Lindsay's Nails and Terry's Nails in End Stage Renal Disease - Case Series

Abstract

Introduction. Nail changes occur as part of a single organ disease, multisystemic diseases or because of the intake of some medications. Chronic kidney disease (CKD) is associated with various nail abnormalities. Тo identify Lindsay’s nails and Terry’s nails in patients with end stage renal disease (ESRD) on maintenance he-modialysis (HD) and to determine the common anam-nestic, clinical and/or laboratory parameters that would help elucidate the etiopathogenesis of these nail pathology. Methods. Twenty patients with ESRD on hemodialysis were included into the study. Dermatological examina-tion took place during the dialysis session. Lindsay’s nails were identified when the distal part of the nail bed is red/rose-brown, clearly separated from the proxi-mal part of the nail bed, occupying 20-60% of the entire length of the nail bed. The proximal part of the nail bed is whitish, resembling grounded glass. When pressing the nail, the discoloration of the distal part of the nail bad does not fade completely. Terry’s nails were identified by a 0.5-3.0 mm wide distal band, pink-brown in color, with a proximal part of the nail bed that is white and occupies 80% of the entire nail bed. Data on demographic characteristics, history of the disease and the laboratory values were noted for each patient. Results. Out of 20 patients, all males, we diagnosed Half-and-Half nails, also called Lindsay’s nails, and Terry’s nails in 6(30%) patients [5 Half-and-Half nails (25%), and 1 with Terry’s nails (5%)]. All patients had sideropenic-free anemia, elevated urea and creatinine values and elevated parathyroid hormone (PTH) values (>190 pg/L, range 190.3-387.5 pg/L). Conclusion. After searching the relevant literature (MEDLINE, PubMed), we found this is the first study to link elevated PTH values and Half-and-Half nails (also called Lindsay’s nails), and Terry's nails in patients with ESRD on HD.