Perforation of the nasal septum in patients with renal failure.

Spontaneous perforation of the nasal septum was observed in 8 out of 104 patients (74 on maintenance hemodialysis; 30 after cadaveric renal transplantation). All patients showed a round or oval defect of the non-osseous septum, which was accompanied by marked atrophic rhinitis. Epistaxis was common in uremic patients in general and was also present in 5 patients with septal perforation, but otherwise the defect was hardly associated with any symptoms. Various factors may play a role in the pathogenesis of this lesion; local trauma from nasal catheters postoperatively; impaired mucosa cell proliferation; disturbed innervation of the vessels in the nasal septum due to polyneuropathy of the autonomous nervous system; ischemia secondary to arteriolar narrowing.