One of the rarest presentations is uremic frost, which occurs in only 3% of the patients with ESRD. 9 It is related to frank uremia and may be recognized as a white deposit on the skin, secondary to crystallized urea excreted in sweat. This manifestation responds well to dialysis. 6.8, 9
The nails may show a number of changes. The most typical alteration of ESRD is called half-and-half nail and is frequently found in 21% of the patients. It is characterized by a marked brownish or pinkish discoloration in the nail extremity (Figure 4). Such manifestation is more prevalent in dialysis patients. There may be remission after renal transplantation. The pathogenesis is attributed to an increase of the melanocyte stimulating hormone (MSH). 7-9