Chronic Kidney Disease and Mees' Lines

Mees' Lines are also known as Aldrich–Mees lines and leukonychia striata. They are white lines of discoloration across the with of the nails of the fingers and toes (leukonychia). As the nail grows they move towards the end, and finally disappear when trimmed.

Mees' lines appear after an episode of poisoning with arsenic, thallium or other heavy metals*, such as lead and chromium, or selenium, opioid MT-45, fluorine, and can also appear if the subject is already suffering from kidney failure. They have also been observed in chemotherapy patients. Other possible causes include altitude sickness, cancer, carbon monoxide poisoning, heart failure, tuberculosis, leprosy, and malaria.

Although the phenomenon is named after Dutch physician Rudolf Adriaan Mees, who described the abnormality in 1919, earlier descriptions of the same abnormality were made by Englishman Ernest S. Reynolds in 1901, and by American Charles John Aldrich in 1904.

Mees described three patients with ‘polyneuritis arsenicosa’ (polyneuropathy due to acute arsenic intoxication) as a result of ingesting a large single dose of arsenic salts[1]. He discussed two cases of attempted suicide and one of attempted murder.

Mees lines can be linked to Chronic Kidney Disease as a sign of systemic stress or toxin buildup. While Chronic Kidney Disease patients often get distinctive 'Lindsay's nails' (half white/half brown), Mees' lines indicate a serious underlying issue affecting nail matrix development, needing medical investigation for the root cause.

To conclude: Mees' lines can occur [1] if you already have Chronic Kidney Disease, because your kidneys cannot process the toxins anymore, or [11] if the toxins themselves have damaged the kidneys so much that Chronic Kidney Disease is the resulting effect.

* The most widely used toxicology textbook, Casarett & Doull’s Toxicology: The Basic Science of Poisons, 9th edition (2018) uses term 'toxic metal', not 'heavy metal', which is more illuminating.

[1] Mees: Een Verschijnsel bij Polyneuritis Arsenicosa in Nederlands Tijdschrift voor Geneeskunde 1919. See here.