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Renal Exam
 
 

Nail Inspection

 
 
 
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Overview

Patients with chronic kidney disease may exhibit signs in the nails such as leukonychia or onycholysis.

Leukonychia

  • Look For

  • Whiteness of the nail beds.
  • Interpretation

  • True Leukonychia

  • Total leukonychia: generalised whitening of the nails.Inherited - rare
  • Transverse leukonychia (Mee’s lines): single white bands running parallel to the nail base, that do not disappear when depressed.Intermittent insult during nail growth - arsenic, chemotherapy, trauma, infection
  • Apparent Leukonychia

  • Muehrcke’s lines: double white bands that disappear when the nail is depressed.Chronic hypoalbuminaemia
  • Half and half nails (Lindsay’s nails): proximal white nail bed and distal brown nail, separated by a transverse ridge.Uraemia
  • Terry’s nails: white proximal nail bed with loss of the lunula (proximal white crescent-shaped area).Cirrhosis, CCF, diabetes, malnutrition, renal transplant

Onycholysis

  • Look For

  • Separation of the nail from the nail bed, either distally or laterally.
  • Causes of Onycholysis

  • Systemic disease - chronic kidney disease, bronchial carcinoma, anaemia, diabetes mellitus, porphyrias, peripheral vascular disease, thyrotoxicosis
  • Nail infection
  • Skin disease - psoriasis, dermatitis, lichen planus
  • Trauma
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