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).
Cabana MD, Ensor A, Tunnessen WW. Picture of the Month. Arch Pediatr Adolesc Med. 1998;152(9):923-924. doi:10.1001/archpedi.152.9.923