Pharmacotherapy And Behavioural-Modifying-Lifestyle For Oral Lesions Management In Multimorbid Patient Post-Pyelolithotomy: A Case Report

Selviana Rizky Pramitha*  -  Universitas Lambung Mangkurat, Indonesia
Arissa Izzati  -  Sungai Andai Community Health Center, Banjarmasin, Indonesia
Maharani Laillyza Apriasari  -  Universitas Lambung Mangkurat, Indonesia
Amy Nindia Carabelly  -  Universitas Lambung Mangkurat
Dewi Puspitasari  -  Universitas Lambung Mangkurat

(*) Corresponding Author
DOI: 10.30659/odj.13.1.87-98
Background: Chronic kidney disease (CKD), a recognized complication of pyelolithotomy along with multimorbidity in the elderly population, presents a higher incidence of oral lesions. Further damage to the renal vasculature interchangeably affects oral-systemic conditions. We report oral lesions management in MCC patient post-pyelolithotomy for better outcomes.  Case: A 65-year-old male patient complained of painful ulceration on the atrophic tongue for two weeks with a fair oral hygiene score. The condition had been managed with various topical agents alternately with no improvement. There was a history of pyelolithotomy and emergency room admission. Laboratory examination presented diabetes mellitus, stage 3B kidney disease and anemia of chronic disease. A diagnosis of ulcerative-type uremic stomatitis with atrophic glossitis in multimorbid patient was obtained. Pharmacotherapy of oral lesion including aloe vera extract mouthwash and povidone-iodine mouthwash showed improvement on the following day. Behavioural-modifying lifestyle involved physical activity, healthy eating, and adherence to treatment (oral hygiene maintenance and regular dental appointment). Systemic conditions were managed by multidiscipline treatment with Internal Medicine. Conclusion: Pharmacotherapy and behavioral modifying lifestyle may support a better prognosis for oral manifestation in multimorbid patient post pyelolithotomy

Keywords: case report; behavioral-modifying lifestyle; multimorbidity; pharmacotherapy; oral lesions management

  1. Hajat C, Stein E. The global burden of multiple chronic conditions: A narrative review. Vol. 12, Preventive Medicine Reports. Elsevier Inc.; 2018. p. 284–93.
  2. Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al. Management and Prevention Strategies for Non-communicable Diseases (NCDs) and Their Risk Factors. Vol. 8, Frontiers in Public Health. Frontiers Media S.A.; 2020.
  3. Huang Y, Su Y, Byun Y, Lee Y, Kim S. Analysis of multiple chronic disease characteristics in middle-aged and elderly South Koreans by exercise habits based on association rules mining algorithm. BMC Public Health. 2023 Dec 1;23(1).
  4. Shang W, Li L, Ren Y, Ge Q, Ku M, Ge S, et al. History of kidney stones and risk of chronic kidney disease: A meta-analysis. PeerJ. 2017;2017(1).
  5. Malabadi RB, Meti NT, Chalannavar RK. Updates on herbal remedy for kidney stone chronic disease [Internet]. Vol. VIII, International Journal of Research and Scientific Innovation (IJRSI) |. 2021. Available from: www.rsisinternational.org
  6. Amira S, Kemala Sari S, Author C. THE CHARACTERISTICS OF KIDNEY STONE PATIENTS AND THEIR MANAGEMENT AT DR. PIRNGADI MEDAN GENERAL HOSPITAL IN 2016. JUSINDO. 2024;6(1).
  7. Carvalho M, Martin RLS, Passos RC, Riella MC. Nephrectomy as a cause of chronic kidney disease in the treatment of urolithiasis: A case-control study. World J Urol. 2013 Oct;31(5):1141–5.
  8. Lau DCW, Shaw E, McMullen S, Cowling T, Witges K, Amitay EL, et al. Acute and chronic complication profiles among patients with chronic kidney disease in Alberta, Canada: a retrospective observational study. BMC Nephrol. 2024 Dec 1;25(1).
  9. Watt RG, Serban S. Multimorbidity: a challenge and opportunity for the dental profession. Br Dent J. 2020 Sep 1;229(5):282–6.
  10. Öçbe M, Çelebi E, Öçbe ÇB. An overlooked connection: oral health status in patients with chronic diseases. BMC Oral Health. 2025 Dec 1;25(1).
  11. Rohani B. Oral manifestations in patients with diabetes mellitus. World J Diabetes. 2019 Sep 15;10(9):485–9.
  12. Silva DF, Oliveira ICR, Medeiros S de A, Baeder FM, Albuquerque ACL de, Lima E de O. Oral health challenges in patients with chronic kidney disease: A comprehensive clinical assessment. Saudi Dental Journal. 2024 Feb 1;36(2):364–7.
  13. Gupta S, Swarup N, Sairam H, Sinha N, Nair SS. Orofacial Manifestations associated with Anemia. World Journal of Anemia. 2017 Jun;1(2):44–7.
  14. Cohen G, Hörl WH. Immune dysfunction in Uremia-An update. Vol. 4, Toxins. 2012. p. 962–90.
  15. Sharif H, Hammash M, Anwer W, Hassan N, Seemi T, Sheikh SS. Evaluation of oral health among people with multimorbidity in the marginalized population of Karachi, Pakistan: A multicenter cross-sectional study. J Taibah Univ Med Sci. 2024 Jun 1;19(3):500–15.
  16. Trzcionka A, Twardawa H, Mocny-Pachońska K, Korkosz R, Tanasiewicz M. Oral mucosa status and saliva parameters of multimorbid adult patients diagnosed with end-stage chronic kidney disease. Int J Environ Res Public Health. 2021 Dec 1;18(23).
  17. Yano H, Kinjo M. Uraemic stomatitis. Vol. 12, BMJ Case Reports. BMJ Publishing Group; 2019.
  18. Wu YH, Hwang MJ, Lee YP, Chiang CP. Atrophic glossitis in pernicious anemia patients can be treated to normal in two weeks by intramuscular injection of vitamin B12. Vol. 15, Journal of Dental Sciences. Association for Dental Sciences of the Republic of China; 2020. p. 558–9.
  19. Lu SY. Oral candidosis: Pathophysiology and best practice for diagnosis, classification, and successful management. Vol. 7, Journal of Fungi. MDPI AG; 2021.
  20. Ivanoski MA, Boal JG, Giovanini AF, de Lima AAS, de Araujo MR. Diagnosis and management of a severe uremic stomatitis: Case report of multiple clinical features. J Stomatol Oral Maxillofac Surg. 2025 Sep 1;126(4).
  21. Cherry-Peppers G, Fryer C, Jackson AD, Ford D, Glascoe A, Smith D, et al. A review of the risks and relationships between oral health and chronic diseases. J Natl Med Assoc. 2024 Dec 1;116(6):646–53.
  22. Villanueva-Vilchis M del C, López-Ríos P, García IM, Gaitán-Cepeda LA. Impact of oral mucosa lesions on the quality of life related to oral health. An etiopathogenic study. Med Oral Patol Oral Cir Bucal. 2016 Mar 1;21(2):e178–84.
  23. Fu D, Shu X, Zhou G, Ji M, Liao G, Zou L. Connection between oral health and chronic diseases. Vol. 6, MedComm. John Wiley and Sons Inc; 2025.
  24. Ain FN, Aryzki S, Abdi MM. Cost Minimization Analysis of Oral Antidiabetic Drugs in Type II Diabetes Mellitus Patiens at Sultan Suriansyah Hospital January-December 2022 Period. Berkala Kedokteran. 2024 Mar 6;20(1):13.
  25. Galicia-Garcia U, Benito-Vicente A, Jebari S, Larrea-Sebal A, Siddiqi H, Uribe KB, et al. Pathophysiology of type 2 diabetes mellitus. Vol. 21, International Journal of Molecular Sciences. MDPI AG; 2020. p. 1–34.
  26. Longo M, Bellastella G, Maiorino MI, Meier JJ, Esposito K, Giugliano D. Diabetes and aging: From treatment goals to pharmacologic therapy. Vol. 10, Frontiers in Endocrinology. Frontiers Media S.A.; 2019.
  27. Nerli R, Jali M, Guntaka A, Patne P, Patil S, Hiremath M. Type 2 diabetes mellitus and renal stones. Adv Biomed Res. 2015;4(1):180.
  28. Gembillo G, Ingrasciotta Y, Crisafulli S, Luxi N, Siligato R, Santoro D, et al. Kidney disease in diabetic patients: From pathophysiology to pharmacological aspects with a focus on therapeutic inertia. Vol. 22, International Journal of Molecular Sciences. MDPI AG; 2021.
  29. Do Ngoc T. Open stone surgery in the treatment of bilateral complex renal stones with left infected hydronephrosis: A case report. Int J Surg Case Rep. 2022 Jan 1;90.
  30. Chen GY, Tang ZQ, Bao ZX. Vitamin B12 deficiency may play an etiological role in atrophic glossitis and its grading: A clinical case-control study. BMC Oral Health. 2022 Dec 1;22(1).
  31. Taderegew MM, Gebremariam T, Tareke AA, Garedew G, Woldeamanuel. Anemia and its associated factors among type 2 diabetes mellitus patients attending debre berhan referral hospital, north-east Ethiopia: A cross-sectional study. J Blood Med. 2020;11:47–58.
  32. Portolés J, Martín L, Broseta JJ, Cases A. Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Vol. 8, Frontiers in Medicine. Frontiers Media S.A.; 2021.
  33. Badura K, Janc J, Wąsik J, Gnitecki S, Skwira S, Młynarska E, et al. Anemia of Chronic Kidney Disease—A Narrative Review of Its Pathophysiology, Diagnosis, and Management. Vol. 12, Biomedicines. Multidisciplinary Digital Publishing Institute (MDPI); 2024.
  34. DeLoughery TG. Microcytic Anemia. New England Journal of Medicine [Internet]. 2014 Oct 2;371(14):1324–31. Available from: https://www.nejm.org/doi/10.1056/NEJMra1215361
  35. Liao CY, Wu CC, Chu PL. Uremic stomatitis. Vol. 110, QJM: An International Journal of Medicine . Oxford University Press; 2017. p. 247–8.
  36. Zhang H, Liu J, Yuan W, Zhang Q, Luo X, Li Y, et al. Ammonia-induced lysosomal and mitochondrial damage causes cell death of effector CD8+ T cells. Nat Cell Biol. 2024 Nov 1;26(11):1892–902.
  37. Miller MA, Zachary JF. Mechanisms and Morphology of Cellular Injury, Adaptation, and Death 1. In: Pathologic Basis of Veterinary Disease [Internet]. Elsevier; 2017. p. 2–11. Available from: www.expertconsult.com.
  38. Chiang CP, Chang JYF, Wang YP, Wu YH, Wu YC, Sun A. Atrophic glossitis: Etiology, serum autoantibodies, anemia, hematinic deficiencies, hyperhomocysteinemia, and management. Vol. 119, Journal of the Formosan Medical Association. Elsevier B.V.; 2020. p. 774–80.
  39. Fourie J, Boy S. Oral mucosal ulceration - a clinician’s guide to diagnosis and treatment. SADJ [Internet]. 2016 Nov;71(10):500–8. Available from: www.sada.co.za
  40. Lepelletier D, Maillard JY, Pozzetto B, Simon A. Povidone iodine: Properties, mechanisms of action, and role in infection control and staphylococcus aureus decolonization. Vol. 64, Antimicrobial Agents and Chemotherapy. American Society for Microbiology; 2020.
  41. Sánchez M, González-Burgos E, Iglesias I, Gómez-Serranillos MP. Pharmacological update properties of aloe vera and its major active constituents. Vol. 25, Molecules. MDPI AG; 2020.
  42. Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron deficiency anaemia: Pathophysiology, assessment, practical management. Vol. 9, BMJ Open Gastroenterology. BMJ Publishing Group; 2022.
  43. Short MW, Domagalski JE. Iron Deficiency Anemia: Evaluation and Management [Internet]. Vol. 87. 2013. Available from: www.aafp.org/afp.
  44. Kautz L, Nemeth E. Molecular liaisons between erythropoiesis and iron metabolism. Blood. 2014 Jul 24;124(4):479–82.
  45. Coger V, Million N, Rehbock C, Sures B, Nachev M, Barcikowski S, et al. Tissue Concentrations of Zinc, Iron, Copper, and Magnesium During the Phases of Full Thickness Wound Healing in a Rodent Model. Biol Trace Elem Res. 2019 Sep 15;191(1):167–76.
  46. Camillo L, Zavattaro E, Savoia P. Nicotinamide: A Multifaceted Molecule in Skin Health and Beyond. Vol. 61, Medicina (Lithuania). Multidisciplinary Digital Publishing Institute (MDPI); 2025.
  47. Kalsi R, Bhushan KS, Mathur MK, Gupta V, Gupta DK, Pandey SK. To Evaluate the Effect of Vitamin B Complex on Wound Healing – A Clinical and Microbiological Study. J Pharm Bioallied Sci. 2024 Feb 1;16:S549–51.
  48. Searcy K, Rainwater S, Jeroudi M, Baliga R. Erythropoietin-stimulating agent-resistant vitamin B6 deficiency anemia in a pediatric patient on hemodialysis. Pediatric Nephrology. 2021 Feb 1;36(2):473–6.
  49. Fawzy El-Sayed KM, Cosgarea R, Sculean A, Doerfer C. Can vitamins improve periodontal wound healing/regeneration? Vol. 94, Periodontology 2000. John Wiley and Sons Inc; 2024. p. 539–602.
  50. Lešić S, Ivanišević Z, Špiljak B, Tomas M, Šoštarić M, Včev A. The Impact of Vitamin Deficiencies on Oral Manifestations in Children. Vol. 12, Dentistry Journal. Multidisciplinary Digital Publishing Institute (MDPI); 2024.
  51. Bindakhil M, Charmelo-Silva S, Dakhil AAB, Alomair IA. The Value of the Oral Medicine Specialty in the Modern Healthcare Systems. Vol. 1, Saudi Journal of Health Systems Research. S. Karger AG; 2021. p. 33–40.
  52. Mathew M. The Role of Internal Medicine in Adult Healthcare. Intern Med. 2024;14:1.
  53. Mehdi U, Toto RD. Anemia, diabetes, and chronic kidney disease. Vol. 32, Diabetes Care. 2009. p. 1320–6.
  54. Hahr AJ, Molitch ME. Management of Diabetes Mellitus in Patients With CKD: Core Curriculum 2022. Vol. 79, American Journal of Kidney Diseases. W.B. Saunders; 2022. p. 728–36.
  55. Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One. 2019 Aug 1;14(8).
  56. Nadal IP, Angkurawaranon C, Singh A, Choksomngam Y, Sadana V, Kock L, et al. Effectiveness of behaviour change techniques in lifestyle interventions for non-communicable diseases: an umbrella review. BMC Public Health. 2024 Dec 1;24(1).
  57. Yang D, Yang Y, Li Y, Han R. Physical Exercise as Therapy for Type 2 Diabetes Mellitus: From Mechanism to Orientation. Vol. 74, Annals of Nutrition and Metabolism. S. Karger AG; 2019. p. 313–21.
  58. Chacko E. Meal frequency and diabetes: A case report. Diabetes Manag. 2021;11(4):210–3.
  59. Wu T, Ding L, Andoh V, Zhang J, Chen L. The Mechanism of Hyperglycemia-Induced Renal Cell Injury in Diabetic Nephropathy Disease: An Update. Vol. 13, Life. MDPI; 2023.
  60. Marckmann P, Osther P, Pedersen AN, Jespersen B. High-Protein Diets and Renal Health. Vol. 25, Journal of Renal Nutrition. W.B. Saunders; 2015. p. 1–5.
  61. Tobón-Cornejo S, Sanchez-Tapia M, Guizar-Heredia R, Velázquez Villegas L, Noriega LG, Furuzawa-Carballeda J, et al. Increased dietary protein stimulates amino acid catabolism via the gut microbiota and secondary bile acid production. Gut Microbes. 2025;17(1).
  62. Knight J, Madduma-Liyanage K, Mobley JA, Assimos DG, Holmes RP. Ascorbic acid intake and oxalate synthesis. Vol. 44, Urolithiasis. Springer Verlag; 2016. p. 289–97.
  63. Juszczak AB, Kupczak M, Konecki T. Does Vitamin Supplementation Play a Role in Chronic Kidney Disease? Vol. 15, Nutrients. Multidisciplinary Digital Publishing Institute (MDPI); 2023.
  64. Singh B, Murphy A, Maher C, Smith AE. Time to Form a Habit: A Systematic Review and Meta-Analysis of Health Behaviour Habit Formation and Its Determinants. Vol. 12, Healthcare (Switzerland). Multidisciplinary Digital Publishing Institute (MDPI); 2024.
  65. Montes GR, Vilella KD, Bonotto DV, Martins MC, de Lima AAS. Atrophic glossitis as a clinical signs of severe anemia – Report of two cases. Polski Przegląd Otorynolaryngologiczny. 2014 Oct;3(4):201–4.
  66. Morou-Bermudez E, Rodriguez S, Bello AS, Dominguez-Bello MG. Urease and dental plaque microbial profiles in children. PLoS One. 2015 Sep 29;10(9).
  67. Funahara M, Yamaguchi R, Honda H, Matsuo M, Fujii W, Nakamichi A. Factors affecting the number of bacteria in saliva and oral care methods for the recovery of bacteria in contaminated saliva after brushing: a randomized controlled trial. BMC Oral Health. 2023 Dec 1;23(1).
  68. Toma AI, Fuller JM, Willett NJ, Goudy SL. Oral wound healing models and emerging regenerative therapies. Vol. 236, Translational Research. Mosby Inc.; 2021. p. 17–34.
  69. Papagerakis S, Pannone G, Zheng L, About I, Taqi N, Nguyen NPT, et al. Oral epithelial stem cells-Implications in normal development and cancer metastasis. Vol. 325, Experimental Cell Research. Academic Press Inc.; 2014. p. 111–29.
  70. Darcey J, Ashley M. See you in three months! the rationale for the three monthly peridontal recall interval: A risk based approach. Vol. 211, British Dental Journal. 2011. p. 379–85.

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