Nails Revealing Systemic Secrets: A Case of Impending Nephrotic Syndrome

Abstract As a window of systemic disease, some nail changes can be a presenting feature before other clinically evident systemic involvement. A 7-year-old boy came to the dermatology department with color changes of nails for 3 months with an insidious onset and gradual progression. He also had tiredness and loss of appetite. On examination, half-and-half nails, Muehrcke’s lines, leuconychia, and distal trachyonychia were found in several finger and toe nails. On further questioning, his mother gave a history of smoky urine for 5 months. But edema was absent. So, we did blood and urine evaluation which revealed hypoalbuminemia, proteinuria >3.5 g/day, hyaline and granular cast. We referred him to the pediatric department with a diagnosis of impending nephrotic syndrome. Hence, an appreciation of these nail signs and an ability to interpret them can help in guiding the diagnosis and management of a more sinister underlying systemic disorder.