A 29-year-old woman with no significant medical history developed anasarca over the course of approximately 2 weeks. On the basis of renal biopsy, a diagnosis of minimal change disease was made. Her nephrotic syndrome was poorly responsive to steroid therapy, and despite high doses of prednisone of up to 120 mg/d, her serum albumin and proteinuria remained 1 g/dL and 10 g/d, respectively. Approximately 1 month after the onset of her symptoms, she developed transverse, nonpalpable, white lines on all her fingernails (Figure). These nail changes are consistent with a diagnosis of Muehrcke’s lines.
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— Nicholas Short, BA, Chirayu Shah, MD
This article originally appeared in the November 2010 issue of The American Journal of Medicine.
