Uremic Stomatitis: A Latin American Case Series and Literature Review

Abstract

Background: Uremic stomatitis is often unfamiliar to healthcare professionals. This study presents five cases of uremic stomatitis, providing a comprehensive analysis of their demographic distribution, clinicopathological features, and management strategies based on existing literature.

Methods: Data were collected from centers across Brazil, Argentina, Venezuela, and Mexico. Electronic searches were conducted in five databases supplemented by manual scrutiny and gray literature.

Results: The series consisted of three men and two women with a mean age of 40.2 years. Lesions mostly appeared as white plaques, particularly on the tongue (100%). The median blood urea level was 129 mg/dL. Histopathological analysis revealed epithelial changes, including acanthosis and parakeratosis, with ballooned keratinocytes in the suprabasal region. Oral lesions resolved subsequent to hemodialysis in three cases (75%). Thirty-seven studies comprising 52 cases of uremic stomatitis have been described hitherto. Most patients were male (65.4%) with a mean age of 43.6 years. Clinically, grayish-white plaques (37.3%) and ulcers/ulcerations (28.9%) were common, particularly on the tongue (30.9%). Hemodialysis was performed on 27 individuals. The resolution rate of oral lesions was 53.3%.

Conclusion: Earlier recognition of uremic stomatitis, possibly associated with long-term uremia, holds the potential to improve outcomes for patients with undiagnosed chronic kidney disease.

Keywords: Chronic Renal Failure; Kidney; Oral Manifestations; Stomatitis; Urea.

Fig. 1

Clinicopathological aspects of uremic stomatitis in a 36-year-old male patient from Brazil (Case #1). (A, B) Thin, flat, and homogeneous white plaques with fissures are observed on the bilateral borders of the tongue, measuring 1.5 × 1.5 cm on the right side and 2.5 × 1.0 cm on the left side. (C) Multiple grayish-white heterogeneous plaques of varying sizes are observed on the left buccal mucosa. (D-F) Histopathological examination reveals epithelium with acanthosis and a parakeratotic zone at the surface, and a layer of ballooned keratinocytes in the suprabasal region (hematoxylin and eosin staining: 40×, 100×, and 400× magnification)

Fig. 2

Clinicopathological aspects of uremic stomatitis in a 32-year-old male patient from Brazil (Case #2). (A) A well-defined, yellow-grayish ulcer measuring 1.0 × 1.0 cm on the right posterior border of the tongue, contiguous to a whitish, irregular plaque with fissures. A crusted ulcer with hemorrhage and well-defined borders, measuring 0.5 × 0.5 cm, is observed on the vermilion of the lower lip. (B) In the retromolar region, there is a whitish irregular plaque measuring 2.0 × 1.0 cm. (C, D) Histopathological examination reveals a hyperplastic epithelium characterized by hyperparakeratinization, accompanied by a limited inflammatory infiltrate. Ballooned keratinocytes are observed in the suprabasal region (hematoxylin and eosin staining: 100× and 400× magnification)

Fig. 3

Clinical manifestations of uremic stomatitis in an 83-year-old female patient from Argentina (Case #3). (A) Diffuse and discrete erythema observed on the right and anterior border of the tongue. Note the presence of extending fissures with a smooth, atrophic, whitish appearance on the dorsal surface of the tongue. (B) Homogeneous and irregular grayish-white and yellowish plaques with erythematous regions involving the entire ventral surface of the tongue. (C) The lesions extend to the floor of the mouth. Note the presence of food debris surrounding the o-ring abutments of an implant-supported overdenture

Fig. 4

Clinical manifestations of uremic stomatitis in a 20-year-old male patient from Venezuela (Case #4). (A, B) Bilateral white lesions are present in the buccal mucosa. A discrete petechia is observed on the left buccal mucosa. (C) An enlarged tongue displaying whitish, scalloped, and homogeneous plaques, measuring 1.5 × 1.0 cm in size, on the left lateral border of the tongue

Fig. 5

Clinical manifestations of uremic stomatitis in a 30-year-old female patient from Mexico (Case #5). (A, B) A white enlarged tongue with scalloping and plaques along its bilateral borders can be observed

Fig. 6

Frequency of oral uremic stomatitis in the literature was analyzed by (A) continent, (B) decade of life, (C) sex, (D) number of affected sites, (E) anatomical location, (F) clinical aspects of the lesion, and (G) resolution of oral lesions/outcomes of patients. Notes: The unit of analysis of the variables anatomical location and clinical aspects of lesions was not the number of individuals, but rather the number of lesions and clinical aspects presented