Trophic implications of altered body composition observed in or near the nails of hemodialysis patients.

In the absence of biochemically determined nutrient status, renal nutrition specialists have been left to assume that hemodialysis (HD) patients with a stable body weight and acceptable macronutrient intakes had adequate micronutrient stores. However, at the University of California Renal Center, using physical examination and laboratory studies, approximately one in three HD patients were found to have micronutrient imbalance. The Nutrition Physical Examination (NPE), an advanced practice, nutrition-focused, physical examination, can be a timely, cost-effective strategy in assessing nutrient status. Trophic changes that have been identified in and around the nails of HD patients suggestive of protein, vitamin, or mineral imbalance include (1) Beau's lines (zinc); (2) koilonychia (iron, copper, zinc, protein); (3) leukonychia (zinc); (4) pale nail beds (iron); (5) Muehrcke's lines (protein); (6) splinter hemorrhages (V-C); (7) onycholysis (iron, niacin); and (8) chronic paronychia (zinc). While these lesions are not pathognomonic of nutrient deficiency, they do provide valuable direction in diagnostic reasoning essential to problem-solving potential maladaptive alterations in the stimulus and function of micronutrients and their enzyme systems.