Help! Is it Cushing's or Glomerulonephritis?

[Caseycase01]

My dog Casey, an almost 10 year old Rott has had protein in her urine an elevated ALP, and high sodium for like a year now. We have senior panels done every 6 mos, and almost to the day we had her current senior panel done, she started drinking gallons of water, and urinating a lot. She is also restless, and not much of an appetite. Her fur is thinning like above her front legs I guess the flank? and having a bit of muscle mass loss in hip area. Our former vet said it is probably glomerulonephritis but current vet thinks it is cushings. She has had an ACTH test which was normal, and has to go tomorrow for ldds test. If that one is negative also, then what? Has anybody else gone through the negative test dilemma? What about holistic treatment for either disease? Thanks.

[labblab]

Hello and welcome to you and Casey, although we're sorry for the worries that have brought you to us. For the most part, Casey's symptoms do indeed seem consistent with Cushing's with the exception of lack of appetite. Cushpups are more typically ravenous as opposed to the opposite. However, there are always exceptions and Casey may be one of them.

In considering her lack of appetite, though, does she have elevations in her bloodwork that would be associated with declining kidney function? The two significant levels in that regard would be creatinine (CR) and BUN. You've mentioned protein in her urine, and that can indeed be secondary to Cushing's, but I'm just wondering whether there is evidence of broader kidney dysfunction.

All in all, I do think it's wise to proceed to the LDDS, because the ACTH does "miss" making the Cushing's diagnosis in a fair number of dogs who truly have the disease. So we'll definitely be anxious to find out those test results, and then we'll be better armed to plan a treatment path going forward.

Once again, welcome to you both!
Marianne

[Caseycase01]

OK so the LDDS test was negative also, they had done a protein creatinine ratio which came back as 49.6!!! And Dr Wu freaked and wanted us to get a kidney biopsy done. I insisted on another test for ratio (no charge) and lo and behold it came back as 4.2. At this point I took her to an internal medicine doctor who did an ultrasound ANOTHER protein creatinine ratio (had been a week since the 4.2 result) and a blood pressure test. The ultrasound showed a mass on both adrenal glands, with the right one being larger with POSSIBLE involvement with the vena cava. Her protein had dropped to 1.3 and her blood pressure was a bit high where previously it had not been. We had to travel for 2 hours to get there and it was almost 100 degrees that day plus she is so sick of going to the doctor, so maybe that is why it was elevated. The doctor came in and said that basically we needed to just make her comfortable and put her down when the time came because the surgery was so involved and expensive. She could not tell me exactly what kind of tumors she has, whether or not malignant, or whether she DEFINITELY does or does not have Cushings! So really are at square one except the fact that we know she does have masses on adrenals. Her symptoms as we speak are some increased drinking and urinating, not as bad as a couple weeks ago, her appetite is back, and she is panting just a bit more than usual. And she has had some fur thinning on sides of neck. the only labs that have been abnormal were the protein, sodium, and ALP. So we are stumped and so is her regular vet quite frankly. He suggests wiping out her adrenals with lysodren and should take out tumors also and then treat her for addisons. This along with holistic therapies. Has anyone ever heard of doing this??? Thanks.

[labblab]

Welcome back again, although I'm very sorry about the worrisome news re: not just one, but two adrenal tumors. Given the normal ACTH and LDDS results, it sounds as though neither of the tumors are generating an excessive amount of cortisol. However, they may be resulting in overstimulation of certain other adrenal hormones and that may be the cause of the overt symptoms you are witnessing.

Personally, without further discussion and guidance from a specialized vet, I wouldn't feel at all comfortable with purposely trying to induce Addison's in your dog with Lysodren. It is true that Lysodren is a chemotherapy drug that actually erodes adrenal tissue, and in a few instances it can cause adrenal tumors to regress or "implode." But especially if your dog truly has tumors on both adrenal glands, this would be a very serious undertaking with no guarantee of success and many risks. I would want to talk with an expert before even considering such a treatment. Given the fact that the IMS who conducted the imaging didn't offer it as a treatment option makes me question it even more.

I see you are in Merced and you say you drove about 100 miles -- by any chance, did you go to the vet school at UC Davis? I am just wondering because an IMS at Davis would have knowledge about the full range of available treatment options in this situation. Either way, I'd encourage you to contact the IMS once again and ask for her opinion about Lysodren treatment. Please do keep us updated as you learn anything more, OK?

Marianne

[Harley PoMMom]

Has an UTI been ruled out as a possible reason for the increased drinking and urination?

[Caseycase01]

I had them do a urine C&S last week, due to history of struvite stones 3 + years ago. At the time, she had large stones and had passed a couple small ones, and 2 vets said surgery was the only option then a special diet. I researched it heavily and discovered that DL Methionine given daily would dissolve stones and keep urine ph'd correctly. I asked our former vet if she would be willing to prescribe some, she agreed, it dissolved every single stone, she takes it daily and has been stone and crystal free ever since. The recent ua C&S was clean.

[Caseycase01]

The IMS thinks that it is canine pheochromocytoma.

[labblab]

I wondered about pheos -- that would be consistent with the normal cortisol and episodic blood pressure spikes. Truly, as I said above, I'd contact the IMS and ask her about the idea of Lysodren treatment. We have had members here with pheos, but off-hand, I can't recall any that were treated with Lysodren as opposed to attempts at surgical removal. I would be very interested in the opinion of the IMS re: attempting full adrenal ablation with Lysodren.

Marianne

[Caseycase01]

OK I will. The outcome is very poor without the surgery isn't it? The IMS said it is between 6,000.00 and 7,000.00! We have spent almost 2400.00 just to find out what we know. It is not about the money however, it is about the risk of losing her on the table. We feel that the vet industry is a racket. I was charged 70.00 to get her blood pressure checked! It makes me wonder whether there is a treatment for this but that they would rather get the big money for surgery. So much of that goes on in human medicine. It is so sad.

[Budsters Mom]

It is about the $$$$ too, for many us us here. I totally understand.

Kathy