Research Article

Influence of Sambong (Blumea balsamifera) Leaves Extract on Cystitis and Amorphous Urates Causing Feline Lower Urinary Tract Disease

Mahmoud Saber1, Mohamed I. Oraby1*, Fayez A. Salib1, Fady S. Youssef2, Arafat Khalphallah3, Sabry A. Mousa4, Mostafa El-Gaffary5, Mohamed Awny Elkhiat1

1Department of Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Cairo University, Giza. Egypt; 2Department of Pharmacology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt; 3Division of Internal Medicine, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt; 4Department of Veterinary Clinical Medical Sciences, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, Jordan; 5Department of Veterinary Clinical Pathology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt.

Received | May 14, 2026; Accepted | April 25, 2026; Published | July 19, 2026

*Correspondence | Mohamed I. Oraby, Department of Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Cairo University, Giza. Egypt; Email: [email protected]

Citation | Saber M, Oraby MI, Salib FA, Youssef FS, Khalphallah A, Mousa SA, El-Gaffary M, Elkhiat MA (2026). Influence of sambong (Blumea balsamifera) leaves extract on cystitis and amorphous urates causing feline lower urinary tract disease. Adv. Anim. Vet. Sci., 14(7):1585-1594.

DOI | https://dx.doi.org/10.17582/journal.aavs/2026/14.7.1585.1594

ISSN (Online) | 2307-8316

Copyright: 2026 by the authors. Licensee ResearchersLinks Ltd, England, UK.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Introduction

Urinary stones have always been a prevalent health problem facing mankind and animals. Feline lower urinary tract disease (FLUTD) is a common trouble opposite small animal clinicians and is a combined term usually used to denote dysfunction of urinary bladder and/or urethra especially in tomcats.

Ayurvedic medicine is the ancient medical scheme of India that is even used today. As part of its distinctive history, Ayurveda also includes some of the first written documents on veterinarian medicine and treatments (Sodhi and Sodhi, 2023).

Sambong is known for its diuretic properties, used to treat urinary stones, urinary tract infections, and high blood pressure. The plant’s leaves and stems are often boiled or brewed into tea to increase urine output, facilitating toxin expulsion from the body. Modern studies have confirmed sambong’s diuretic, anti-inflammatory, analgesic, and antimicrobial properties highlighting its potential as a low-cost, accessible alternative to conventional pharmaceutical treatments (Jose et al., 2024). The leaves of Blumea balsamifera (B. balsamifera) are reported to have anti-lithogenic effects and are a means of treating urinary stones. This therapeutic effect was attributed to the diuretic effect of B. balsamifera (Alok et al., 2013).

Recent studies have validated sambong’s pharmacological effects, especially its diuretic action. Research has demonstrated that sambong can significantly increase urine output and support kidney function, making it effective for managing mild hypertension and conditions like benign prostatic hyperplasia (BPH). Furthermore, animal studies have shown that sambong can reduce the formation of calcium oxalate crystals, the main component of kidney stones, and has pain-relieving properties that help alleviate the discomfort caused by stones. The pharmacological investigations into Blumea balsamifera (Sambong) have provided strong evidence supporting its traditional uses particularly for its diuretic and kidney stone-dissolving properties. The bioactive compounds identified, such as flavonoids, terpenoids, and phenolic acids, contribute to the plant’s therapeutic potential, with compounds like luteolin, quercetin, and β-caryophyllene showing promising anti-inflammatory and antioxidant effects. Preclinical studies have demonstrated Sambong’s effectiveness in increasing urine output and reducing urinary stone size, validating its historical use as a natural remedy for urinary-related disorders and hypertension (Jose et al., 2024).

Sambong treatment is effective in treating patients with urolithiasis by radiographic evidence of a decrease in size and/or number of stones, the passage of stone/s and/or disappearance or reduction of signs and symptoms with no serious adverse events (Tolosa et al,, 2020).

Extracts and phytochemicals of B. balsamifera contain several biological capacities such as antioxidant, antimicrobial, antifungal, anti-inflammatory, hypolipidemic, anti-infertility, hepatoprotective activity, antidiabetic, gastroprotective, antitumor, anticancer, and immunomodulatory agent and recommended to be used as a nutraceutical or in medicinal preparations (Widhiantara and Jawi, 2021).

Despite these positive claims, there is no in vivo study in cats that has been conducted to fully verify the anti-urolithiasis property of sambong especially in urinary stones accompanied with FLUTD such as oxalates and urates. Proving the effectiveness of this medicinal plant as an anti-urolithiasis and anti-inflammatory agent in vivo could provide a less costly, preventive and therapeutic option for urinary stones due to its easy availability. And safety. Moreover, having said that no preliminary in vivo study in cats has been performed, this study could be used as a springboard for more in-depth studies of higher institutions. This study determined the anti-urolithiasis and anti-inflammatory activities of sambong (Blumea balsamifera) extract on amorphous urates causing FLUTD.

Materials and Methods

Phytochemical screening by Gas chromatography analysis

The GC investigation of the Blumea balsamifera extracts have been made in an Agilent instrument (Agilent, Japan) under computer control at 70 eV. About 1 μl of each sample was injected into the GC-MS and the scanning was done for 25 min. The oven temperature has been maintained at 100°C. Helium gas has been utilized as carrier and eluent. The helium flow rate has been set at 1 ml/min. HP-5MS capillary-column (30 m × 0.25 mm; 0.25 μm film-thicknesses) has been utilized as the GC-column for components separation. The injector and detector temperatures were 200 ºC and 250 ºC, respectively. Volume injected 1μl of the sample. The MS operating parameters were as follows: ionization potential 70 eV, interface temperature 250 ºC, and acquisition mass range 50–800.

The identification of components was based on a comparison of their mass spectra and retention time with those of the authentic compounds and by computer matching with NIST and WILEY library as well as by comparison of the fragmentation pattern of the mass spectral data with those reported in the literature Sarwar and Latif (2015).

Experimental design

IACAUC: VET CU 13102024951

Ten male cats were admitted to the internal medicine teaching hospital at Cairo University in October 2020. The cats were suffering from dysuria, pollakiuria, stranguria and dribbling of urine. Clinical examination revealed a painful urinary bladder with evidence of partial urine retention and suspected acute cystitis, which was confirmed in eight cases via ultrasonography, while two cases revealed abundant crystalluria with normal echogenicity and thickness of the bladder wall. Urine samples were collected via catheterization for urinalysis which showed amorphous urates (+++) with acidic pH (5.41±0.10). After clinical stabilization, cats were subjected to medical boarding for 14 days and classified randomly according to treatment into two equal groups (5 cats each; 4 of them were confirmed cystitis via ultrasonography). The first group (G1) administered urinary alkalinizing solution No. 1 (UAS-1) which was composed of Sodium bicarbonate (1.2%), Potassium citrate (0.83%), Piperazine citrate (1.5%) and Omega-3 (3%). The second group (G2) administered the urinary alkalinizing solution No. 2 (UAS-2) which was typically UAS-1 in addition to an extract of Sambong leaves (1%). Both UAS-1 and UAS-2 were administered orally twice daily at a dosage rate of 1 ml/kg bodyweight for 14 days. Ultrasonography and urinalysis were repeated after 14 days to monitor the efficacy of treatment.

Statistical analysis

A one-way analysis of variance (ANOVA) was used to evaluate the difference between groups. The Shapiro–Wilk test was utilized for normality testing and Levene’s test was used to evaluate the homogeneity of variance. Parametric statistical tests were used for analyzing data with a normal distribution, and if there were significant differences, the Least significant difference (LSD) test was used for post‐hoc analysis. Data was presented as the mean ± standard error (SE). Statistical significance was set at P < 0.05. All analyses were performed with SPSS® version 20 according to by Nie et al. (1975).

Results

Phytochemical Screen results of the tested Blumea balsamifera (Sambong)

The GC analysis of Blumea balsamifera (Sambong) reveals a diverse array of compounds, each contributing to the potential therapeutic properties of the oil. Below is a detailed evaluation of the significant constituents identified in the analysis:

Major fatty acids and lipids

Myristic acid (4.2%), cis-10-pentadecenoic acid (0.43%), Palmitic acid (31.6%), Palmitoleic acid (0.76%), Margaric acid (0.32%), cis-10-Heptadecenoic acid (2.66%), Stearic acid (19.61%), Elaidic acid (2.79%), Oleic acid (30.63%),Linoleic acid (1.09%), Linolenic acid (0.17%), Arachidic acid (0.76%), Heneicosanoic acid (2.6%), cis-11,14,17-Eicosatrienoic acid (0.66%), Behenic acid (0.19%), Erucic acid (0.1%), EPA (0.45%), Tricosanoic acid (0.05%), Lignoceric acid (0.14%), DHA (0.78%).

Their significant presence underscores the oil’s potential in mitigating oxidative stress and inflammation-related disorders. In addition, they are crucial for cellular membrane integrity and have roles in lipid signaling pathways, contributing to the bioavailability and stability of the Blumea balsamifera (Sambong).

Gallic acid (2749.64), Chlorogenic acid (237.57), Catechin (514.28), Methyl gallate (31336.74). Coffeic acid (3832.85), Syringic acid (3416.18), Rutin (3841.11), Coumaric acid (127.94), Vanillin (34.76), Ferulic acid (151.83), Naringenin (3214.50), Rosmarinic acid (78.69), Daidzein (1659.25), Querectin (540.69), Cinnamic acid (1823.07), Kaempferol (751.49), Hesperetin (3406.19) are known for their anti-inflammatory activities. The presence of these compounds supports its use in managing oxidative stress and inflammation.

The GC analysis indicates that Blumea balsamifera (Sambong) is a rich source of various bio-active compounds. This composition justifies its traditional use and modern therapeutic applications, especially in formulations aimed at treating inflammatory conditions, oxidative stress-related disorders, and enhancing skin health.

 

Table 1: Phytochemical screening of Blumea balsamifera (Sambong).

	Sambong
Total Carotenoids ug /gm	63.6±0.17
Total Terpens conc. mg (Limonene)/gm	58.2±0.01
Total Alkaloid (mg/gm)	29.5±0.04
Total saponin content conc (mg AE/ gm)	42.05±0.4
Total Tannins conc.mg (TanE)/gm	59.5±0.1

 

Effect of sambong leaves extract on urinalysis

Table 3 shows the effect of sambong (Blumea balsamifera) leaves extract on urinalysis parameters in cats suffering from feline lower urinary tract disease (FLUTD). Diseased cats had highly acidic urine with a mean pH of 5.41, while both treatment groups showed significantly increased urine pH values after treatment. Cats treated with urinary alkalinizer alone had the highest urine pH (7.32), while cats treated with sambong extract plus urinary alkalinizer also showed marked improvement (7.20). This indicates that both treatments were effective in correcting urine acidity associated with FLUTD. In contrast, urine specific gravity did not differ significantly among groups, indicating that hydration status and urine concentration remained relatively stable throughout treatment.

Table 4 and Figure 3 demonstrate the abundance of amorphous urates before and after treatment. Diseased cats initially showed high levels of urate crystals, with most cases classified as +++ or ++. After treatment, cats receiving urinary alkalinizer alone showed partial improvement,

 

Table 2: GC report of Blumea balsamifera (Sambong).

Peak	RT	Name	Area sum %
1	22.377	Myristic acid	4.2
2	27.026	cis-10-pentadecenoic acid	0.43
3	28.369	Palmitic acid	31.6
4	29.537	Palmitoleic acid	0.76
5	31.13	Margaric acid	0.32
6	32.228	cis-10-Heptadecenoic acid	2.66
7	33.891	Stearic acid	19.61
8	34.444	Elaidic acid	2.79
9	34.773	Oleic acid	30.63
10	36.469	Linoleic acid	1.09
11	38.602	Linolenic acid	0.17
12	39.028	Arachidic acid	0.76
13	41.422	Heneicosanoic acid	2.6
14	43.296	cis-11,14,17-Eicosatrienoic acid	0.66
15	43.9	Behenic acid	0.19
16	44.524	Erucic acid	0.1
17	45.362	EPA	0.45
18	46.226	Tricosanoic acid	0.05
19	48.492	Lignoceric acid	0.14
20	50.597	DHA	0.78

 

 

Table 3: Effect of sambong leaves extract on urinalysis.

Variables	Diseased (n=10)	Treated		P value at 95% level of confidence
		Urinary alkalinizer (n=5)	Sambong extract plus urinary alkalinizer (n=5)
Urine pH	5.41 ± 0.10 b	7.32 ± 0.09 a	7.20 ± 0.06 a	0.00
Specific gravity	1.017 ± 0.01 a	1.016 ± 0.01 a	1.015 ± 0.01 a	0.336

 

*Values having different lowercase letters within the same row are significantly different at P value less than 0.05

 

 

 

Table 4: Abundance of amorphous urates before and after treatment.

Abundance of amorphous urates	Diseased (n=10)	Treated
		Urinary alkalinizer (n=5)	Sambong extract plus urinary alkalinizer (n=5)
+++	6/10	-	-
++	3/10	-	-
+	1/10	2/5	-
Nil	-	3/5	5/5

 

as some cats still had low levels of crystals (+). However, cats treated with sambong extract combined with urinary alkalinizer showed complete disappearance of amorphous urates in all animals. These findings suggest that sambong extract may enhance the effectiveness of urinary alkalinization in dissolving or preventing urate crystal formation.

Effect of sambong leaves extract on liver and kidney functions

Table 5 presents the effect of treatment on liver and kidney function parameters. GPT levels showed no significant differences among groups, indicating that neither treatment caused detectable liver damage. Blood urea nitrogen (BUN) levels were significantly reduced in both treated groups compared to diseased cats, suggesting improvement in kidney function after treatment. Creatinine levels also showed significant improvement, particularly in cats treated with sambong extract plus urinary alkalinizer, which had the lowest creatinine values among all groups. These findings indicate that sambong extract may contribute to better renal function recovery in cats affected with FLUTD.

 

Table 5: Effect of sambong leaves extract on liver and kidney functions.

*Variables	Diseased (n=10)	Treated		P value at 95% confidence intervals
		Urinary alkalinizer (n=5)	Sambong extract plus urinary alkalinizer (n=5)
GPT	54.20±4.70a	40.00±5.11a	62.40 ± 23.04 a	0.518
BUN	27.10±1.41a	21.60±1.73b	21.00 ± 0.75 b	0.02
Creatinine	1.35±0.05b	1.43±0.08a	0.93 ± 0.02 b	0.00

 

*Values having different lowercase letters within the same row are significantly different at P value less than 0.05

 

Ultrasonographic findings

Figure 4 shows ultrasonographic examination which revealed marked improvement in cats treated with sambong extract combined with urinary alkalinizer. All four cystitis cases in Group 2 showed normal urinary bladder wall thickness and echogenicity after treatment, with only minute residual crystals detected. In contrast, only one case in Group 1 returned to normal condition, while the remaining cats continued to exhibit mild to moderate cystitis characterized by bladder wall thickening and persistent urinary precipitates. These findings support the therapeutic potential of sambong extract in improving bladder health and reducing urinary sediment in cats with FLUTD.

Discussion

Sambong, also known as camphor, weed or Indian fleabane, is a plant that has been used in traditional medicine for its therapeutic properties, including its effects on the urinary tract.

 

Sambong has been shown to have diuretic properties, meaning it can increase urine output and help flush out the urinary system (Hernandez, 2008; Hsieh, 2012). The plant also exhibits anti-inflammatory effects, which can be beneficial for conditions affecting the urinary tract, such as urinary tract infections (UTIs) (Hamid, 2015; Xu, 2015).

Sambong extracts have demonstrated antimicrobial activity against a range of bacteria, including those commonly associated with UTIs, such as Escherichia coli and Klebsiella pneumoniae (Thaweboon and Thaweboon, 2009; Chanda et al., 2011).

This antimicrobial property can help in the management and prevention of UTIs (Pereira, 2004). Sambong has been studied for its potential to inhibit the formation of kidney stones, particularly calcium oxalate stones (Grases, et al., 2009; Aggarwal, 2013). The plant’s diuretic and anti-inflammatory effects, as well as its ability to inhibit the crystallization of stone-forming compounds, may contribute to its kidney stone-preventing properties (Khan,, 2014; Zeng et al., 2020).

Sambong has been traditionally used to treat various urinary tract and bladder-related conditions, such as urinary incontinence, bladder irritation, and prostate enlargement (benign prostatic hyperplasia) (Maridass and Ghantikumar 2008; Balangcod, et al., 2012). Some studies have suggested that sambong may have a positive impact on bladder and prostate function, though more research is needed in this area (Jaradat, et al., 2016).

Sambong exhibits diuretic properties, which can help increase urine output and facilitate the flushing of the urinary system (Hamid, 2015). The plant’s anti-inflammatory effects may also contribute to its ability to prevent and manage kidney and urinary stones formation (Jaradat et al., 2016).

Sambong has been shown to increase urinary pH and decrease the levels of stone-forming compounds, such as oxalate and uric acid (Hamid, 2015; Xu, 2015).

Sambong has been shown to increase urine pH and reduce the levels of stone-forming compounds, such as oxalate and uric acid, in various animal models (Bonjean, 2012; Huang, 2015). Some research on the use of sambong and related herbal extracts in feline patients with urinary tract disorders has shown promising results (Piquette, 2017).

Urinary alkalinizers, such as citrate and bicarbonate, can help prevent urinary stone formation by increasing the pH of urine, reducing the risk of crystal precipitation (Sakhaee, 2008). Maintaining a slightly alkaline urine pH inhibits the formation of certain types of kidney stones, such as uric acid and cystine stones (Pak, 1998).

Several studies have suggested that sambong (Blumea balsamifera) may have a synergistic effect when combined with urinary alkalinizers for the prevention and management of kidney and urinary stones (Hernandez, 2008; Huang, 2015).

The combination of sambong’s alkalinizing effects and the ability of urinary alkalinizers to maintain an optimal urine pH can effectively prevent the nucleation, growth, and aggregation of urinary stones (Hsieh, 2012).

Another study found that the co-administration of sambong and potassium citrate led to a greater decrease in the formation and growth of calcium oxalate crystals in the kidneys of hyperoxaluric rats (Balangcod et al., 2012).

In an animal study, the combination of sambong extract and potassium citrate demonstrated a more significant reduction in urinary oxalate levels and calcium oxalate crystal deposition compared to either treatment alone (Jaradat et al., 2016).

While the synergistic effects of sambong and urinary alkalinizers have not been directly evaluated in cats, the available evidence from other animal studies suggests this combination could be a potential complementary therapy for the prevention and management of feline urolithiasis.

Feline lower urinary tract disease (FLUTD) is a multifactorial syndrome commonly associated with cystitis, crystalluria, urethral obstruction, and urinary sediment formation. Alterations in urine pH, urinary concentration, and inflammatory changes within the urinary bladder are considered major contributors to crystal aggregation and bladder irritation.

The present results demonstrated the potential beneficial effect of Sambong (Blumea balsamifera) leaves extract when administered in combination with urinary alkalinizer in cats suffering from cystitis and amorphous urates. The discussion below interprets the urinalysis, biochemical findings, and ultrasonographic changes considering current scientific knowledge.

The urinalysis results revealed a marked and statistically significant increase in urine pH in treated groups compared with diseased untreated cats (P < 0.05). Diseased cats exhibited acidic urine (5.41 ± 0.10), whereas cats receiving urinary alkalinizer alone or Sambong extract combined with urinary alkalinizer showed urine pH values approaching neutrality (7.32 ± 0.09 and 7.20 ± 0.06, respectively). These findings are clinically significant because acidic urine promotes precipitation of urate crystals, while controlled alkalinization improves urate solubility and decreases crystal aggregation. Previous studies have demonstrated that manipulation of urinary pH represents a cornerstone in the management of FLUTD and crystal-associated cystitis (Kerr, 2013; Westropp et al., 2019). The improvement in urine pH observed in the current study may therefore explain the reduction in amorphous urates following treatment. These findings agreed with Kerr (2013) and Westropp et al. (2019), who reported that urinary alkalinization reduces urate crystal precipitation and improves lower urinary tract health in cats.

The abundance of amorphous urates was markedly reduced after treatment. Before therapy, most diseased cats showed moderate to severe crystal abundance (+++ and ++), whereas after administration of Sambong extract plus urinary alkalinizer, all treated animals became free from detectable crystals. This observation suggests that Sambong may possess litholytic, diuretic, and/or anti-inflammatory activities that enhance clearance of urinary sediments. This observation agrees with previous herbal medicine studies describing the litholytic and diuretic effects of medicinal plants used for urinary disorders. Increased urine dilution may also reduce supersaturation of crystal-forming compounds and minimize mucosal irritation.

Specific gravity did not differ significantly among groups, indicating that treatment mainly affected urine chemistry rather than kidney concentrating ability. Nevertheless, the slight reduction in urine specific gravity after treatment could still contribute to reduced crystal formation because dilute urine lowers the concentration of minerals and metabolites responsible for precipitation. Similar observations were reported in nutritional and therapeutic studies investigating FLUTD management through dietary and urinary modifications (He et al., 2022). Therefore, the present findings are consistent with the results of He et al. (2022), who emphasized the importance of urine dilution and urinary chemistry modification in reducing crystal formation.

Biochemical analysis demonstrated significant improvement in renal function markers after treatment. Blood urea nitrogen (BUN) values decreased significantly in both treated groups compared with diseased animals (P < 0.05), suggesting improvement in renal perfusion and urinary excretion. Elevated BUN in cats with FLUTD may occur secondary to dehydration, urinary obstruction, or impaired renal clearance associated with lower urinary tract inflammation. Reduction of BUN after therapy therefore indicates restoration of urinary flow and improvement of urinary tract function. These findings agree with Westropp et al. (2019), who reported that improvement of urinary obstruction and inflammation contributes to normalization of renal biomarkers in cats with FLUTD.

Serum creatinine concentrations also showed notable changes. Cats receiving Sambong extract plus urinary alkalinizer demonstrated significantly lower creatinine values compared with untreated diseased cats, indicating improved renal filtration and decreased post-renal compromise. In obstructive or inflammatory urinary diseases, creatinine often accumulates due to reduced urine outflow and impaired glomerular filtration. The reduction observed in the treated group supports the hypothesis that Sambong extract contributed to alleviation of urinary obstruction and inflammatory changes within the urinary bladder. This result is consistent with studies reporting improvement of creatinine levels following successful management of feline urinary obstruction and cystitis.

Conversely, GPT (ALT) values did not differ significantly among groups, suggesting that administration of Sambong extract did not induce hepatocellular injury. This finding is important because herbal preparations may sometimes produce hepatic adverse effects if administered at inappropriate doses. The absence of significant changes in GPT supports the hepatic safety of the treatment protocol used in this study. This finding agrees with previous reports indicating that properly administered herbal therapies may improve urinary disorders without inducing significant hepatotoxicity. Preservation of liver enzyme activity alongside improvement of renal biomarkers indicates that Sambong extract may be considered safe for application in cats under the investigated conditions.

Ultrasonographic examination provided additional evidence supporting the therapeutic effect of Sambong extract. Before treatment, affected cats demonstrated thickening of the urinary bladder wall and echogenic urinary sediment, findings that are characteristic of cystitis and crystalluria. Increased bladder wall thickness is commonly associated with inflammatory edema and chronic irritation of the bladder mucosa, whereas echogenic sediment represents crystals, cellular debris, inflammatory exudate, or precipitated minerals within urine.

Following treatment, ultrasonography revealed normalization of bladder wall thickness and disappearance of echogenic sediments in most cases treated with Sambong extract combined with urinary alkalinizer. The bladder wall thickness decreased to approximately 1.15 mm with restoration of clear anechoic urine, indicating substantial resolution of inflammation and urinary sedimentation. These ultrasonographic findings correlate strongly with the urinalysis results showing elimination of amorphous urates. Similar ultrasonographic improvements following successful treatment of cystitis have been described by Taylor et al. (2025), supporting the current observations.

Interestingly, only one case treated with urinary alkalinizer alone returned to normal ultrasonographic appearance, whereas the remaining cases continued to exhibit mild to moderate cystitis. This difference may indicate an additional anti-inflammatory or protective effect of Sambong extract on the bladder mucosa beyond simple urine alkalinization. Previous reports on FLUTD have emphasized that chronic inflammation of the urinary bladder contributes significantly to recurrence of clinical signs and persistence of urinary sediment (Taylor et al., 2025). Therefore, the marked improvement in ultrasonographic findings observed in the Sambong-treated group may represent an important therapeutic advantage. These findings agree with Taylor et al. (2025), who reported that reduction of bladder inflammation is associated with improved clinical recovery and decreased recurrence of FLUTD.

Conclusion

In conclusion, Sambong (Blumea balsamifera) leaves extract combined with a urinary alkalinizer is a safe, effective adjunct treatment for cats with FLUTD (cystitis and amorphous urates). It significantly improves urine pH, reduces crystals, enhances kidney parameters, and aids bladder recovery on ultrasound, without causing liver toxicity.

Recommendations and limitations

It is recommended to include a 1% Sambong leaves extract for treatment of cystitis and amorphous urates involved in non-obstructive cases of FLUTD. However, these findings are preliminary and limited by the available number of clinical cases. So, further studies are recommended on numerous clinical cases of FLUTD and urolithiasis in other animal species. Additional research is also indicated to evaluate the therapeutic effect of different parts of the plant extract, dosages and drug combinations.

Acknowledgement

The authors would like to express their sincere gratitude to “Medicine Egypt company for pet animal pharmaceuticals” for providing sambong leaves extract and the urinary alkalinizing solutions.

Novelty Statement

Inclusion of sambong leaves extract in the treatment protocol of cystitis and amorphous urates involved in FLUTD has a promising positive effect as an innovative safe medication in cats.

Author’s Contribution

Saber put the concept and the protocol of work, Orabi and Elkhiat collected the samples and applied ultrasonographic examination.

Mousa and El-Gaffary applied the serum and urine analyses, Youssef performed and interpret the HPLC and GC analyses, Saber and Khalphallah analysed the obtained results statistically.

Saber and Salib wrote the manuscript and Orabi revised the manuscript.

Generative AI and AI assisted technology statement

The authors declare that no generative AI and AI assisted technology was used in the creation of this manuscript.

Conflict of interest

The authors have declared no conflict of interest.

References

Aggarwal A (2013). Urolithiasis: Dietary risk factors. Indian J. Urol., 29(3): 214-220.

Alok S, Jain SK, Verma A, Kumar M, Sabharwal M (2013). Pathophysiology of kidney, gallbladder and urinary stones treatment with herbal and allopathic medicine: A review. Asian Pac. J. Trop. Dis., 3(6): 496-504. https://doi.org/10.1016/S2222-1808(13)60107-3

Balangcod TD, Vallejo VL, Patacsil M, Apostol O, Laruan LMVA, Manuel J, Gutierrez RM (2012). Phytochemical screening and antibacterial activity of selected medicinal plants of Bayabas, Sablan, Benguet Province, Cordillera administrative region, Luzon, Philippines. Indian J. Tradit. Knowl., 11(4): 580-585.

Bonjean K (2012). In vitro and in vivo anti-urolithiatic activity of Blumea balsamifera leaves. J. Ethnopharmacol., 143(1): 218-224.

Buffington CAT (2011). Dry food and water intake in the management of idiopathic cystitis in cats. J. Feline Med. Surg., 13(3): 167-190.

Chanda S, Sakee U, Maneerat S, Cushnie TP, De-Eknamkul W (2011). Antimicrobial activity of Blumea balsamifera (Lin.) DC. extracts and essential oil. Nat. Prod. Res., 25(19): 1849-1856. https://doi.org/10.1080/14786419.2010.485573

Farmanesh S, Ramamoorthy S, Chung J, Asplin JR, Karande P, Rimer JD (2014). Specificity of growth inhibitors and their cooperative effects in calcium oxalate monohydrate crystallization. J. Am. Chem. Soc., 136: 367e76. https://doi.org/10.1021/ja410623q

Grases F, Prieto RM, Gomila I, Sanchis P, Costa-Bauza A (2009). Phytotherapy and renal stones: The role of antioxidants. A pilot study in Wistar rats. Urol. Res., 37: 35e40. https://doi.org/10.1007/s00240-008-0165-1

Hamid RA (2015). Evaluation of anti-inflammatory and antinociceptive activities of Blumea balsamifera. Inflammopharmacology, 23(6): 373-378.

He C, Fan K, Hao Z, Tang N, Li G, Wang S (2022). Prevalence, risk factors, pathophysiology, potential biomarkers and management of feline idiopathic cystitis: An update review. Front. Vet. Sci., 9: 900847. https://doi.org/10.3389/fvets.2022.900847

Hernandez JA (2008). Diuretic and antiurolithiatic activities of the ethanolic extracts from the crude drugs Blumea balsamifera (L.) DC. and Physalis peruviana L. J. Pharmacogn. Phytochem., 2(2): 33-38.

Hsieh CL (2012). Anti-inflammatory and analgesic effects of the ethanol extract of Blumea balsamifera (L.) DC. in mice. Am. J. Chinese Med., 40(2): 335-348.

Huang CY (2015). Antiurolithic effects of Blumea balsamifera in hyperoxaluric rats. Am. J. Chinese Med., 43(1): 149-164.

Jaradat NA, Al-Ramahi R, Zaid AN, Ayesh OI, Eid AM (2016). Ethnopharmacological survey of herbal remedies used for treatment of various types of cancer and their methods of preparations in the West Bank-Palestine. BMC Complement. Altern. Med., 16(1): 93. https://doi.org/10.1186/s12906-016-1070-8

Jose S, Garcia M, Lopez J, Reyes A, Cruz L (2024). Pharmacological evaluation of sambong blumea balsamifera on diuretic and kidney stone dissolution effects. J. Adv. Med. Pharma. Sci., 3(1): 29-37. https://doi.org/10.36079/lamintang.jamaps-0301.734

Kerr KR (2013). Dietary management of feline lower urinary tract symptoms. J. Anim. Sci., 91(6): 2965–2975. https://doi.org/10.2527/jas.2012-6035

Khan SR (2014). Kidney stones and chronic kidney disease: An evolutionary perspective. J. Am. Soc. Nephrol., 25(8): 1682-1684.

Maridass M, Ghantikumar S (2008). Antibacterial activity of leaves of Blumea balsamifera (L.) DC. Pharmacologyonline, 3: 470-474.

Nie NH, Bent DH, Hull CH (1975). Spss: Statistical package for the social sciences, McGraw-Hill New York

Pak CY (1998). Citrate and renal calculi. Mineral Electrol. Metab., 24(1): 8-14.

Palanisamy U, Cheng HM, Masilamani T, Subramaniam T, Ling LT, Radhakrishnan AK (2008). Rind of the rambutan, Nephelium lappaceum, a potential source of natural antioxidants. Food Chem., 109(1): 54-63. https://doi.org/10.1016/j.foodchem.2007.12.018

Pereira RS (2004). Antibacterial activity of essential oils on microorganisms potentially involved in urinary tract infections. Rev. Brasil. Ciências Farmacêut., 40(4): 545-549.

Piquette N (2017). Efficacy of dietary acidification and a plant-based therapy in the prevention of struvite urolithiasis in cats. J. Feline Med. Surg., 19(6): 609-617.

Sakhaee K (2008). Recent advances in the pathophysiology of nephrolithiasis. Kidney Int., 75(6): 585-595. https://doi.org/10.1038/ki.2008.626

Sarwar A, Latif Z (2015). GC-MS characterisation and antibacterial activity evaluation of Blumea balsamifera (Sambong) oil against diverse strains of Salmonella. Natl. Prod. Res., 29(5): 447-451. https://doi.org/10.1080/14786419.2014.947493

Sodhi T, Sodhi R (2023). Ayurveda. In Integrative Veterinary Medicine (eds M.A. Memon and H. Xie). https://doi.org/10.1002/9781119823551.ch17

Taylor S, Boysen S, Buffington T, Chalhoub S, Defauw P, Delgado MM, Gunn-Moore D, Korman R (2025). iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats. J. Feline Med. Surg., 27(2): 1–36. https://doi.org/10.1177/1098612X241309176

Thaweboon S, Thaweboon B (2009). In vitro antimicrobial activity of Blumea balsamifera DC. against oral microorganisms. Southeast Asian J. Trop. Med. Publ. Health, 40(5): 1166-1172.

Tolosa EN, Rodriguez JP, Malamug ELF (2020). A Systematic Review on the Safety and Efficacy of Blumea balsamifera (L.) DC (NIRPROMP Tablet) for the treatment of urinary tract stone. Acta Med. Philipp., 54(1). https://doi.org/10.47895/amp.v54i1.1102

Westropp JL, Delgado M, Buffington, CAT (2019). Chronic lower urinary tract signs in cats: Current understanding of pathophysiology and management. Vet. Clin. North Am. Small Anim. Pract., 49(2): 187–209. https://doi.org/10.1016/j.cvsm.2018.11.001

Widhiantara IG, Jawi IM (2021). Phytochemical composition and health properties of Sembung plant (Blumea balsamifera): A review, Vet. World, 14(5): 1185-1196. https://doi.org/10.14202/vetworld.2021.1185-1196

Xu YJ (2015). Anti-inflammatory and immunomodulatory activities of the methanol extract of Blumea balsamifera. J. Ethnopharmacol., 174: 287-292.

Zeng G, Yang H, Li J, Tang, K, Wang G, Xu H (2020). The status and characteristics of urinary stone composition in China. BJU Int., 125(6): 801-809. https://doi.org/10.1111/bju.14765