Case Letter
Uremic stomatitis
Paulo Ricardo Martins Souzaa,b, Gabriela Mosenac,
, Manuela Lima Dantasd, Gerson Vettoratod
Corresponding author
a Dermatology Service, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
b Department of Dermatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
c Clínica Privada de Dermatologia, Caxias do Sul, RS, Brazil
d Clínica Privada de Dermatologia, Porto Alegre, RS, Brazil
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=> "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Uremic stomatitis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "404" "paginaFinal" => "405" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Paulo Ricardo Martins Souza, Gabriela Mosena, Manuela Lima Dantas, Gerson Vettorato" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Paulo Ricardo Martins" "apellidos" => "Souza" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "Gabriela" "apellidos" => "Mosena" "email" => array:1 [ 0 => "gabriela.mosena@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span 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array:3 [ "entidad" => "Clínica Privada de Dermatologia, Porto Alegre, RS, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1114 "Ancho" => 1674 "Tamanyo" => 206839 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whitish plaque with threadlike projections adhered to the left lateral border of the tongue.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 42-year-old male patient was seen at the Dermatology Service due to the presence of whitish lesions on the oral mucosa, affecting mainly the tongue. Moreover, he reported significant dysgeusia and a lack of appetite. He had chronic kidney disease and had been undergoing conservative treatment so far. The examination of the oral cavity showed whitish plaques with threadlike projections adhered to the lateral borders of the tongue (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>) and a white plaque on the left cheek mucosa (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). He had ketone breath on examination. The patient was awaiting dialysis and had a serum creatinine level of 17 mg/dL, with uremia of 200 mg/dL. After a few hemodialysis sessions, the lesions regressed significantly.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Uremic stomatitis is an underreported disease of the oral mucosa, possibly associated with long-term uremia in patients with chronic kidney disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It was first mentioned by Lancereaux in 1887 and described by Barie in 1889 as an uncommon but characteristic complication of advanced kidney disease.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It has a low incidence<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> which notably decreased with the advent of dialysis, and is rarely seen nowadays.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The etiology remains unknown, and it has been suggested that it may be due to high levels of ammonia compounds.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Ammonia is formed through the action of bacterial ureases that modify salivary urea, which is elevated in renal patients. The clinical characteristics are poorly defined and are rarely detailed in publications.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The affected patients may complain of pain, dysgeusia, and a burning sensation.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> Four clinical types of uremic stomatitis have been described: pseudomembranous, ulcerative, hemorrhagic, and hyperkeratotic.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The ulcerative type is the most common,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> with an erythematous appearance, and the hyperkeratotic type is a rare alteration that can occur in long-term renal failure. Diagnosis is based on clinical signs and symptoms, and histopathology is characterized by epithelial hyperplasia and unusual hyperparakeratinization.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a> Lichen planus, hypertrophic candidiasis, oral hairy leukoplakia, and vitamin deficiencies are important differential diagnoses.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The treatment consists in improving blood urea levels.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The manifestations usually persist for two to three weeks. Hydrogen peroxide washes can contribute to the elimination of anaerobic bacteria that produce ammonia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Despite the high frequency of patients with kidney disease, only a few cases of uremic stomatitis have been published. Investigations are required for a better understanding of the pathogenic mechanism of this disorder.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0015" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Paulo Ricardo Martins Souza: Approval of the final version of the manuscript; drafting and editing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gabriela Mosena: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Manuela Lima Dantas: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Gerson Vettorato: Approval of the final version of the manuscript; drafting and editing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-25" "fechaAceptado" => "2020-09-12" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1114 "Ancho" => 1674 "Tamanyo" => 206839 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whitish plaque with threadlike projections adhered to the left lateral border of the tongue.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1112 "Ancho" => 1674 "Tamanyo" => 108715 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Whitish plaque with threadlike projections adhered to the right lateral border of the tongue.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1235 "Ancho" => 1674 "Tamanyo" => 131628 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Whitish plaque on the left cheek mucosa.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uremic stomatitis in chronic renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 26 | 7 | 33 |
| 2024 October | 186 | 69 | 255 |
| 2024 September | 165 | 86 | 251 |
| 2024 August | 184 | 101 | 285 |
| 2024 July | 152 | 100 | 252 |
| 2024 June | 135 | 70 | 205 |
| 2024 May | 177 | 74 | 251 |
| 2024 April | 136 | 69 | 205 |
| 2024 March | 143 | 77 | 220 |
| 2024 February | 178 | 79 | 257 |
| 2024 January | 105 | 59 | 164 |
| 2023 December | 105 | 59 | 164 |
| 2023 November | 130 | 92 | 222 |
| 2023 October | 110 | 96 | 206 |
| 2023 September | 105 | 77 | 182 |
| 2023 August | 106 | 40 | 146 |
| 2023 July | 126 | 37 | 163 |
| 2023 June | 131 | 35 | 166 |
| 2023 May | 146 | 29 | 175 |
| 2023 April | 116 | 16 | 132 |
| 2023 March | 132 | 46 | 178 |
| 2023 February | 100 | 28 | 128 |
| 2023 January | 122 | 41 | 163 |
| 2022 December | 109 | 30 | 139 |
| 2022 November | 96 | 54 | 150 |
| 2022 October | 191 | 57 | 248 |
| 2022 September | 84 | 61 | 145 |
| 2022 August | 69 | 51 | 120 |
| 2022 July | 115 | 57 | 172 |
| 2022 June | 116 | 77 | 193 |
| 2022 May | 109 | 76 | 185 |
| 2022 April | 43 | 36 | 79 |
| 2022 March | 22 | 26 | 48 |
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