Need Help? (888) GET LABS

What Do Your Nails Look Like With Kidney Disease?

Medically Approved by Dr. Edward Salko

Kidney disease nails are often an early outward sign of internal dysfunction. Renal disease affects more than just your filtration system — it can lead to visible nail changes that reflect worsening metabolic balance. As the kidneys lose their ability to remove nitrogenous waste, toxins like urea and creatinine accumulate in the bloodstream. This toxic buildup interferes with cellular health, often resulting in changes in nail texture, color, and shape.

These nail abnormalities may include spoon-shaped depressions, yellow or brown discoloration, split nail coloration, brittleness, or detachment from the nail bed. Each of these signals could point to advancing kidney disease or renal failure. Understanding these changes may help with early detection and better clinical outcomes. The following sections outline the most common nail symptoms associated with kidney dysfunction.

types of nail problems caused by kidney disease
  1. White Streaks (Muehrcke’s Nails)

Muehrcke’s nails appear as pale white bands or streaks that run horizontally across the nail plate and are often associated with reduced albumin levels in the blood. This condition, named after physician Robert C. Muehrcke, can occur when chronic kidney disease disrupts protein synthesis and circulation in the nailbed. The diminished blood flow caused by impaired renal function leads to visible white streaks that do not move with nail growth, distinguishing them from other nail abnormalities.

In people with advanced kidney disease, these streaks often reflect hypoalbuminemia, a condition characterized by low serum albumin that commonly occurs during end-stage renal failure. Although a single white line may not indicate a major concern, the presence of multiple bands suggests deeper systemic issues and warrants diagnostic testing. Physicians typically confirm Muehrcke’s nails through clinical observation and a blood test measuring albumin levels, which may reveal how severely the kidneys are compromising the body’s protein regulation.

  1. Concave Nails (Spoon-shaped Dent) 

Concave nails, medically referred to as koilonychia, are marked by a noticeable scooped or spoon-like indentation in the nail plate. This abnormal curvature typically results from iron deficiency anemia, which is especially prevalent among individuals with chronic kidney disease. When renal function declines, the body’s ability to regulate iron stores and produce erythropoietin is impaired, leading to anemia that directly impacts nail structure and hardness.

In addition to kidney-related causes, koilonychia can also appear in patients with hemochromatosis, diabetes, lupus, psoriasis, and thyroid dysfunctions such as hypothyroidism. However, in the context of kidney disease nails, this condition often indicates a systemic shortage of iron and disrupted nutrient absorption caused by renal insufficiency. The presence of spoon-shaped nails should not be dismissed, especially if accompanied by fatigue or other symptoms of anemia, as they may signal an advancing stage of renal pathology that requires both hematologic and nephrologic evaluation.

Spoon nails as shown by the prominent dent or press (Source: Wikimedia Commons)

Did You Know? Iron deficiency anemia is common among women and can be easily overlooked. Learn about how serious iron deficiency anemia can get to take proper action to restore your health. 
  1. Beau’s Lines

Beau’s lines are deep, transverse indentations that stretch across the width of the nail and develop when nail growth is temporarily halted due to a physiological disturbance. These grooves often reflect an underlying systemic event that interrupts normal cell division in the nail matrix. Among individuals with acute or chronic kidney disease, the presence of Beau’s lines typically indicates that renal impairment has caused significant metabolic disruption.

As renal function declines, the accumulation of nitrogenous waste and imbalance in electrolytes can interfere with keratin formation and overall nail production. This disruption halts uniform nail growth and leads to the characteristic horizontal depression. In many cases, Beau’s lines mark a period of systemic stress tied to renal decompensation, infection, or dialysis-related complications. Their appearance offers a visible timeline of when the interruption occurred, making them a critical clinical marker for both past and ongoing issues related to kidney disease.

Beau’s lines with the sharp indentation (Source: Wikimedia Commons)

  1. Lindsay’s Nails

Lindsay’s nails, commonly referred to as half-and-half nails, are defined by a distinct color separation on the nail plate — the proximal half appears pale or white, while the distal portion displays a reddish-brown or darker hue. This striking two-tone pattern is most frequently observed in individuals with chronic kidney disease and is believed to result from uremia and systemic acidosis caused by impaired glomerular filtration.

Approximately 20% to 50% of patients with kidney disease develop Lindsay’s nails, and the condition is more often seen in toenails than fingernails. The discoloration is thought to arise from the accumulation of nitrogenous waste in the bloodstream, which affects vascular flow and pigment distribution beneath the nail. For patients on dialysis, these nail changes typically persist, although some cases show reversal following successful kidney transplantation. While Lindsay’s nails can occasionally be seen in liver disease, their presence in renal patients is a highly specific visual cue indicating the depth of toxic burden and metabolic imbalance associated with end-stage kidney dysfunction.

Half-and-half nails or Lindsay’s nails showing the separate colors of the nail plate (Source: Wikimedia Commons)

Did You Know? Lindsay’s nails can also show in liver disease. But the most common nail problem associated with hepatic or liver disease is Terry’s nail. It is a type of discoloration notable for its ground glass opacity that makes the nail appear washed out. 
  1. Yellow Coloration

Yellow discoloration in the nails is one of the most visibly apparent signs that may suggest underlying kidney dysfunction. In individuals with chronic kidney disease, this yellowing typically occurs due to the buildup of nitrogenous waste products such as urea and creatinine in the bloodstream. These substances, which the kidneys normally excrete, begin to accumulate when glomerular filtration is compromised, leading to metabolic byproducts circulating through and affecting peripheral tissues like the nails.

The discoloration may appear localized at first but can eventually cover the entire nail plate, signaling a progressive decline in renal clearance. Monitoring this symptom alongside other markers of renal performance is essential. Physicians commonly rely on blood urea nitrogen (BUN) levels and serum creatinine testing to assess whether impaired filtration is contributing to the pigmentation change. Persistent yellowing of the nails should be taken seriously, especially in patients with known or suspected kidney disease, as it often reflects elevated systemic toxicity requiring medical attention.

  1. Detached Nails 

Onycholysis, the separation of the nail plate from the nail bed, may occur in individuals with advanced kidney disease and is often a sign of chronic renal failure. This detachment can be partial or complete and usually begins at the distal edge of the nail. The lifting of the nail exposes sensitive tissue beneath, increasing the risk of secondary bacterial or fungal infections, particularly in patients with weakened immune responses due to renal impairment.

The development of onycholysis in kidney disease nails is often associated with prolonged toxin buildup, nutritional deficiencies, or changes in protein structure resulting from impaired kidney filtration. As the metabolic waste accumulates and systemic inflammation increases, nail adhesion weakens and detachment occurs more easily. This condition not only reflects local nail damage but also points to deeper systemic imbalances associated with late-stage kidney dysfunction. Early recognition and clinical management are important to avoid infection and to assess the progression of renal failure.

A nail detaching from the nail bed (Source: Wikimedia Commons)

  1. Brittle Nails

Brittle nails are a common symptom in individuals with chronic kidney disease and often indicate deteriorating nail integrity caused by systemic nutrient depletion. As kidney function declines, the body’s ability to regulate minerals, vitamins, and protein balance weakens, resulting in insufficient keratin production. Keratin is the structural protein responsible for nail hardness, and its deficiency leaves nails thin, fragile, and prone to splitting or breaking under minimal pressure.

The development of brittle, ridged, or cracking nails in the context of kidney disease can reflect both dietary restrictions and the body’s inability to properly absorb or retain essential nutrients. In many patients, brittle nails signal the need to reassess the renal diet and consider medical supplementation to restore the structural foundation of the nails. Although this condition may appear minor on the surface, it offers a useful indicator of how kidney dysfunction disrupts broader cellular repair and protein synthesis.

A brittle nail sustaining damage from a light scratch (Source: Wikimedia Commons)

Why Do Nails Change With Kidney Disease?

Nail hygiene and care flat lay

If you have renal disease or other conditions affecting your kidneys and blood circulation, your body will have difficulties eliminating waste products like BUN and creatinine. Without a functioning filtering system to remove them, these substances can build up in the bloodstream, causing prominent changes in the body. 

In the case of patients with kidney disease, fingernails and toenails will start to change in form, texture, and coloration as nitrogen becomes excessive. 

Additionally, some renal diets for kidney disease also limit specific nutrient quantities to prevent overloading the already-limited filtration function of the kidneys. As a result, you may suffer from nutrient deficiencies that affect keratin production. Keratin is a protein responsible for strengthening the nails and preventing hair loss.

When To See A Doctor

While kidney disease and nails may seem to have a direct connection, taking note of the changes in your fingernails and toenails will not be enough to assess the severity of the medical condition.

Still, a significant change in your nails could warrant a visit to your doctor. If your nail looks far off from what is normal and you exhibit other symptoms of chronic kidney disease like shortness of breath, irregular urination, blood in urine, insomnia, and muscle cramps, schedule an appointment with your physician immediately. 

Frequently Asked Questions 

How do I check if my kidneys are OK?

The surest way to check your kidney’s health is through kidney function tests. Your doctor may order lab work as simple as a urinalysis or multiple blood tests such as those in a comprehensive metabolic panel (CMP14). It will depend on your symptoms, family history, and risk for developing specific kidney disorders. 

Does kidney health also affect hair?

Chronic kidney disease can lead to hair loss because the severe impairment in the kidneys’ glomerular filtration results in vitamin, mineral, and protein deficiencies, which affects hair growth. As with nails, hair needs keratin, which becomes limited with CKD. 

What other diseases show up in your nails?

Aside from renal disease, changes in your nails can reveal other medical problems, such as heart disease, lung issues, inflammatory bowel disease (IBD), Reiter’s syndrome, liver disease, psoriasis, diabetes, and thyroid disease. 

The Bottom Line 

Although kidney disease primarily affects your internal physiology, it doesn’t take long before your outward appearance catches up and starts to decline. For some, the so-called “renal failure nails” are apparent symptoms of kidney disease or even kidney failure, but for others, they may appear as unimportant alterations. However, given the complications of renal disease, it is imperative to spot the nail problem’s severity.  

Sources:

1 Lakshmi BS, Ram R, Kumar VS. Nail changes in a renal patient. Indian J Nephrol. 2015 Nov-Dec;25(6):383. doi: 10.4103/0971-4065.152727. PMID: 26664218; PMCID: PMC4663780.

2 Pérez Pico AM, Dorado P, Santiesteban MÁ, Mingorance-Alvarez E, García-Bernalt Funes V, Mayordomo R. Prevalence of foot disorders according to chronic kidney disease stage. J Ren Care. 2021 Mar;47(1):17-26. doi: 10.1111/jorc.12342. Epub 2020 Jul 30. PMID: 33216453.

3 Raja, S. M. (2021). Chronic kidney disease entertained from Lindsay’s nails: A case report and literature review. Clinical Case Reports, 9(7). https://doi.org/10.1002/ccr3.4426

4 Goel, V., Sil, A., & Das, A. (2021). Cutaneous Manifestations of Chronic Kidney Disease, Dialysis and Post-Renal Transplant: A Review. Indian Journal of Dermatology, 66(1), 3-11. https://doi.org/10.4103/ijd.IJD_502_20

5 Aqil N, Nassiri A, Gallouj S, Mernissi FZ (2019) Nail Disorders in Patients with Chronic Renal Failure. J Dermatol Res Ther 5:065. doi.org/10.23937/2469-5750/1510065

Share this article

Facebook
LinkedIn
Email
Print