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Picture of the Month
Michael D. Cabana, MD;
Alison Ensor, MD;
Walter W. Tunnessen, Jr, MD
From the Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Cabana and Ensor); and the American Board of Pediatrics, Chapel Hill, NC (Dr Tunnessen).
Arch Pediatr Adolesc Med. 1998;152:923-924.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. |
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A 20-YEAR-OLD morbidly obese woman with systemic lupus erythematosus and resultant end-stage renal disease was referred for evaluation of hypotension and hypovolemia. She had recently begun hemodialysis. On physical examination, it was noted that the fingernails had an unusual appearance (Figure 1). Abnormal laboratory study results included a serum creatinine level of 1025 µmol/L (11.6 mg/dL) and a serum urea nitrogen level of 32.13 mmol/L (90 mg/dL).
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Figure 1.
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Denouement and Discussion: Half-and-Half Fingernails
Figure 1. The white proximal portion of the fingernails is sharply delineated from the distal brownish portion.
Abnormal fingernails may be pathognomonic of systemic disease. In chronic renal failure, the half-and-half fingernail is an occasional but extremely specific finding. It is estimated that up to 40% of patients with renal insufficiency have half-and-half fingernails during the course of their disease.1 The characteristics were first described by Bean2 . . . [Full Text of this Article]
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