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Special Feature
September 1998

Picture of the Month

Author Affiliations


Arch Pediatr Adolesc Med. 1998;152(9):923-924. doi:10.1001/archpedi.152.9.923

A 20-YEAR-OLD morbidly obese woman with systemic lupus erythematosus and resultant end-stage renal disease was referred for evaluation of hypotension and hypovolemia. She had recently begun hemodialysis. On physical examination, it was noted that the fingernails had an unusual appearance (Figure 1). Abnormal laboratory study results included a serum creatinine level of 1025 μmol/L (11.6 mg/dL) and a serum urea nitrogen level of 32.13 mmol/L (90 mg/dL).