Hi New to forum - George JRT

[bonh]

Hi
We're new to the this forum. My 12yo JRT was diagnosed with diabetes a year ago. We've had our ups and downs but the last few months have been tough. He's had a high protein creatinine test in December >2, it's now >4.His liver enzymes were high so the vet did an ultrasound on his liver which came back clear. He's also had ketones in his urine for about 3 or more weeks, which they are putting down to his high BG. He was in the ER for 4 days but the ketones persisted and he still had them when they sent him home. He had a urine culture done which came back clear so the vet siad the problem is in his kidneys, diagnosing diabetic nephropathy or pyelonephritis. He wants to do a kidney biopsy next week. He shows signs of cushings but the vet dismisses it every time we bring it up. I was wondering if cushings could cause the high protein creatinine ratio? Any thoughts or advice would be gratefully received.

[goldengirl88]

Welcome to you and your JRT. I have one too her name is Tipper. I am sorry for all you are going thru. Dogs can get a high protein level in their urine when they have Cushings. That being said, there can be other causes also. You did not mention your dog presenting with any Cushing's symptoms. Does George have any? If so I think you are right to ask for some of the diagnostics used to determine Cushings, especially in lite of the Urine creatinine results, which you have had. There is also an ACTH, Dex, and ultra sound used. What was George's prognosis from the cancerous mass removed from the liver? Are you consulting with a specialist on the kidney issues? Blessings
Patti

[Harley PoMMom]

Hi and welcome to you and your boy!

I am sorry for the reasons that brought you to us but glad you found your way here. First and foremost I urge you to join our sister site K9diabetes.com (http://www.k9diabetes.com/forum/) The wonderful people there are very knowledgeable about canine diabetes and will be able to help you immensely with the diabetes, while we can help with the Cushing's aspect.

Many, many things can influence UPC results such as any inflammation, some medications, and bladder/kidney infections, to name just a few. Having an elevated UPC result does not necessarily mean kidney disease. I'm providing you with a link to an article that has information regarding proteinuria and the tests used for detecting protein loss: Proteinuria in dogs and cats (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354822/) Proteinuria can be secondary to another illness, such as diabetes, and once the underlying illness is resolved or under control the protein loss may stop.

Other non-adrenal illnesses share many of the same symptoms as Cushing's, diabetes and thyroid problems are two of them. Also uncontrolled diabetes can create false positive results on all tests for Cushing's. So, if this were me, I would concentrate on getting the diabetes under control and put everything else on the back burner for now.

Please know we are here to help in any way we can so do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[molly muffin]

Hello and welcome to the forum.
I want to let you know that we also have a sister site for dogs with diabetes.

http://k9diabetes.com/forum/

I highly recommend that you pop over there, as they have some great people with a lot of knowledge about the diabetes angle. We do have several members with dogs who have both diabetes and cushings, but it is important to get the diabetes figured out and regulated as that can cause inaccurate results on any testing for cushings.
Were the adrenal glands enlarged on the ultrasound?
The symptoms for diabetes and cushings can often overlap making it much harder to get an accurate diagnosis for cushings.

Sharlene and molly muffin

[bonh]

Hi
Thanks for your response. The vet that would be carrying out the kidney biopsy is a vet at the ER hospital, I don't think he's a specialist, he's not our regular vet but did the ultrasound and dealt with George when he was admitted with ketosis.

The vet we were with when he was diagnosed with diabetes wanted to test for cushings as we really struggled with his BG & displayed other symptoms but once we got his numbers under control she said he couldn't have cushings. We have changed vets twice since diagnosis.
The ultrasound they did last week came back clear with no liver issues, he said the kidneys looked fine, they did the liver ultrasound due to high liver enzymes but it didn't show anything.

Symptoms include:drinking & peeing (although it was a lot worse when first diagnosed) we occaionally have an accident in the house, ravenous appetite, weight loss, muscle loss, bony head, poor skin condition, skin infections, blackheads on his belly, he lost the fur on the backs of his legs last year(has since grown back, pigmentation on his belly, high liver enzymes, insulin resistance - his BG has been very high for the last 8 weeks.

He has allergies and food intolerances, he was on steroids for a few years to control these and was weaned from them after diabetes diagnosis.

They also did a blood test last week and said his pancreas enzymes are elevated & that we need to change his diet, although he is already on a low phosphorus and low fat diet.

Sorry to bombard you with info but my poor little chap has quite a few issues going on.

[goldengirl88]

I wanted to add that liver disease can influence UPC results also. I do also recommend going to the diabetes site.
Patti

[bonh]

[

Hi
Thanks for the link, Lori. I am concerned the kidney biopsy is an extreme next step.
We have been a member on k9diabetes for quite a while, we've learned a lot of valuable info on there & is where I heard about you guys.

[bonh]

Were the adrenal glands enlarged on the ultrasound?

Hi
Thanks for your response, I didn't ask the vet about the adrenal glands tbh. I will ask the him. The vet has said that while he has a kidney issue and mild pancreatitus trying to get his bg stable will be impossible?

[molly muffin]

It will certainly make it more difficult while other things are going on. Just like it makes it more difficult to get a firm cushings diagnosis.

Think of it like this, the body's natural response to anything going on, including a chronic illness/disease, is to produce more cortisol to make the dog feel better. So, I would fully expect that cortisol would be high on any test to measure it with other issues going on. I think that would rule out an ACTH as being definitive right there. Maybe an LDDS test, but it too can give a false reading if something else is going on.

At the same time, if cushings is a part of the picture, higher cortisol can make it harder to control BG.

So, if the cortisol is high, not even because of cushings but pancrease, kidneys, then it is very difficult to get the BG controlled. It puts you between a rock and a hard place.

I don't know what I would think of a kidney biopsy. Biopsy's in general make me nervous and I'd want the most experienced person possibility to it. Some of the other that have had experience will be along hopefully to give their thoughts. I wish that Trish was in this weekend as her dog has under gone several surgeries and she might have a different perspective on the kidney biopsy.

Oh good, I'm glad you are already a member at K9diabetes. They are great and very knowledgeable.

Sharlene and molly muffin

[Harley PoMMom]

[

Hi
Thanks for the link, Lori. I am concerned the kidney biopsy is an extreme next step.
We have been a member on k9diabetes for quite a while, we've learned a lot of valuable info on there & is where I heard about you guys.

So glad to see that you are a member with the k9diabetes site!

Does George have any elevations in the following: creatinine, potassium, phosphorus, and calcium?

Link to a really informative article regarding the tests for kidney disease: Tests used to Diagnose Kidney Disease in Dogs (http://www.dogaware.com/health/kidneytests.html)

Hugs, Lori

[bonh]

Hi
We've got an appointment with the vet tomorrow as he's had a flare up with his skin, which has persisted for over a week. I've already requested they make copies of his most recent test results. I'll post the results tomorrow.

Thanks for all your help.

[molly muffin]

Make sure they take a skin scraping to find out exactly what is going on with the skin irritation. It could be an infection or something. Yeast can cause flare ups.

Sharlene and molly muffin

[bonh]

Hi
We've been to the vet this morning. He's started George on a course of antibiotics for his skin infection. We saw our regular vet that agreed cushings tests would be a better next step than a kidney biopsy so we've got an ACTH test on Wednesday.

[molly muffin]

hmm, if he has a skin infection, then you want to wait for that to be cleared up before doing an ACTH test, as the results can be raised if there is an infection. Just be aware of that.

Good luck on Wed and I hope the antibiotics clear up the skin problem quickly.

Sharlene and Molly Muffin

[Squirt's Mom]

I'm going to disagree with the plan to test for Cushing's first. IF there is something going on with the kidneys that could 1) cause false positives on the cush testing resulting in drugs for treatment that are not needed and 2) cause signs that are common with Cushing's yet have nothing to do with this disease, confusing the picture. If I were you, I would let the skin infection clear (UNLESS you see a derm vet who can tell you this is CC - Calcinosis cutis, a condition often tied to Cushing's) and have the kidney's checked BEFORE testing for Cushing's. The better approach, in my mind, is to rule out as many other things as possible and to allow all current illnesses to subside before doing any cush testing. ;)

[bonh]

I'm going to disagree with the plan to test for Cushing's first. IF there is something going on with the kidneys that could 1) cause false positives on the cush testing resulting in drugs for treatment that are not needed and 2) cause signs that are common with Cushing's yet have nothing to do with this disease, confusing the picture. If I were you, I would let the skin infection clear (UNLESS you see a derm vet who can tell you this is CC - Calcinosis cutis, a condition often tied to Cushing's) and have the kidney's checked BEFORE testing for Cushing's. The better approach, in my mind, is to rule out as many other things as possible and to allow all current illnesses to subside before doing any cush testing. ;)

Hi
The vet said it was pyoderma...Are there kidney tests we can do that aren't a biopsy. I am concerned about the risks of this.
The vet said today because George can still concentrate his urine and because his blood urea and creatinine were within normal limits it doesn't point towards kidney disease it's just the high urine protein creatinine ratio... I'm so confused, I feel like we're going round in circles at the moment. I'm wondering whether we should look for a specialist, the nearest is a fair way from us but it may be money well spent. All the tests we've had done in the last few months we're no closer to a diagnosis. :confused: