Alterações ungueais nos pacientes portadores de insuficiência renal crônica em hemodiálise

Abstract

BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86% of the hemodialysis patients and in 75% of subjects in the control group. Absent lunula (62.9%) and half and half nails (14.4%) were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p<0.05). Longitudinal striae were more common in the control group compared to the hemodialysis group (24.1%). CONCLUSIONS: Absent lunula and half and half nails were the most common nail disorders found in patients on hemodialysis, corroborating the findings of previous studies. Longitudinal striae were more common in the control group and future studies may clarify whether structural abnormalities such as absent lunula may be related to this finding. Key words: chronic renal failure; kidney dialysis; nail disorders. Resumo: FUNDAMENTOS:A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD), e compará-los com uma amostra pareada da população geral. MÉTODOS: Realizado um estudo caso-controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86% dos pacientes em HD e 75% do grupo controle tiveram, pelo menos, uma alteração ungueal. Ausência de lúnula (62,9%) e unha meio a meio (14,4%) as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p<0,05%). Estrias longitudinais foram mais comuns nos controles em relação ao grupo HD (24,1%). CONCLUSÕES: Ausência de lúnula e unha meio a meio as alterações ungueais foram mais encontradas nos pacientes em HD, corroborando com achados relatados, em estudos anteriores. Estrias longitudinais foram mais observadas no grupo controle e estudos posteriores poderão elucidar se alterações estruturais, tal qual a ausência de lúnula, poderiam relacionar-se a este achado.

Nail Disorders in Patients with Chronic Renal Failure

“…It is likely that this change is more related to conditions imposed by CRF than to HD. In our study, the prevalence rate was as high as that found in Martinez MAR's study [18]. However, the absence of lunula can be seen in normal subjects, without any renal insufficiency [19].…”

Letter to the Editor Half-and-half nail in a case of isoniazid-induced pellagra

“…Although this change may be seen in patients with no demonstrable systemic abnormality, it is noted most commonly in patients with chronic renal failure undergoing hemodialysis. Prevalence of half-and-half nail is reported to be 7.7–50.6% in this group [3]. The pathogenesis of this color change is not clear; some authors have reported melanin deposits in the nail plate and thickening in the capillary wall, but others have considered the whiteness of this disorder to be caused by excessive development of connective tissue between the nail and bone that reduces the quantity of blood in the subpapillary plexus [4, 5].…”

Chronic kidney disease entertained from Lindsay's nails: A case report and literature review

“…2 The two most common nail disorders among ESRD patients on hemodialysis are absent lunula and Lindsay's nails. 3,4 Lindsay's nails, also known as half-and-half nails, were first reported by Bean 5 in 1964 in azotemia and later described and coined "half-and-half nails" by Lindsay 6 in 1967 in a series of 1500 patients with chronic kidney disease. Lindsay's nails are seen in 20%-50% of patients with chronic kidney disease.…”

“…Nail changes are common in chronic kidney disease, affecting more than 75% of hemodialysis patients 2 . The two most common nail disorders among ESRD patients on hemodialysis are absent lunula and Lindsay's nails 3,4 . Lindsay's nails, also known as half‐and‐half nails, were first reported by Bean 5 in 1964 in azotemia and later described and coined "half‐and‐half nails" by Lindsay 6 in 1967 in a series of 1500 patients with chronic kidney disease.…”