Both altered distal renal tubular acidification
and urinary tract infection may be associated with relevant
hyperammonemia in both children and adults [Clericetti LM 2018].
Urinary tract infection caused by urea-splitting bacteria, despite being
unusual in pediatric patients, must be taken into account [Acosta P 2017]
Hyperammonemia is not an uncommon finding in distal renal tubular
acidosis, and should be included among differential diagnosis of
hyperammonemia in infants and children [Pela L 2007]