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Skip Navigation LinksHome > November 2009 - Volume 102 - Issue 11 > Half and Half Nail Secondary to Chronic Renal Failure
Southern Medical Journal:
doi: 10.1097/SMJ.0b013e3181bad0ac
Special Sections: Letters to the Editor

Half and Half Nail Secondary to Chronic Renal Failure

Lin, Cheng-Jui MD; Wu, Chih-Jen MD, PhD; Chen, Yi-Chou MD; Chen, Han-Hsiang MD

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Department of Internal Medicine; Nephrology Division; Mackay Memorial Hospital; Mackay Medicine, Nursing and Management College; Taipei, Taiwan (Lin)

Department of Internal Medicine; Nephrology Division; Mackay Memorial Hospital; Mackay Medicine, Nursing and Management College; Graduate Institute of Medical Sciences; Taipei Medical University; Taipei, Taiwan (Wu)

Department of Internal Medicine; Nephrology Division; Mackay Memorial Hospital; Taipei, Taiwan (Chen)

Department of Internal Medicine; Nephrology Division; Mackay Memorial Hospital; Mackay Medicine, Nursing and Management College; Taipei, Taiwan (Chen)

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To the Editor:

A 54-year-old woman had type 2 diabetes more than 5 years without regularly taking an oral hypoglycemic agent. She took a Chinese herb to control blood sugar for several years and presented with one week of progressive nausea and malaise. On physical examination, the cardiac and pulmonary examinations were unremarkable. Her abdomen was soft and not tender, and her fingernails had a distinctive pinkish red transverse band distally and diffuse, dull whitening of the proximal nail beds (Fig.). Laboratory evaluation revealed blood sugar 350 mg/dL, hemoglobin 6.9 g/dL, blood urea nitrogen 122 mg/dL, creatinine 9.2 mg/dL, sodium 139 mg/L, and potassium 5.1 mEq/L.

Fig. Photograph of t...
Fig. Photograph of t...
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Abnormal nail appearance usually reflects the status of certain systemic diseases. Half and half nail (Lindsay nail) is usually diagnosed in patients with chronic renal disease.1 This disorder was reported first by Bean2 in 1963. The typical picture of half and half nail includes red, pink, or brown transverse distal bands occupying 20–60% of the total nail length with the remaining proximal portion exhibiting a dull whitish ground glass appearance.

In our patient, constricting venous return from the nail bed caused the distal bands to become redder and only a slight pinkness was induced in the proximal area, and the contrast between the two zones remained sharply demarcated. It is most common in fingernails but sometimes can be observed in toenails.

The estimated frequency of this change varies from 20–50% in patients with chronic renal disease.3 There is no correlation between the severity of renal disease and the depth of the distal color band.

This disorder usually remains unchanged even after undergoing hemodialysis, but it may disappear after successful kidney transplantation. The definite pathogenesis of half and half nail in chronic renal failure is still unclear.4

Cheng-Jui Lin, MD

Department of Internal Medicine

Nephrology Division

Mackay Memorial Hospital

Mackay Medicine, Nursing and Management College

Taipei, Taiwan

Chih-Jen Wu, MD, PhD

Department of Internal Medicine

Nephrology Division

Mackay Memorial Hospital

Mackay Medicine, Nursing and Management College

Graduate Institute of Medical Sciences

Taipei Medical University

Taipei, Taiwan

Yi-Chou Chen, MD

Department of Internal Medicine

Nephrology Division

Mackay Memorial Hospital

Taipei, Taiwan

Han-Hsiang Chen, MD

Department of Internal Medicine

Nephrology Division

Mackay Memorial Hospital

Mackay Medicine, Nursing and Management College

Taipei, Taiwan

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References

1. Lindsay PG. The half-and-half nail. Arch Intern Med 1967;119:583–587.

2. Bean WB. Nail growth: a twenty-year study. Arch Intern Med 1964;111:476–482.

3. Stewart WK, Raffle EJ. Brown nail-bed arcs and chronic renal disease. Br Med J 1972;1:784–786.

4. Smith AG, Shuster S, Thody AJ, et al. Role of the kidney in regulating plasma immunoreactive beta-melanocyte-stimulating hormone. Br Med J 1976;1:874–876.

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Section Description

Letters to the Editor are welcomed. They may report new clinical or laboratory observations and new developments in medical care or may contain comments on recent contents of the Journal. They will be published, if found suitable, as space permits. Like other material submitted for publication, letters must be typewritten, double-spaced, and must not exceed two typewritten pages in length. No more than five references and one figure or table may be used. See “Information for Authors” for format of references, tables, and figures. Editing, possible abridgment, and acceptance remain the prerogative of the Editors.

© 2009 Southern Medical Association

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