Cushings & Kidney Disease?

[Anne&Frank]

Hi there! This is my first post here. I just got the word that my dog has Cushing’s Disease. A month ago my vet had diagnosed him with kidney disease. Based on the blood test, I was skeptical. So I took Franklin to a different vet for a second opinion. That vet suspected Cushing’s. He ran new blood work and confirmed kidney disease. :( Franklin’s kidney values had elevated from the month before. He said he still suspected Cushing’s so Franklin had then LDDS test or whatever it’s called yesterday. The vet just called to tell me the news.

I told him I was worried if Cushing’s medication would effect kidneys. He said he would consult with his colleagues and get back to me with a treatment plan tomorrow.

Do any of your babies have both kidney & cushings?? What do you do for treatment? Thanks!

[Harley PoMMom]

Hi and welcome to you and Franklin!

Could you get copies of all tests that were done on Franklin and post those values that are marked abnormal with there reference ranges? What symptoms does Franklin display that led you or the vet to test for Cushing's in the first place?

Diagnosing Cushing's is tricky enough and when there is another illness present while the tests for Cushing's are performed it sure makes it difficult to get a confirmed diagnosis for this disease because any non-adrenal issue can yield a false positive result from all Cushing's tests. In this situation it may be beneficial seeing an IMS as they see more cases of dogs with multiple health problems than a regular GP. Many of our members, including me, have had an IMS on board that was used mainly for our GP vet to confer with.

My Harley had both Cushing's and kidney disease along with pancreatitis. His vet, IMS, and I decided to stop the medication for the Cushing's as it was causing his creatinine levels to increase. This was a very hard decision for me to make but in Harley's case it was the best one for him. Since all dogs are different, Franklin's situation can be completely different than Harley's.

I sure am sorry for the circumstances that brought you here but so glad you found us and we will help in any way we can.

Hugs, Lori

[labblab]

Welcome from me, too! Lori has gotten you off to a great start, and I just wanted to add this one additional comment. Worldwide, Vetoryl (chemical name is trilostane) is probably the most commonly prescribed Cushing's med, but it carries this contraindication on its U.S. Product Insert:

"Do not use VETORYL Capsules in animals with primary hepatic [liver] disease or renal insufficiency."

Given this warning, I agree with Lori that it will be important to determine the nature and severity of Franklin's kidney involvement before moving forward with Cushing's treatment -- at least with using Vetoryl.

Marianne

[Anne&Frank]

Thanks! What’s weirdest to me is that both of these issues were identified basically at the same time.

Up until a month ago he had no symptoms. Other then being a ravenous eater, which I think he has been for a couple of years at least.

Then we get the initial blood tests, switch him to prescription food and it was like a light switched. He started drinking and peeing all the time, he had accidents in the house. I asked my vet for a urinalysis. She even said that the drinking and peeing was a lot for how little his BUN was raised. The urinalysis tested positive for blood, she assumed UTI and prescribed Simplicef. That course of antibiotics will be done this Friday, and has made no impact on his drinking/peeing. The other noticeable changes is lethargy, what almost seems like depression, and most alarming hind leg weakness. He has also seemed to have lost his appetite, but it’s hard to tell the cause bc he HATES the prescription food and now seems skeptical about anything I give him (besides green tripe).

I didn’t realize kidney disease could yield false positive on LDDS? This new vet did tell me that kidney levels could be raised due to Cushings. He is super young and doesn’t have a lot of experience but readily admitted to that and is consulting with the other doctors in his practice (which is a huge practice).

I’m not sure how to insert a copy of the most recent labs here?

[Anne&Frank]

Does this link work to view his labs?

https://drive.google.com/open?id=0B-ItYvmmbqGhbkMyQ1pNU29Xb0E

[Anne&Frank]

In this situation it may be beneficial seeing an IMS as they see more cases of dogs with multiple health problems than a regular GP. Many of our members, including me, have had an IMS on board that was used mainly for our GP vet to confer with.

How did you go about doing this? There is one IMS in the area, about 50 minutes away. Did you ask your vet for a referral? How do you get them working together? I’m trying to make it so I don’t need to drive 50 minutes there and back every time I need a checkup or there is a problem. I don’t have much time left of from work since I have taken so much already.

[molly muffin]

Hello and welcome from me too.

Yes you get a referral to the IMS usually and then you get them to work with your regular vet so you don't always have to drive back and forth.

Your vet can also call Dechra the manufacturer of vetroyl and speak with them directly.

It is true that the insert says not to give vetroyl with liver or renal insufficiency.
My dog too had high cortisol and kidney disease. We gave vetroyl for awhile, as long as her creatinine was within normal limits. Once it wasn't, we focused on the kidneys over the cushings. I think this is a determination though that has to be made with vet and as I said, he can call Dechra and he can do a phone consult with an IMS, faxing them the lab results maybe?
I would definitely speak with him about both possibilities.

Yes they labs are viewable.

The creatinine isn't too far out of range. Has it maintained like that or risen?
Based on the lab work, I can see why they are saying kidney disease and it does seem to be the primary issue.

I am guessing that is what the vets are going to want to focus on over all.

[Anne&Frank]

I am just so overwhelmed right now. I feel like I’m going to have a nervous breakdown, I’m not even kidding. This has been so stressful for the past month and now it’s even more complicated.

Is this vet going to be offended I ask him to consult with the internal medicine specialist?! He is already consulting with his colleagues regarding treatment. Someone on the FB cushings page looked at the labs and said she thought something else was going on and that I should ask IMS for an ultrasound and now I’m paranoid it’s cancer or something. :(

For the past month I have been struggling with low phosphorus diets and getting him to eat, he seems so depressed and his legs are weak, I am like researching all these supplements and different diet resources and now cushings is thrown in? Good god, man. I just think it’s so odd that they were diagnosed at the same time.

[molly muffin]

We totally understand overwhelmed around here. I had that same feeling when dealing with the same situation.
It is possible it is something else that is causing the kidney numbers to go up.

I don't think he would be offended by asking about an IMS. If it were me, I'd word it something like, "do you think we should see an IMS about this situation? I am so concerned and would you be willing to work with a specialist?" something like that. You aren't looking to cut him out, just to work with both.

At the moment, as I said before, I think the focus will be on the kidneys and seeing if can figure that out and how to get those numbers back in range if possible.

An ultrasound is one of those good bang for the buck, as it can take a closer look at the kidneys and the liver, adrenal glands, pancreas, gall bladder a whole slew of things and see how they look. I wouldn't go straight to cancer, but more of a you want to eliminate all possibilities, figure out the root problem and go from there. We did ultrasounds about every 6 months to keep an eye on what was going on internally. Bang for the buck, it's a decent option if feasible.

Keep in mind too that dogs with kidney issues, are notoriously finicky eaters. Add in that they may not like the prescription food and boom, it becomes a struggle.

[Anne&Frank]

Thanks much. I am trying to keep myself together, but I am losing it. I know he is an old guy, but I think he has some life left in him. Plus I’m scared about his quality of life if either of them are left untreated. I just want him to be happy and comfortable. I just started him on Kidney Support Gold, which contains Rehmannia. I was reading that Rhemannia helps adrenal function as well. Do you know if anyone who has tried it?

At least he had a good day today. Apart from refusing food except green tripe kibble with raw green tripe on top. Kibble isn’t good for KD dogs bc it’s dehydrating, but at this point I guess I’m making getting food into him the priority.

When I talk to the vet tomorrow I will ask about working with a specialist. I know the only IMS in my area requires a referral so I will need that from him at the minimum.

Thanks again for your help.

[Harley PoMMom]

IDEXX laboratory has a relative new test for kidney disease called SDMA, I'm including a link to the IDEXX website that has information regarding the SDMA and also includes "frequently asked questions" about this test.

https://www.idexx.com/small-animal-health/products-and-services/sdma-faq.html

You may want to mention this test to the vet and see what he has to say.

P.S. Here's another website that has a wealth of information regarding kidney disease in dogs, I found their article to be quite informative. http://dogaware.com/health/kidneydiet

[Anne&Frank]

Yes, thanks. That is one of the tests he had initially about a month ago, and it was elevated which is why my original vet diagnosed kidney disease.

this was before his kidney levels has worsened and before the cushings diagnosis.

[Harley PoMMom]

Kudos to the vet for performing this test, what were the results?

I surely understand how worried you must feel, I was a mess when Harley was diagnosed with Cushing's. The wonderful people here took my hand and guided me in every step of our journey. Please know we are here for you both so do not hesitate to come here and talk to us, ok?

Hugs, Lori

[Anne&Frank]

Aw, thanks. That made me cry. For the millionth time today. 😂😭

The SDMA result? At the time was 17. Anything above 15 is considered a positive for kidney disease.

[molly muffin]

Yea, that SDMA is a newer and more accurate precursor for kidney disease.

I watched that number like a hawk, and had a definite love hate relationship with sdma, bun, creatinine results. I'd get excited if one even dropped a little bit, only to be totally over wrought if one of them when up. Drove me batty and i watched poor molly like a hawk for any and every possible change.

So please know that we understand how this can drive a person crazy.

[Harley PoMMom]

Here is yet another link, :o this is from our Helpful Resource Thread and may help in finding an IMS in your area: http://www.k9cushings.com/forum/showthread.php?t=182

[Momofdude]

I am just so overwhelmed right now. I feel like I’m going to have a nervous breakdown, I’m not even kidding. This has been so stressful for the past month and now it’s even more complicated.

Is this vet going to be offended I ask him to consult with the internal medicine specialist?! He is already consulting with his colleagues regarding treatment. Someone on the FB cushings page looked at the labs and said she thought something else was going on and that I should ask IMS for an ultrasound and now I’m paranoid it’s cancer or something. :(

For the past month I have been struggling with low phosphorus diets and getting him to eat, he seems so depressed and his legs are weak, I am like researching all these supplements and different diet resources and now cushings is thrown in? Good god, man. I just think it’s so odd that they were diagnosed at the same time.

I cannot be of much assistance because Like you I am brand new to this, However I can relate in that My dude has recently been diagnosed with cushings and kidney issues. I Hope the specialist can get you both on the right track for a few more years of life :)

[Anne&Frank]

Thanks, me too.

Good news: I was able to get a referral for an Internal Medicine Specialist. I will be seeing her next Tuesday!

[Joan2517]

Your vet should not be offended. You are only looking out for the welfare of your baby and you have every right to consult with other doctors.

It is so stressful dealing with all of this. We have all been there. When Lena was first diagnosed, even before the diagnosis, I was driving myself crazy. I knew something was wrong, and then when I knew what it was, I went into panic mode. She's been gone almost 2 years now and I have not calmed down yet. My poor other babies...as soon as they burp wrong, I'm making a vet appointment!

[Harley PoMMom]

Thanks, me too.

Good news: I was able to get a referral for an Internal Medicine Specialist. I will be seeing her next Tuesday!

That's awesome! I don't know if you're like me but when went to see the IMS or the vet I would take a tape recorder along because my head was so jumbled I knew that I'd forget what they told me. :o

Also, when i was at home if any questions would pop up in my head I kept pen and paper close by so I could jot them down, in this way my list of questions were all ready for the vet/IMS to answer.

The first IMS that i took Harley to was a 2 hours drive away (one way) so I would take some food and water along as they always wanted him to be fasted.

Let us know what they say.

Hugs, Lori

[molly muffin]

Excellent. Yes write down any questions you think of now and take with you u. My mind at least tends to go blank when I need it the most.

[Anne&Frank]

Just to confirm, Cushings can cause hind leg weakness right? He is standing so funny and his back legs just seem wobbly. It’s alarming to see, to be honest.

We had a little win yesterday after a weak of eating very little. I went to the vet and got he got a shot for nausea & an appetite stimulant (as well as Prilosec) and he ate ALL of his prescription food. Plus some. I am so relieved.

She just gave him enough prescription to make it until Tuesday when we see the internal medicine doc. I will be curious to get her thoughts on whether Cushing’s might have started the kidney symptoms.

[labblab]

Hi, yes, Cushing's can indeed cause hind leg weakness. Before starting treatment, my boy could no longer climb stairs or jump up on the couch. I'm so glad you'll be seeing the specialist on Tuesday in order to help sort things out, though. Definitely keep us updated, OK?

Marianne

[Anne&Frank]

I got back from the appointment like 45 minutes ago. What a long day. Poor Franklin is just laying on his side, he is so exhausted. He was poked and prodded all day long. Looking at him so tired I feel badly for putting him through it. He was such a good sport all day, but totally stressed out. Poor baby.

The good news is I really like the doctor and she’s very thorough. The bad news is thorough = expensive. The other bad news is I won’t have any answers until the test results are in.

She did:
Physical exam (everything looks and sounds good)
New full blood panel
Lipid panel
Adrenal panel (geez, this was expensive and won’t be back for 10-14 days)
ACT stim or whatever that’s called
X-rays
Full abdominal ultrasound
Urinalysis
Blood pressure test (normal)

Thank god he’s insured. Geez louise. I am glad I took him and didn’t just go with the other vets plan to prescribe Vetronyl. She said the LDDS was in a gray area, not totally conclusive and that she wouldn’t prescribe based on hide results. Hopefully between the rest of the millions of tests we’ll get a more definitive answer.

It’s going to be very hard for me to stay patient during the 10-14 days for the adrenal panel. Why does that take so long??!?

[DoxieMama]

Hi Anne,

I don't have an answer regarding the adrenal panel - not sure what that entails, to be honest. Maybe one of the admins or other knowledgeable folks around here can shed some light on that.

In the meantime, we'll sit here with you while you wait for those results. As you said, hopefully you'll have some answers soon.

Shana

[Squirt's Mom]

If this is one of the adrenal panels from the University of Tennessee in Knoxville (UTK) it is probably because this is the only facility we know of that does this sort of testing - ie looking at the intermediate or sex hormones. These hormones can cause some of the same signs as elevated cortisol. It is a form of Cushing's called Atypical in which the cortisol is NORMAL but two or more of 5 intermediate hormones are elevated. It is thought that Atypical may be a precursor to true Cushing's with elevated cortisol. That was the case with my Squirt. ;)

What caught my eye was that the adrenal panel and an ACTH were run. The *full* panel from UTK includes the cortisol so the ACTH would be a repeat IF that is the test your vet had done. UTK can also run a panel that does not include the cortisol so hopefully that what they had done.

It sounds like your baby got a good going over so hopefully you will get some solid answers and a viable solution. Meanwhile, love on Franklin and spoil him rotten. We are here if you need to talk or have any questions. When you get the results of those most recent tests the IMS ran it would be great if you could post the results here. ;)

Hugs,
Leslie

[labblab]

Hi again, Anne! Yes indeed, it sounds as though the specialist was very thorough and I'm hopeful you'll all gain some new insight as to what is going on with Franklin.

I'm betting Leslie is correct in assuming that the full adrenal panel refers to analysis performed by the lab at the University of Tennessee in Knoxville. If so, then it actually does make sense that both an ACTH stimulation test and the full adrenal panel would be listed. This is because the two blood samples that UTK analyzes would have been drawn at the specialist's office, before and after injecting an agent that stimulates adrenal hormone production. The blood samples are then sent to Tennessee. So there are actually two different procedures and costs involved. The vet charges for the ACTH stimulation agent in conjunction with the blood draws; then there's a separate charge for the UTK lab analysis itself. At least, that's typically how it's done. And what you'll end up with is an analysis of multiple adrenal hormone levels, including cortisol, both before and after the stimulation of the adrenal gland.

We'll be really anxious to hear how all these tests turn out!
Marianne

[molly muffin]

So glad that you are happy with the IMS and that she is being thorough. yes, the diagnostic phase is often the most expensive. Trying to figure out what is going on is the worst part.

I agree, sounds like it is the U of Tenn adrenal panel and mine took 10 - 14 days to come back also, so that isn't unusual, although some do come back sooner i think. So, hold on to that.

[Anne&Frank]

Well, I have an update finally! The good news is this... if Franklin has Cushing’s it is mild and atypical. His cortisol was within normal range. But estrogen, progesterone and a third one I can’t remember the name of. I’m glad I took him there, she said if I had just given him the Vetronyl it would have made the progesterone level raise even more. Right now he doesn’t need to be treated, but we will monitor him to watch those levels. His adrenals looked normal, except a nodule on one of them. She said it’s nothing to be overly concerned about. Given his age, and all of his ailments, he is in pretty darn good shape. Now that his appetite is back and he’s eating the kidney diet, he seems more like himself. Which is all I can ask for, really!

[DoxieMama]

That's wonderful news! So happy for you both. :)

[molly muffin]

This Is good news. I’m glad he doesn’t have regular Cushing’s. One less thing to worry about. And eating fine. Yay. What a good boy.