Peer-reviewed veterinary case report
High ammonia levels in cats with kidney disease
By Carvalho, Lauren et al.·Published in Journal of feline medicine and surgery·2021·Cummings School of Veterinary Medicine at Tufts University, United States·View original on PubMed →
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Original publication title: Hyperammonemia in azotemic cats.
- Species:
- cat
Plain-English summary
A group of 18 cats with kidney disease, aged between 4 and 19 years, were tested for high ammonia levels in their blood. Four of these cats showed elevated ammonia, which was linked to worsening kidney function. The study found that higher ammonia levels correlated with increased blood urea nitrogen, creatinine, and phosphorus levels, indicating more severe kidney issues. While the cats with high ammonia levels were experiencing acute kidney injury or worsening chronic kidney disease, the study suggests that further research is needed to explore treatment options for managing high ammonia in cats with kidney disease.
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Abstract
OBJECTIVES: Hyperammonemia occurs in cats with hepatobiliary and nutritional (cobalamin and arginine deficiency) disorders, and has also been documented in four cats with renal azotemia. We hypothesized that in cats with renal azotemia, fasting hyperammonemia would correlate with indices of worsening kidney function, and would be independent of cobalamin, potassium, systemic inflammation or urinary tract infection (UTI) with urease-producing bacteria. METHODS: A fasted blood sample was prospectively collected for ammonia and cobalamin analysis from 18 client-owned cats with renal azotemia (creatinine [Cr] ⩾1.6 mg/dl, urine specific gravity <1.030 or documentation of historical chronic kidney disease [CKD]). Correlations between blood ammonia and selected biochemical parameters were analyzed using Pearson's correlation coefficient. RESULTS: Seven castrated males and 11 spayed females with a median age of 12 years (range 4-19 years) were enrolled. Ten of 18 (56%) cats presented for acute kidney injury (AKI) or acute on chronic kidney disease (AoCKD), and 8/18 (44%) presented for progressive CKD. The median Cr was 5.9 mg/dl (range 1.9-24.7 mg/dl). Hyperammonemia was documented in 4/18 (22%) cats, with a median of 95 µmol/dl (range 85-98 µmol/dl), and all four of these cats were classified as AKI/AoCKD. Blood ammonia concentrations had a significant moderate positive correlation between blood urea nitrogen (BUN) ( = 0.645, = 0.003), Cr ( = 0.578, = 0.012) and serum phosphorus ( = 0.714, = 0.0009) but not with cobalamin, potassium or white blood cell count. No cats had UTIs with urease-producing bacteria. CONCLUSIONS AND RELEVANCE: A correlation exists between blood ammonia and BUN, Cr and phosphorus in cats with renal azotemia. Future studies are warranted in a larger population of cats to determine the true prevalence, etiology and potential therapeutic effect of medical management of hyperammonemia on long-term prognosis in cats with kidney disease.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/33215950/