Findings associated with chronic hypocalcemia and secondary hyperparathyroidism of renal failure are common. These findings were described previously. Uremic stomatitis is an uncommon finding of renal failure. When present, it is commonly associated with acute renal failure and a blood urea nitrogen level of greater than 30 mmol/L. The characteristic manifestation is an erythematous, pseudomembranous stomatitis. This presents as white mucoid plaques or crusts on the gingiva, buccal mucosa, tongue, and floor of the mouth, possibly extending into the pharynx. Ulcerative lesions are less common. Patients usually complain of oral pain or a burning sensation. The etiology is uncertain, but it is felt that the urease in oral flora metabolizes salivary urea to ammonia. It is this free ammonia that damages the oral mucosa. An astute clinician may be able to detect an odor of ammonia.38
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