52 year old female patient with CKD on Dialysis for 3 years presented with this finding.
What is it?
What is the Pathogenesis of this condition?
Answer:
HALF AND HALF NAIL
Half and half nail (Lindsay nail) is usually diagnosed in patients with chronic renal disease. This disorder was reported first by Bean 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.
The estimated frequency of this change varies from 20-50% in patients with chronic renal disease. 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 pathogenesis of this condition is unknown. Stimulation of nail melanocytes by high levels of melanotrophic hormone has been postulated and high levels of this hormone have been documented in patients with CKD in dialysis.
