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Images in Nephrology
24 (
5
); 330-330
doi:
10.4103/0971-4065.133038

Half-and-half nails

Department of Nephrology, Sawai Man Singh Hospital, Jaipur, Rajasthan, India
Address for correspondence: Dr. Kunal Gandhi, Department of Nephrology, Sawai Man Singh Hospital, Jaipur - 302 004, Rajasthan, India. E-mail: kunalgandhi85@live.com
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

A 65-year-old male with type 2 diabetes diagnosed 11 years ago presented with 1 month of persistent malaise, nausea and decreased appetite. Other medical problems include hypertension diagnosed 5 years ago. His physical examination was unremarkable except for pallor and mild peripheral edema. He also had evidence of other chronic complications of diabetes including neuropathy and retinopathy. His fingernails showed a distinctive [Figure 1] distal pinkish transverse band occupying approximately 1/3rd total nail length with proximal dull white appearance [Figure 2]. A diagnosis of “half and half nails” was made. His laboratory investigation revealed hemoglobin 10.5 g/dl, blood urea 311 mg/dl, creatinine 11.98 mg/dl, sodium 132 mEq/L, potassium 6.8 mEq/L, blood sugar 212 mg/dl. Urine showed 2+ albumin. Ultrasound of the abdomen revealed bilateral small kidneys. He was initiated on a regular hemodialysis program.

Figure 1
Arrow showing line of demarcation
Figure 2
Half and half nails

First described in 1964 by Bean,[1] half-and-half nails or Lindsay's nails are seen in 20-50% of hemodialysis patients.[2] They are characterized by red, pink or brownish discoloration of distal 20-60% nail with a dull, whitish, ground-glass appearance of the remaining nail.[2] The distinction remains even after constricting the venous return from the nail bed. It can affect a single or all nails of fingers and/or toes. The mechanism of half and half nails is still unclear. There is no known correlation of this finding with the severity or duration of renal failure.[3] It does not improve after hemodialysis, however, may regress after renal transplantation.[4]

Source of Support: Nil

Conflict of Interest: None declared.

References

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  3. , , , . Nail diseases in haemodialysis patients: Case-control study. Br J Dermatol. 2001;144:445-6.
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  4. , , . Half and half nails. NDT Plus. 2011;4:361.
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