunula across the width of the nail. Muehrcke's lines occur in patients with hypoalbuminemic states and disappear when the protein level normalizes.[3] It is unusual to find both the nail changes in same patient. Muehrcke lines differ from Beau's lines, which are palpable, and Mees lines, which do not disappear on blanching.[4]
Figure 1: Half and half nail and Muehrcke's lines

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  References Top

1.
Fawcett RS, Linford S, Stulberg DL. Nail abnormalities: Clues to systemic disease. Am Fam Physician 2004;69:1417-24.  Back to cited text no. 1
    
2.
Lindsay PG. The half-and-half nail. Arch Intern Med 1967;119:583-7.  Back to cited text no. 2
    
3.
Muehrcke RC. The finger-nails in chronic hypoalbuminaemia; a new physical sign. Br Med J 1956;1:1327-8.  Back to cited text no. 3
    
4.
Huang TC, Chao TY. Mees lines and Beau lines after chemotherapy. CMAJ 2010;182:E149.  Back to cited text no. 4
    


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