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[Two Cases of Obstructive Pyelonephritis with Hyperammonemia Causing Impaired Consciousness]
Takao Haitani1, Daisuke Takahashi1, Shigeki Koterazawa1
1The Department of Urology, Ijinkai Takeda General Hospital.
Hinyokika Kiyo. Acta Urologica Japonica
|September 1, 2025
Summary
Obstructive pyelonephritis can cause hyperammonemia, leading to impaired consciousness. Prompt treatment, such as ureteral catheterization, can improve neurological symptoms in these rare cases.
Area of Science:
- Nephrology
- Neurology
- Urology
Background:
- Obstructive pyelonephritis is a serious kidney infection.
- Hyperammonemia, elevated ammonia levels in the blood, can cause neurological dysfunction.
- The association between obstructive pyelonephritis and hyperammonemia is rare but clinically significant.
Purpose of the Study:
- To report two cases of obstructive pyelonephritis presenting with hyperammonemia and impaired consciousness.
- To highlight the importance of considering hyperammonemia in patients with urinary tract infections and altered mental status.
Main Methods:
- Case report of two elderly female patients.
- Diagnostic evaluation included computed tomography (CT) for hydronephrosis and hydroureter.
- Blood ammonia levels were measured.
Main Results:
- Both patients presented with impaired consciousness and hematuria.
- CT revealed obstructive pyelonephritis in both cases.
- Elevated blood ammonia levels (208 μg/dl and 133 μg/dl) were observed.
- Neurological symptoms improved after ureteral catheterization (10 days and 7 days, respectively).
Conclusions:
- Hyperammonemia is a rare but potential complication of obstructive pyelonephritis.
- Clinicians should suspect hyperammonemia in patients with urinary tract infections and prolonged impaired consciousness.
- Ureteral catheterization can be an effective treatment for resolving hyperammonemia and improving consciousness in these patients.
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