Introduction Ketosis is a disease leading to economic losses because of its treatment costs and the decrease in milk yield and fertility (1-3). It is a subacute and chronic carbohydrate metabolism disorder caused by a negative energy balance as a result of a failure to meet the growing energy need in the first months of lactation in highly productive dairy cows. It is characterized by the consumption of liver glycogens and other glucose reserves, a decrease in glyconeogenetic activity, fatty degeneration in the liver, hypoglycemia, ketonemia, ketonuria, ketolactia, and an increase in ketone bodies in the respiratory air (1-4). Ketosis arises primarily from insufficient intake of appropriate feeds or secondarily from the prevention of feed intake due to other diseases, including retentio secundunarium, metritis, mastitis, traumatic reticuloperitonitis, and left displaced abomasum (1-3). It can also be classified as subclinical or clinical according to the existence of clinical symptoms and the levels of ketone bodies in the blood, urine, and milk (3). Its clinical form has digestive and nervous presentations (2). Gul and Grunder (5) reported increases in bilirubin, aspartate amino transaminase (AST), and serum bile acids due to liver degeneration in dairy cows with ketosis. It was reported by Li et al. (6) that renal functions were slightly disrupted in dairy cows with subclinical ketosis and new studies were needed to explore the extent of this disruption. The purpose of the present study was to research the changes in renal and hepatic functions of highly productive dairy cows diagnosed with subclinical and clinical ketosis. 2. Materials and methods The study involved 30 high milk yielding dairy cows aged between 3 and 7 years. The breeds Brown Swiss (5 heads), Holstein (18 heads), and Simmental (4 heads), and their crossbreeds (3 heads) were represented. The diagnosis of ketosis was based on anamnesis, physical examination, the determination of ketone bodies in the urine, and serum β-hydroxybutyric acid. The animals were divided according to their serum β-hydroxybutyric acid levels into control, subclinical, and clinical ketosis groups, each of which included 10 cows. The cows in the control and subclinical ketosis groups were from various facilities in Elazığ's central district, while those in the clinical ketosis group were selected from animals admitted to the clinics