Half-and-half nail

A 55-year-old man presented with decreased urine output and altered sensorium of a week’s duration. On examination, asterixis was present. Examination of his hands revealed pinkish bands on the distal part of his nails with whitened proximal nails. Further evaluation revealed deranged kidney function tests (blood urea,189 mg/dL and serum creatinine, 8.8 mg/dL) and bilaterally shrunken kidneys. A diagnosis of chronic kidney failure with renal encephalopathy was established and the patient initiated on haemodialysis, and later he was discharged. First described by Lindsay,1 half-and-half nails are a specific manifestation of chronic kidney disease (CKD). It is seen in about 28% of patients with CKD.2 The pathogenesis of this manifestation is not known. Although it is reported to disappear with kidney transplantation within few weeks, dialysis has no effects on it. Half-and-half nails have no relation with severity of CKD. The presence of these nail changes warrant evaluation to rule out azotemia.3