Some of the most common cutaneous manifestations of chronic renal failure manifest in the nails. Half-and-half nails, absence of lunula, and splinter hemorrhage are the most frequent nail alterations in patients with chronic renal failure. Half-and-half nails, or Lindsay's nails, are characterized by a red, pink, or brown discoloration of the distal nail bed occupying 20%-60% of the nail length. Often, the proximal portion of the nails has a dull, whitish, ground glass appearance.

Splinter hemorrhages and absence of lunula can also be observed in patients with chronic renal failure. Transverse leukonychia affecting all fingernails may be observed after the treatment of acute or chronic renal failure, particularly in patients that have received a transplant.

Other changes seen in patients with chronic renal failure include koilonychia, onycholysis, onychomycosis, Beau lines, and pincer nails. Most nail changes seen in patients with chronic renal failure first appear or worsen with dialysis and improve with kidney transplantation.

Acquired brachyonychia may be seen in some patients with chronic renal failure and hyperparathyroidism.