Uremic Stomatitis in Chronic Renal Failure

The clinical fea-tures of uremic stomatitis are poorly defined and are rarelydetailed in relevant textbooks. The present report detailsthe clinical and histopathological features of probableuremic stomatitis in a patient with longstanding chronic re-nal failure and reviews current knowledge of this unusualoral mucosal disorder.A 46-year-old man was referred by the Nephrology De-partment of Hospital das Clinicas to the Oral Medicine unitof Universidade Federal de Pernambuco, Recife, Brazilcomplaining of a burning sensation of the oral mucosa anddysgeusia. The burning sensation affected all oral mucosalsurfaces, had been present for the previous 3 months, wascontinuous, and had no notable initiating or precipitatingfeatures. In addition, the patient had had adherent white le-sions of the oral mucosa for the previous 3 months that hadnot resolved with topical nystatin suspension used for 30days.The patient was a taxi driver, married, with 2 healthychildren. He had previously drunk up to 20 units of alco-hol per week and smoked 40 cigarettes per day, but he hadstopped both habits at 22 years of age. He had developedchronic renal disease due to nonspecific nephritis associ-ated with severe hypertension in 1991, at which time thepatient commenced hemodialysis. In the same year the pa-tient underwent renal transplantation, but the renal allograftwas rejected 4 years later. The patient subsequently devel-oped hepatitis B infection as a consequence ofhemodialysis and was treated with interferon for approxi-mately 3 months. He continued hemodialysis 3 timesweekly for 10 years until he underwent a further renal trans-plant in 2001. At the time of his referral to Oral Medicine(late 2003), the patient was on a combination of pred-nisolone (10 mg daily) and azathioprine (150 mg daily);his renal disease was considered stable aside from some el-evation of plasma urea and creatinine. A renal biopsy in2003 revealed no histopathological features of rejection.Extra-oral examination revealed no obvious signs of re-nal disease other than a uremic oral malodor. There was nocervical lymphadenopathy, and the cranial nerves weregrossly intact.Intra-oral examination revealed adherent white plaquesof the floor of the mouth, buccal mucosae, lateral bordersof the tongue, and gingivae (Figs. 1-3). There were no othermucosal lesions likely to explain the oral mucosal soreness.In view of the extensive nature of the oral lesions, uremicstomatitis was judged to be the working diagnosis; how-ever, the differential diagnosis included oral lichen planusand chronic hyperplastic candidosis. In addition, since thepatient had been on immunosuppressive treatment that in-cluded azathioprine and prednisolone, oral hairy leucopla-kia (OHL) could also account for the clinical signs ob-