Your fingernails can tell you a lot about your overall health, including your kidney health. In the early stages of immunoglobulin A (IgA) nephropathy, you might notice subtle nail changes. These may be linked to side effects of medication or early signs of reduced renal (kidney) function. As the condition progresses, more noticeable or severe nail changes may appear.

Here’s a breakdown of the types of nail changes you might see and what they can mean.

What Are Nails?

Your nails are the hard coverings at the ends of your fingers and toes. They’re made of skin cells that produce keratin, a protein that gives nails their strength and hardness.

The hard, curved part we usually think of as the nail is called the nail plate. It sits on top of the nail bed, the skin underneath. The lunula is the pale, half-moon-shaped area at the base of your nail, where new nail cells are made and growth happens. It may be more or less visible depending on your skin tone.

Your nails grow slowly, about one-tenth of an inch every month. It can take three to six months for a fingernail to fully grow out. Toenails grow even more slowly, so replacing one can take even longer.

Several factors can affect your nails — including skin conditions, vitamin or mineral deficiencies, and chronic (long-term) illnesses like kidney disease.

How Can IgA Nephropathy Affect Your Nails?

Some nail changes are indirectly related to the kidneys not working as well as they should because of IgAN. Your kidneys filter waste and extra fluid from your blood. When kidney function is reduced, waste products can build up in the body, which may make you feel unwell and can also affect the health and appearance of your nails.

Complications of IgAN that may affect your nails include:

• Anemia (low levels of red blood cells) — Reduced amounts of oxygen reaching your nails may cause them to look pale, thin, or brittle, or grow more slowly.
• Nutritional deficiencies — Low levels of iron, zinc, or protein may lead to ridged, weak, or slow-growing nails.
• Medication side effects — Some treatments can affect nail growth, color, or strength as a side effect.
• Acute illness or flares (periods of active symptoms) — The body may temporarily slow down nail growth when you’re sick or experiencing a flare, leading to lines, dents, or changes in texture.

IgAN often progresses slowly and can take decades to lead to kidney failure. If IgAN does progress to kidney failure, dialysis treatment may also affect your nails. Studies have found that about 3 out of every 4 people receiving hemodialysis experience nail changes, such as discoloration, ridges, or thickening.

What Nail Changes Can Appear in IgA Nephropathy?

IgAN can change the look and feel of your nails in several ways.

Ridged Nails

Some people with IgAN develop abnormal ridges in their nails. A ridge can run horizontally or vertically in your nail.

Beau’s lines are a possible type of nail ridge seen in kidney diseases like IgAN. These are horizontal dents that mean nail growth temporarily stopped. Growth interruption can happen from an illness (such as acute kidney failure) or an infection.

Spoon-Shaped Nails

Spoon-shaped nails — also known as koilonychia — may develop with IgAN. People with koilonychia have soft nails that grow in a dented spoon shape rather than straight.

The most common cause of koilonychia is iron-deficiency anemia. Anemia affects 1 in 7 people with chronic kidney disease.

Brittle or Thinning Nails

You may notice that your nails are thinner or more brittle than usual. This may affect people with IgAN due to medication side effects or by not getting sufficient nutrients.

Fungal Nail Infections

Some people with IGA nephropathy may experience fungal nail infections called onychomycosis. This can be a potential side effect of immunosuppression. That means your ability to fight off diseases and infections is lower than average.

Nail Changes if IgAN Progresses to Advanced Chronic Kidney Disease

If your kidneys are severely damaged from IgAN, you may be more likely to notice additional nail changes. This can happen if the disease progresses to advanced chronic kidney disease (CKD), a long-term condition in which the kidneys lose their ability to filter waste effectively.

These nail changes are not caused directly by IgAN but, rather, by the effects of:

• Long-term kidney dysfunction
• Metabolic imbalances (problems with how the body manages fluids, minerals, and waste)
• Dialysis
• Other related complications

White Nails

Some people with kidney disease may notice that their nails become pale or white, a condition known as leukonychia. Leukonychia refers to white discoloration of the nail plate and is one of the most common nail changes in people who have received a kidney transplant.

Three types of leukonychia may be associated with kidney disease:

• Muehrcke’s lines — Pairs of horizontal white lines that run parallel to the lunula and that don’t move as the nail grows
• Terry’s nails — When most of the nail appears white, with a narrow band of darker color near the tip
• Lindsay’s nails (or half-and-half nails) — Causes the lower half of the nail to turn white while the upper half is darker red, pink, or brown

Half-and-Half Nails

If you have half-and-half nails — also called Lindsay’s nails — the bottom halves of them (closest to your knuckles) appear white. The top halves (closest to your fingertips) are discolored pink, red, or brown. This nail change affects about a third of people with kidney failure on dialysis.

Detached Nails

When the nail plate becomes separated from the nail bed, it looks like opaque white sections on the nail. This condition, called onycholysis, is seen in kidney disease and with other issues, like nail injuries, skin conditions, or infections.

According to some research, onycholysis may affect around 71 percent of people with renal failure.

Splinter Hemorrhages

Splinter hemorrhage looks like a splinter is stuck under your nail. Splinter hemorrhages can appear as red or purple lines under your nails. Some research suggests that 58 percent of people with renal failure have splinter hemorrhages.

You may develop a splinter hemorrhage if the capillaries (small blood vessels) under your nail become fragile, which is common in kidney disease. Splinter hemorrhages are most often caused by trauma, but they can also be caused by other conditions that affect blood vessels.

Why Your Nails Matter

Your nail health can reveal important clues to the health of your body as a whole. Nail abnormalities can occur even if your IgAN is mild and well treated. Issues like anemia, malnutrition, medical side effects, and fungal infections can be a concern for people with IgAN. Discussing nail symptoms can help pinpoint any underlying problems that should be addressed.

Talk to your healthcare team about a treatment plan that includes proper nail care and nutrition.

Join the Conversation

On myIgANteam, people share their experiences with IgA, get advice, and find support from others who understand.

How has IgA affected your nails? Let others know in the comments below.