Challenges in identifying oral lesions associated with renal disorders: Case report

Introduction: Oral conditions often indicate systemic disorders. This report presents an oral lesion in an undetected renal disorder. 

Case report: A 69-year-old male patient presented complaints of pain and multiple ulcers, with a history of heart disease, hypertension, pneumonia, and suspected TB. At first visit, mild edema of the extremities was seen. IO showed multiple ulcerations, irregular in shape, surrounded by erythema, yellowish base, varying in size in the oral cavity. The working diagnosis of systemic aphthous-like ulcer was unclear. He was instructed to improve oral hygiene with 0.9% NaCl and 0.2%, Chlorhexidine mouthwash 100 mg Doxycycline for ulceration, referred to an internist. Patient was counselled to ensure that he maintain adequate oral hygiene throughout the treatment period. At the last visit, ulceration on the palate molle, irregular shape, solitary, surrounded by erythema with yellowish white pseudo membrane, lesion showed typical uremic stomatitis. He was referred for urea and creatinine examination. Two days after the last visit, the patient's condition worsened, and was brought to the ER. The results of the urea and creatinine tests showed high results (201 mg/dL; 4.69 mg/dL) and acute kidney injury. He eventually died due to worsening systemic conditions. 

Discussion: Systemic diseases often affect the mouth. Understanding acute kidney damage and its oral symptoms and complete care are crucial for patients. 

Conclusion: It is essential to identify and perform a comprehensive clinical examination of both systemic and oral conditions, to avoid undesirable consequences.