NDT Plus (2011) 4: 361 doi: 10.1093/ndtplus/sfr087 Advance Access publication 26 July 2011
Images in Nephrology (Section Editor: G. H. Neild)
Half and half nails Helen Alston and Aine Burns University College London Centre for Nephrology, Royal Free Hospital, London, UK Correspondence and offprint requests to: Helen Alston; E-mail:
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This 68-year-old patient with Stage 4 chronic kidney disease was reviewed in our low clearance clinic 2 months after formation of a left arteriovenous fistula. The prominent ‘half-and-half’ appearance of his nails was noted. Nail disorders are common in chronic renal failure, affecting up to 70% of haemodialysis patients [1]. Half-and-half or Lindsay nails [2], where the proximal half of the nail is white and the distal half red or brown (first described by Bean in 1964) [3], are thought to be present in up to one-third of patients starting haemodialysis [1]. The disorder does not improve with haemodialysis, but sometimes regresses after transplantation. The precise aetiology is not known but is thought to be related to uraemia. Other common nail disorders associated with chronic renal failure include absent lunula and splinter haemorrhages.
This patient also demonstrates hyperaemia of his fistula hand (left), which is visibly more erythematous than the non-fistula hand. It was also noticeably warmer to the touch due to increased blood flow through the arm from the fistula. Conflict of interest statement. None declared.
References 1. William J, Timothy B, Dirk E. Andrews’ Diseases of the Skin: Clinical Dermatology. 10th edn. Saunders, Philadelphia (PA): ISBN 0721629210, 2005 2. Lindsay PG. The half-and-half nail. Arch Intern Med 1967; 119: 583–587 3. Bean WB. Nail growth: a twenty-year study. Arch Intern Med 1964; 111: 476–482 Received for publication: 14.6.11; Accepted in revised form: 20.6.11
Fig. 1. Half and half nails. Note also hyperaemia of patient’s left hand.
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