新英格兰NEJM:慢性肾病引的甲改变

一位59岁女性16年前左肾因多囊肾而进行了肾移植,3年来指甲出现了改变。该患者一直接受强的松,霉酚酸酯和他克莫司的免疫抑制治疗。该患者处于慢性肾闰4期,一年来出现血肌酐水平升高(1.7-2.2mg/dl「150-194umol/l」),血尿毒瘾氮升高(26-28mg/dl 「9.3-13.6mmol/l」)。查体发现患者的所有指甲远端50%的部分甲床呈粉红色,近端出现白色带。Lindsay甲,也叫对半甲,最早见于1967年报道,指慢性肾病患者20-60%的甲床出现红色,粉红色或者褐色。氮质血症水平和甲床之间并无相关性。近端出现白色带可能与慢性贫血有关,褐色带可能与β-黑素细胞刺激激素增多而引起的黑色素沉积增多有关。本病无特殊治疗方法,以治疗原有疾病为主,控制慢性肾病是第一位的。


Lindsay’s Nails in Chronic Kidney Disease


A 59-year-old woman who had undergone transplantation of the left kidney 16 years earlier for the treatment of polycystic kidney disease presented with an incidental finding of nail changes that had been present for at least 3 years. She was undergoing treatment with prednisone, mycophenolate mofetil, and tacrolimus for immunosuppression. She had stage 4 chronic kidney disease, with elevated levels of creatinine (1.7 to 2.2 mg per deciliter [150 to 194 μmol per liter]) and blood urea nitrogen (26 to 38 mg per deciliter [9.3 to 13.6 mmol per liter]) during the past year. On examination, all the patient’s fingernails had a pinkish red band occupying 50% of the nail bed distally and a white band proximally. Lindsay’s nails, or half-and-half nails, were described in 1967 as red, pink, or brown bands occupying 20 to 60% of the nail bed in patients with chronic kidney disease. There is no correlation between the degree of azotemia and the percentage of nail bed that is occupied. The proximal white band is thought to result from chronic anemia and the brown band from increased melanin deposition distally, possibly from an increased concentration of β-melanocyte–stimulating hormone. There is no specific therapy beyond the treatment of the underlying chronic kidney disease.

原文:http://www.nejm.org/doi/full/10.1056/NEJMicm1406572


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