Nail diseases among renal patients

Abnormalities of the skin and its appendage are commonly encountered in renal patients. In this chapter we will discuss nail changes involving the nail bed and/or the nail matrix. These are useful clues in the diagnosis of systemic renal disease because often times, the presentation of the nail pathology can precede the time of diagnosis and renal involvement The most frequent associated nail changes among chronic kidney disease (CKD) patients are half-and-half nails, absence of lunula, and splinter hemorrhage. Other frequently observed onychomycopathies in CKD patients include onychomycosis, onycholysis, leukonychia, clubbing, and brittle nails. Onychomycosis, a commonly encountered fungal infection, also often manifests among CKD patients. Nail diseases in patients on maintenance hemodialysis are common and may affect up to 71.4 % of these patients. There is no direct relation between the dose and duration of hemodialysis and the increased prevalence of nail abnormalities. A significant incidence of nail changes among renal transplant recipients has also been described with a reported overall frequency of 56.6 %. Nail pathology increases with age and correlates with longer duration of immunosuppression. The most commonly encountered nail changes in renal transplant recipients include leukonychia, absence of lunula, onychomycosis, longitudinal ridging, and Muehrcke lines.