Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2016  |  Volume : 27  |  Issue : 1  |  Page : 179--180

Muehrcke's line


Rajesh Kumar, Amith V. L. D' Souza, Vinay Malhotra 
 Department of Nephrology, S. M. S. Medical College, Jaipur, Rajasthan, India

Correspondence Address:
Rajesh Kumar
Department of Nephrology, S. M. S. Medical College, Jaipur, Rajasthan
India




How to cite this article:
Kumar R, D' Souza AV, Malhotra V. Muehrcke's line.Saudi J Kidney Dis Transpl 2016;27:179-180


How to cite this URL:
Kumar R, D' Souza AV, Malhotra V. Muehrcke's line. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2020 Aug 11 ];27:179-180
Available from: http://www.sjkdt.org/text.asp?2016/27/1/179/174218


Full Text

To the Editor,

A 17-year-old boy presented with a history of progressive swelling involving the whole body since one year. He was diagnosed as nephrotic syndrome and responded to oral corticosteroids. He discontinued his therapy himself and remained asymptomatic for the next four months. Presently, he has been admitted for recurrence of the symptom. His serum albumin was 1.2 mg/dL and his 24-h urine protein excretion was 4.2 g. On general physical examination, his fingernails showed two horizontal white bands [Figure 1], which were not well demarcated in the toenails as in the fingernails. The distal white bands were broader. The nail-bed tissue was pink and normalappearing between the two white lines. The lines were smooth, non-palpable and without indentation. A diagnosis of Muehrcke's lines was made.{Figure 1}

This condition is named after Robert Muehrcke's, who had described this condition in the British Medical Journal in 1956. [1] Muehrcke's lines are the two smooth white bands that run parallel to the lunula across the width of the nail. The lines are non-palpable and, unlike Beau's lines, do not indent the nail itself. Normal-appearing pink nail-bed tissue is seen between the two white lines. They are often most prominent on the second, third and fourth fi ngernails and frequently spare the thumbnail (as typically seen in our patient). [2] The exact cause of Muehrcke's lines is not clearly understood. The lines are not caused by injury to the cuticle or nail area. Muehrcke's lines are a non-specific finding that may be associated with periods of metabolic stress that transiently impairs the ability of the body (and particularly of the liver) to synthesize proteins. Duration of hypoproteinemia is proportional to the width of the white bands. One possible theory for the appearance of Muehrcke's lines is that these diseases lead to swelling in the nail bed. The swelling puts pressure on the blood vessels that run underneath the nail, causing color changes. [3]

The lines are also seen in older people receiving chemotherapy who are normoalbuminic. However, Muehrcke's lines most often occur in those with marked hypoalbuminemia.

Muehrcke's lines are also seen in: [3],[4]

Kidney disease, including nephrotic syndrome and glomerulonephritisCancer after chemotherapyLiver disease, including cirrhosis

An unbalanced diet that leads to an extreme lack of nutrients in the body (severe malnutrition).

References

1Muehrcke RC. The finger-nails in chronic hypoalbuminaemia; a new physical sign. Br Med J 1956;1:1327-8.
2Short N, Shah C. Muehrcke's lines. Am J Med 2010;123:991-2.
3Wolff K, Johnson RA. Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology. 6th ed. New York: McGraw-Hill Professional; 2009.
4Schwartz RA, Vickerman CE. Muehrcke's lines of the fingernails. Arch Intern Med 1979;139:242.