Urea and blood urea nitrogen levels in pediatric and adult patients with uremic stomatitis: a systematic review

Abstract Background Chronic kidney disease (CKD) is a condition characterized by a progressive loss of kidney function with increased levels of urea and blood urea nitrogen (BUN) in the blood, which contribute to the development of uremic stomatitis. Uremic stomatitis is an oral manifestation of CKD, characterized by inflammation and lesions on the oral mucosa due to irritation from ammonia produced by the hydrolysis of urea in saliva by urease-producing bacteria. The objective of this research was to systematically review and synthesize the reported urea and BUN levels in pediatric and adult patients with uremic stomatitis. Methods This study utilized a systematic review approach based on PRISMA guidelines and reviewed articles from electronic databases such as PubMed, ScienceDirect, Scopus, Cochrane, and Google Scholar. The analyzed articles included observational studies and case reports that examined the relationships between urea and BUN levels and uremic stomatitis in both pediatric and adult CKD patients. Results Out of 282 identified articles, 10 were selected for analysis, comprising 391 patients. The review findings indicate that CKD patients with uremic stomatitis present significantly elevated urea and BUN levels beyond the normal range. Reported urea levels ranged from 72.8 to 321 mg/dL, while BUN levels ranged from 180 to 400 mg/dL. Uremic stomatitis has been reported in patients with BUN levels exceeding 150 mg/dL and is characterized by white lesions on the oral mucosa, pain, a burning sensation, and an ammonia-like breath odor. Conclusion The available evidence indicates an association between elevated urea and BUN levels and the occurrence of uremic stomatitis in CKD patients. While urea and BUN are routinely measured to monitor CKD, elevated levels may support the diagnosis of uremic stomatitis. The presence of uremic stomatitis may also serve as a clinical indicator of advanced or poorly controlled renal dysfunction. Trial registration PROSPERO (CRD420251021047).