You are correct. The pt had BUN of 223 mg/dL and creatinine of 28.6 mg/dL, low albumin, and UA positive for protein, w/o RBCs or casts. CT showed bilateral atrophic kidneys, all consistent w/ end-stage kidney failure of unknown cause. Uremic stomatitis occurs when BUN is >150 mg/dL and is a rare manifestation of uremia that resolves w/ renal replacement tx. Chemical irritation of the oral mucosa w/ ammonia compound, which is made from nitrogen hydrolyzed by urease in saliva, is presumed to cause uremic stomatitis. Tongue pain leading to anorexia and dysgeusia are the typical presentations. The pt’s appetite and taste returned to normal, and the white patches on his tongue disappeared, 1wk after renal replacement tx.

BMJ Case Reports CP 2019;12:e231948.